COVID-19 Vaccination and Cardiovascular Outcomes in Older Adults With Coronary Artery Disease and Heart Failure: Insights From a Large Propensity-Matched Cohort Study.

BACKGROUND

Patients with coronary artery disease or heart failure (HF) face heightened COVID-19 and cardiovascular risk, yet the long-term cardiac effects of COVID-19 vaccination in this population remain uncertain.

METHODS

We performed a retrospective, propensity-matched cohort study using the TriNetX US Collaborative Network (December 2020-December 2022). Adults with coronary artery disease or HF were matched 1:1, creating 74 236 vaccinated and 74 236 calendar-aligned unvaccinated patients. Outcomes included mortality, acute myocardial infarction, stroke, HF hospitalization, deep vein thrombosis/pulmonary embolism, atrial fibrillation hospitalization, myocarditis, pericarditis, percutaneous coronary intervention, and coronary artery bypass grafting at 1-year and 2-year follow-ups.

RESULTS

Vaccination was associated with a dose-dependent reduction in all-cause mortality. Landmark hazard ratios (HRs) remained favorable, 0.92 (95% CI, 0.89-0.95), 0.99 (95% CI, 0.96-1.02), and 0.72 (95% CI, 0.70-0.74), confirming robustness across time periods. Vaccination was also associated with fewer HF hospitalizations (2-year HR, 0.90 [95% CI, 0.87-0.94]) and lower revascularization rates (percutaneous coronary intervention HR, 0.87; coronary artery bypass grafting HR, 0.80), while showing no significant association with acute myocardial infarction, stroke, or venous thromboembolism. Although the study was underpowered to definitively assess rare safety events, a small increase in myocarditis was observed (2-year HR, 1.36), representing a potential safety signal that warrants further investigation; pericarditis was not significantly elevated.

CONCLUSIONS

COVID-19 vaccination was associated with a graded reduction in mortality that persisted after landmark adjustment, as well as lower rates of HF admissions and revascularizations. Findings support the use of complete vaccination, including boosters, as part of secondary prevention, pending confirmation in prospective studies.