Link between COVID-19 vaccines and myocardial infarction

Table 1 Concept table for building the search strategy

Key concepts	Concept 1	Concept 2	Concept 3	Concept 4
	COVID-19	Vaccines	Myocardial infarction	Link
Free text terms		Vaccination	Heart attack	Relation
		Shot		Interrelation
		Jab
		Dose
		Booster
Controlled vocabulary terms (MeSH terms, Emtree terms)	2019 novel coronavirus	Viral Vaccines	Anterior wall myocardial infarction	Association
		Immunization
	2019-nCoV disease
	2019-nCoV infection		Inferior wall myocardial infarction
	COVID-19 pandemic
			Non-ST elevated myocardial infarction
	COVID-19 virus disease
			ST elevation myocardial infarction
	COVID-19 virus infection
	SARS-CoV-2 infection

SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; COVID-19: Coronavirus disease 2019.

Table 2 Analysis/summary of important findings in various studies

Ref.	Study design	No. of cases reported	Type of vaccine given	Time during symptoms and vaccination	Dose of vaccine, 1st or 2nd	Type of MI	Patient outcome, dead or alive
Jabagi et al[10]	Cross sectional	6510/11113 (58.6%) after first dose, 4843/11113 (43.6%) after second dose of vaccine	Pfizer	Not given	1st and 2nd both	Not given	NA
Li et al[11]	Cohort study	Ages 35-74 incidence = between 1/100 and 1/1000 ages 75 and above incidence = between 1/10 and 1/100 patients	NA	Not given	NA	Not given	NA
Aye et al[12]	Cohort and systematic review	29 in cohort, 35 in systematic review	Pfizer 30/35 (86%), Moderna 1/35 (3%), AstraZeneca 4/35 (11%), Janssen 0%	Median of 1 d	2nd	STEMI 20/35 (57%) NSTEMI 15/35 (43%)	1 dead, remaining were alive
Maadarani et al[13]	Case report	1	AstraZeneca	1.5 h	1st	STEMI and NSTEMI	Alive
Fazlollahi et al[14]	Systematic review	3	2 Pfizer, 1 Moderna	Case 1: 6 h, case 2: 1 h, case 3: 30 min	1st	Case 1: NSTEMI, case 2: STEMI, case 3: STEMI	Case 1: alive, case 2: alive, case 3: dead
Şancı et al[15]	Case report	1	Pfizer	15 min	1st	STEMI	Alive
Chatterjee et al[16]	Case report	1	AstraZeneca	2 d	1st	STEMI	Alive
Jeet Kaur et al[17]	Cross sectional	Pfizer: 44, AstraZeneca: 1, Moderna: 3	Pfizer, AstraZeneca, and Moderna	NA	NA	NA	NA
Iqbal et al[18]	Case report	1	Moderna	90 min	1st	NSTEMI	Alive
Cari et al[19]	Cross sectional	Pfizer: 0.00044%, AstraZeneca: 0.00168%, Janssen: 0.00217%	Pfizer, AstraZeneca, Janssen	Not given	NA	NA	Dead Pfizer: 0.00013%, AstraZeneca: 0.0004%, Janssen: 0.00048%
Tajstra et al[20]	Case report	1	Pfizer	30 min	1st	STEMI	Dead
Flower et al[21]	Case report	1	AstraZeneca	8 d	1st	STEMI	Alive
Chiang et al[22]	Case report	1	AstraZeneca	8 d	1st	NSTEMI	Alive
Fialho et al[23]	Case report	1	AstraZeneca	20 min	1st	STEMI	Alive
Hsu et al[24]	Case report	1	AstraZeneca	9 d	1st	STEMI	Dead
Showkathali et al[25]	Cross sectional	37 (42%)	AstraZeneca was the most used vaccine-28 (76%), while 9 (24%) had Covaxin	< 1 wk: 9 (24%), 1-4 wk: 19 (52%), and > 4 wk: 9 (24%)	1st (65%), 2nd dose (35%)	STEMI and NSTEMI	NA
Whiteley et al[26]	Cross sectional	Post vaccination < 28 d 3814/13787 (27.66%). Post vaccination > 28 d 2050/7758 (26.42%)	AstraZeneca and Pfizer	NA	1st	NA	Dead, < 28 d 16192/43766 (37.00%), > 28 d 11738/19496 (60.21%)
Shiravi et al[5]	Narrative review	Not given	Pfizer, AstraZeneca, and Sinovac vaccines	15 min to 2 d	NA	NA	NA
Barda et al[27]	Cross sectional	59/892785 = 0.006%	Pfizer	Not given	NA	NA	NA
Barsha et al[6]	Case report	1	Moderna	12 h	1st	NSTEMI	Alive
Boivin et al[28]	Case report	1	Moderna	1 h	1st	STEMI	Alive
Hippisley-Cox et al[29]	Cross sectional	AstraZeneca: 0-7 d 1983/22079 (8.98%), 8-21 d 4028/22079 (18.23%), 22-28 d 1889/22.79 (8.55%). Pfizer: 0-7 d 1578/15124 (10.43%), 8-21 d 3457/15124 (22.83%), 22-28 d 1510/15124 (10.00%)	AstraZeneca and Pfizer	AstraZeneca: 0-7 d 1983, 8-21 d 4028, 22-28 d 1889, Pfizer: 0-7 d 1578, 8-21 d 3457, 22-28 d 1510	1st	Not given	Not given
Edler et al[30]	Case series	1	Pfizer	2 d	1st	Not given	Dead
Hana et al[7]	Systematic review	1644 cases total	AstraZeneca, Pfizer and Moderna	NA	NA	Not given	NA
Ho et al[31]	Systematic review	10	Pfizer, Moderna, AstraZeneca, Sinovac	NA	1st	STEMI and NSTEMI	Some dead, some alive
Sung et al[32]	Case series	2	Moderna	Case 1 < 24 h, case 2 < 12 h	1st	Case 1 STEMI, case 2 Not given	Alive
Pottegård et al[33]	Cross sectional	Incidence rate 1.04/1.21, no of cases 20	AstraZeneca	Not given	1st	Not given	NA
Agostino et al[34]	Case report	1	AstraZeneca	12 d	1st	Not given	Dead
Bardenheier et al[35]	Cross sectional	1	Pfizer	2 d	2nd	Not given	NA

MI: Myocardial infarction; NA: Not available; STEMI: ST-segment elevation myocardial infarction; NSTEMI: Non-ST-segment elevation myocardial infarction; NA: Not Applicable.