Preheat the oven to 350°F and prepare baking sheet. Line sheet with aluminum foil and place oven-proof wire rack over top. Spray with non-stick cooking spray.
Add all meatball ingredients to a large bowl. Gently mix with your hands until combined. Roll into about 3/4 inch meatballs. You should have about 25 meatballs. *See Note
Bake for about 15 minutes until lightly browned and cooked through. Set aside for later.
Vodka Sauce
Cook pasta to al dente according to package instructions in salted water. Reserve about 1/2 a cup of pasta water. Set aside the pasta and pasta water for later.
Meanwhile, heat olive oil in an high-rimmed sauté pan over medium-high heat. Add the onions and 1/4 tsp salt and stir to combine. Cook for 5 minutes, stirring occasionally. Add the minced garlic and cook another minute, stirring often.
Add the Calabrian chili paste and tomato paste. Stir to combine. Cook for 4 minutes until the paste darkens in color.
Pour in the vodka to deglaze the pan. Scrape any stuck bits off the bottom with a wooden spoon. Let the liquid cook off for a couple minutes.
Pour in the can of crushed tomatoes then add the sugar, another 1/4 tsp salt, and pepper. Simmer for a few minutes. Turn off the heat and pour in the heavy cream. Stir until completely combined. Simmer for 5 minutes over medium-low heat.
Turn heat to low and stir in the heavy cream until well combined. Stir in the cooked meatballs. Add the cooked pasta and toss everything together well. Add splashes of pasta water as needed to reach your desired consistency.
Divide among bowls to serve and top with freshly grated parmesan cheese and sliced chives as desired.
Note/Pro tip: These are the same meatballs from my Italian Wedding Soup recipe.If you make my Italian Wedding Soup recipe, make double the meatballs and set aside half to make this pasta the same week! Or if you make this recipe first, you can save the rest of the meatballs for Italian Wedding Soup!