# Commentary: raised c-troponin levels as a sign of myocardial injury after COVID-19 vaccination in healthy individuals are worrying

## TL;DR

This paper challenges a claim that myocardial injury after mRNA vaccines is less severe than after natural COVID-19 infection, using data from Germany and Switzerland.

## Contribution

The paper provides empirical evidence refuting the claim that myocardial injury is less after vaccination than after natural infection.

## Key findings

- Myocardial damage after vaccination may be higher than after natural infection in the general population.
- The claim by Buergin et al. is not supported by empirical data from Germany and Switzerland.
- Systematic observational studies are needed to better assess vaccine risk-benefit ratios.

## Abstract

Recently, Buergin et al. (Eur J Heart Fail 25(10):1871–1881, 2023 doi:10.1002/ejhf.2978) thoroughly measured a frequency of 2.8% elevated high-sensitivity cardiac troponin T levels, a sign of myocardial damage, after mRNA-1273 (Moderna) booster vaccinations. In their discussion, they claim that before vaccinations were available, the incidence and extent of myocardial damage associated with COVID-19 infection would have been much higher. We here scrutinize this claim based on empirical data.

Burgin et al. have only cited papers in support of their claim which considered hospitalized COVID-19 patients. After extracting COVID-19 infection data from Germany and Switzerland and the expected frequency of elevated troponin levels after COVID-19 infection in both hospitalized and non-hospitalized individuals, we find that the extent of myocardial damage after vaccinating a considerable proportion of the general population is expected to be much higher than after natural infections.

The claim that the extent of myocardial injury after COVID-19 infection would be higher than after vaccination is not supported by empirical evidence and therefore wrong. We conclude that cross-national systematic observational studies should be conducted that allow a more precise estimation of the risk–benefit ratio of COVID-19 mRNA vaccinations.