Clinical impact of influenza vaccination after ST- and non-ST-segment elevation myocardial infarction - insights from the IAMI trial.

Autor: Fröbert O; Örebro University, Faculty of Health, Department of Cardiology, Örebro, Örebro, Sweden. Electronic address: ole.frobert@regionorebrolan.se., Götberg M; Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden., Erlinge D; Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden., Akhtar Z; International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Dhaka, Bangladesh; The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia., Christiansen EH; Department of Cardiology, Aarhus University Hospital, Aarhus, Aarhus , Denmark., MacIntyre CR; The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia., Oldroyd KG; Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom and West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Glasgow, Scotland, United Kingdom., Motovska Z; Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic and University Hospital Kralovske Vinohrady, Prague, Bohemia, Czech Republic., Erglis A; Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Riga, Latvia., Moer R; LHL-sykehuset Gardermoen, Oslo, Ostiandet, Norway., Hlinomaz O; nternational clinical research center, St. Anne University Hospital and Masaryk University, Brno, South Moravian, Czech Republic., Jakobsen L; Department of Cardiology, Aarhus University Hospital, Aarhus, Aarhus , Denmark., Engstrøm T; Rigshospitalet, University of Copenhagen, Copenhagen, Copenhagen, Denmark., Jensen LO; Department of Cardiology, Odense University Hospital, Odense, Odense, Denmark., Fallesen CO; Department of Cardiology, Odense University Hospital, Odense, Odense, Denmark., Jensen SE; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Kommune, Denmark., Angerås O; Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Gothenburg, Västergötland , Sweden., Calais F; Örebro University, Faculty of Health, Department of Cardiology, Örebro, Örebro, Sweden., Kåregren A; Västmanlands sjukhus Västerås, Västerås, Västmanland, Sweden., Lauermann J; Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Linköping, Östergötland, Sweden., Mokhtari A; Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden., Nilsson J; Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umea, Västerbotten län, Sweden., Persson J; Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Södermanland and Uppland, Sweden., Stalby P; Department of Cardiology, Karlstad Central Hospital, Karlstad, Värmland, Sweden., Islam AKMM; National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Dhaka, Bangladesh., Rahman A; National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Dhaka, Bangladesh., Malik F; National Heart Foundation Hospital & Research Institute, Dhaka, Dhaka, Bangladesh., Choudhury S; National Heart Foundation Hospital & Research Institute, Dhaka, Dhaka, Bangladesh., Collier T; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, London, United Kingdom., Pocock SJ; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, London, United Kingdom., Pernow J; Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: American heart journal [Am Heart J] 2023 Jan; Vol. 255, pp. 82-89. Date of Electronic Publication: 2022 Oct 21.
DOI: 10.1016/j.ahj.2022.10.005
Abstrakt: Background: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI.
Methods: A total of 2,571 participants were prospectively enrolled in the Influenza vaccination after myocardial infarction (IAMI) trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in eight countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2,467 participants with ST-segment elevation MI (STEMI, n = 1,348) or non-ST-segment elevation MI (NSTEMI, n = 1,119). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. Cumulative incidence of the primary and key secondary endpoints by randomized treatment and NSTEMI/STEMI was estimated using the Kaplan-Meier method. Treatment effects were evaluated with formal interaction testing to assess for effect modification.
Results: Baseline risk was higher in participants with NSTEMI. In the NSTEMI group the primary endpoint occurred in 6.5% of participants assigned to influenza vaccine and 10.5% assigned to placebo (hazard ratio [HR], 0.60; 95% CI, 0.39-0.91), compared to 4.1% assigned to influenza vaccine and 4.5% assigned to placebo in the STEMI group (HR, 0.90; 95% CI, 0.54-1.50, P = .237 for interaction). Similar findings were seen for the key secondary endpoints of all-cause death and cardiovascular death. The Kaplan-Meier risk difference in all-cause death at one year was more pronounced in participants with NSTEMI (NSTEMI: HR, 0.47; 95% CI 0.28-0.80, STEMI: HR, 0.86; 95% CI, 0.43-1.70, interaction P = .028).
Conclusions: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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