tetano
Editor, Senior Moderator
Am Heart J
. 2022 Oct 21;S0002-8703(22)00198-3.
doi: 10.1016/j.ahj.2022.10.005. Online ahead of print.
Clinical Impact of Influenza Vaccination after ST- and Non-ST-segment elevation Myocardial Infarction Insights from the IAMI trial
Ole Fröbert[SUP] 1 [/SUP], Matthias Götberg[SUP] 2 [/SUP], David Erlinge[SUP] 2 [/SUP], Zubair Akhtar[SUP] 3 [/SUP], Evald H Christiansen[SUP] 4 [/SUP], Chandini R MacIntyre[SUP] 5 [/SUP], Keith G Oldroyd[SUP] 6 [/SUP], Zuzana Motovska[SUP] 7 [/SUP], Andrejs Erglis[SUP] 8 [/SUP], Rasmus Moer[SUP] 9 [/SUP], Ota Hlinomaz[SUP] 10 [/SUP], Lars Jakobsen[SUP] 4 [/SUP], Thomas Engstrøm[SUP] 11 [/SUP], Lisette O Jensen[SUP] 12 [/SUP], Christian O Fallesen[SUP] 12 [/SUP], Svend E Jensen[SUP] 13 [/SUP], Oskar Angerås[SUP] 14 [/SUP], Fredrik Calais[SUP] 15 [/SUP], Amra Kåregren[SUP] 16 [/SUP], Jörg Lauermann[SUP] 17 [/SUP], Arash Mokhtari[SUP] 2 [/SUP], Johan Nilsson[SUP] 18 [/SUP], Jonas Persson[SUP] 19 [/SUP], Per Stalby[SUP] 20 [/SUP], Abu K M M Islam[SUP] 21 [/SUP], Afzalur Rahman[SUP] 21 [/SUP], Fazila Malik[SUP] 22 [/SUP], Sohel Choudhury[SUP] 22 [/SUP], Timothy Collier[SUP] 23 [/SUP], Stuart J Pocock[SUP] 23 [/SUP], John Pernow[SUP] 24 [/SUP]
Affiliations
Abstract
Background: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI.
Methods: A total of 2571 participants were prospectively enrolled in the IAMI trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2467 participants with ST-segment elevation MI (STEMI, n=1348) or non-ST-segment elevation MI (NSTEMI, n=1119). 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
, 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=0.237 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 1 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=0.028).
Conclusions: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.
Keywords: Influenza vaccination; Myocardial infarction; Percutaneous coronary intervention.
. 2022 Oct 21;S0002-8703(22)00198-3.
doi: 10.1016/j.ahj.2022.10.005. Online ahead of print.
Clinical Impact of Influenza Vaccination after ST- and Non-ST-segment elevation Myocardial Infarction Insights from the IAMI trial
Ole Fröbert[SUP] 1 [/SUP], Matthias Götberg[SUP] 2 [/SUP], David Erlinge[SUP] 2 [/SUP], Zubair Akhtar[SUP] 3 [/SUP], Evald H Christiansen[SUP] 4 [/SUP], Chandini R MacIntyre[SUP] 5 [/SUP], Keith G Oldroyd[SUP] 6 [/SUP], Zuzana Motovska[SUP] 7 [/SUP], Andrejs Erglis[SUP] 8 [/SUP], Rasmus Moer[SUP] 9 [/SUP], Ota Hlinomaz[SUP] 10 [/SUP], Lars Jakobsen[SUP] 4 [/SUP], Thomas Engstrøm[SUP] 11 [/SUP], Lisette O Jensen[SUP] 12 [/SUP], Christian O Fallesen[SUP] 12 [/SUP], Svend E Jensen[SUP] 13 [/SUP], Oskar Angerås[SUP] 14 [/SUP], Fredrik Calais[SUP] 15 [/SUP], Amra Kåregren[SUP] 16 [/SUP], Jörg Lauermann[SUP] 17 [/SUP], Arash Mokhtari[SUP] 2 [/SUP], Johan Nilsson[SUP] 18 [/SUP], Jonas Persson[SUP] 19 [/SUP], Per Stalby[SUP] 20 [/SUP], Abu K M M Islam[SUP] 21 [/SUP], Afzalur Rahman[SUP] 21 [/SUP], Fazila Malik[SUP] 22 [/SUP], Sohel Choudhury[SUP] 22 [/SUP], Timothy Collier[SUP] 23 [/SUP], Stuart J Pocock[SUP] 23 [/SUP], John Pernow[SUP] 24 [/SUP]
Affiliations
- PMID: 36279930
- DOI: 10.1016/j.ahj.2022.10.005
Abstract
Background: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI.
Methods: A total of 2571 participants were prospectively enrolled in the IAMI trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2467 participants with ST-segment elevation MI (STEMI, n=1348) or non-ST-segment elevation MI (NSTEMI, n=1119). 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
, 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=0.237 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 1 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=0.028).
Conclusions: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.
Keywords: Influenza vaccination; Myocardial infarction; Percutaneous coronary intervention.