Acute Myocardial Infarction Within 24 Hours After COVID-19 Vaccination: Is Kounis Syndrome the Culprit?

Epidemiology, clinical ramifications, and cellular pathogenesis of COVID-19 mRNA-vaccination-induced adverse cardiovascular outcomes: A state-of-the-heart review

“…Notably, myocarditis predominantly affected younger males while pericarditis was observed in older males [24] , [27] . While myocarditis is the highest reported cardiovascular ramification, other serious complications are also being increasingly reported [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [27] , [31] , [32] , [33] . Nevertheless, the strength of association between the mRNA COVID-19 vaccines and cardiovascular complications is temporal, and any causality or underlying pathogenesis remain unclear and the subject of a pathophysiological conundrum.…”

“…The immunological response induced by the vaccines could explain the inflammatory processes of myocarditis, pericarditis, and perimyocarditis. As briefly mentioned earlier, MI induced by the vaccines could be attributed to Kounis syndrome, which is largely explained by components within the vaccines known as excipients [11] . Excipients are pharmaceutical substances found alongside the active substances in a vaccine.…”

“…In this case, the COVID-19 vaccine excipients are speculated to be potentially eliciting hypersensitivity reactions amongst some recipients [11] . Different excipients are noted in various vaccine formulations; polyethylene glycol (Pfizer-BioNTech vaccine); polyethylene glycol and tromethamine/trometamol (Moderna vaccine); polysorbate 80 (Johnson & Johnson vaccine); polysorbate 80 and disodium ethylenediaminetetraacetic acid dihydrate (Sputnik V vaccine); and disodium hydrogen phosphate, sodium dihydrogen phosphate monohydrate, and sodium chloride (Sinovac-Coronavac vaccine) [11] . An IgE-mediated hypersensitivity reaction concurrent with an acute coronary syndrome (ACS) or MI is termed Kounis syndrome [16] .…”

“…An IgE-mediated hypersensitivity reaction concurrent with an acute coronary syndrome (ACS) or MI is termed Kounis syndrome [16] . This syndrome is accompanied by clinical and laboratory evidence of MI whose more predominant etiologies have been excluded and instead attributed to a hypersensitivity reaction characterized by release of inflammatory mediators such as histamine, neutral proteases (tryptase, chymase, and cathepsin-D), arachidonic acid metabolites, platelet-activating factor (PAF), cytokines, and chemokines released during mast-cell degranulation and by immune cells such as T-cells, B-cells, plasma cells, and macrophages [11] , [16] , [17] . The mechanism of action of COVID-19 mRNA vaccines is elucidated in Fig.…”

“…More importantly, most developed MI symptoms after the first dose [9] , [10] . A potential mechanism for post-vaccination MI could be Kounis syndrome, an allergic hypersensitivity reaction to potentially immunogenic components found within vaccines [9] , [11] . The vast spectrum of cardiovascular complications reportedly associated with COVID-19 mRNA vaccinations is delineated by Fig.…”