tetano
Editor, Senior Moderator
Int J Stroke
. 2025 Sep 19:17474930251383626.
doi: 10.1177/17474930251383626. Online ahead of print. INFLUENZA VACCINATION FOR PREVENTION OF DEATH AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH A HISTORY OF STROKE: A SUBANALYSIS OF THE VIP-ACS TRIAL
Henrique Andrade Fonseca[SUP] 1 [/SUP], Gisele Sampaio Silva[SUP] 1 2 [/SUP], Frederico Monfardini[SUP] 1 [/SUP], José Carlos Nicolau[SUP] 3 [/SUP], Luiz Vicente Rizzo[SUP] 1 [/SUP], Otávio Berwanger[SUP] 1 4 [/SUP]
Affiliations
Background: An in-hospital double-dose influenza vaccination strategy's effect on preventing major cardiovascular events (MACE) in patients with previous stroke is still uncertain. This study is a prespecified analysis of the vaccine against influenza to avoid cardiovascular events after the Acute Coronary Syndrome (VIP-ACS) trial.
Methods: The VIP-ACS trial was a randomized, pragmatic, multicenter, open-label trial with blinded-adjudication endpoints. Adult patients with acute coronary syndrome (ACS) ≤ seven days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine or a standard-dose vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of all-cause death, myocardial infarction (MI), stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analyzed by the win ratio (WR) method. The secondary endpoint was a hierarchical composite consisting of CV death, MI and stroke (MACE). Patients were followed for 12 months each influenza season.
Results: The trial enrolled 1,801 patients (31% female). A total of 67 patients had a history of stroke. There were no significant differences between groups on the primary hierarchical endpoint: 11.4% wins in the double-dose vaccine group vs 12.1% wins in the standard-dose vaccination group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke. However, in-hospital double-dose vaccination favored individuals with previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8% wins). Results were consistent for hierarchical MACE (WR:3.01; 95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital double-dose vaccination.
Conclusions: After an ACS, in-hospital double-dose influenza vaccination prevents hospitalizations and death compared with standard-dose vaccination at 12 months in individuals with previous strokes.
Keywords: Acute; Acute coronary syndrome; Cardiovascular Events; Influenza vaccine; Stroke; mortality.
. 2025 Sep 19:17474930251383626.
doi: 10.1177/17474930251383626. Online ahead of print. INFLUENZA VACCINATION FOR PREVENTION OF DEATH AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH A HISTORY OF STROKE: A SUBANALYSIS OF THE VIP-ACS TRIAL
Henrique Andrade Fonseca[SUP] 1 [/SUP], Gisele Sampaio Silva[SUP] 1 2 [/SUP], Frederico Monfardini[SUP] 1 [/SUP], José Carlos Nicolau[SUP] 3 [/SUP], Luiz Vicente Rizzo[SUP] 1 [/SUP], Otávio Berwanger[SUP] 1 4 [/SUP]
Affiliations
- PMID: 40973981
- DOI: 10.1177/17474930251383626
Background: An in-hospital double-dose influenza vaccination strategy's effect on preventing major cardiovascular events (MACE) in patients with previous stroke is still uncertain. This study is a prespecified analysis of the vaccine against influenza to avoid cardiovascular events after the Acute Coronary Syndrome (VIP-ACS) trial.
Methods: The VIP-ACS trial was a randomized, pragmatic, multicenter, open-label trial with blinded-adjudication endpoints. Adult patients with acute coronary syndrome (ACS) ≤ seven days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine or a standard-dose vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of all-cause death, myocardial infarction (MI), stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analyzed by the win ratio (WR) method. The secondary endpoint was a hierarchical composite consisting of CV death, MI and stroke (MACE). Patients were followed for 12 months each influenza season.
Results: The trial enrolled 1,801 patients (31% female). A total of 67 patients had a history of stroke. There were no significant differences between groups on the primary hierarchical endpoint: 11.4% wins in the double-dose vaccine group vs 12.1% wins in the standard-dose vaccination group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke. However, in-hospital double-dose vaccination favored individuals with previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8% wins). Results were consistent for hierarchical MACE (WR:3.01; 95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital double-dose vaccination.
Conclusions: After an ACS, in-hospital double-dose influenza vaccination prevents hospitalizations and death compared with standard-dose vaccination at 12 months in individuals with previous strokes.
Keywords: Acute; Acute coronary syndrome; Cardiovascular Events; Influenza vaccine; Stroke; mortality.