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Clinical impact of influenza vaccination after ST- and non-ST-segment elevation myocardial infarction - insights from the IAMI trial
O. Fröbert, M. Götberg, D. Erlinge, Z. Akhtar, EH. Christiansen, CR. MacIntyre, KG. Oldroyd, Z. Motovska, A. Erglis, R. Moer, O. Hlinomaz, L. Jakobsen, T. Engstrøm, LO. Jensen, CO. Fallesen, SE. Jensen, O. Angerås, F. Calais, A. Kåregren, J....
Language English Country United States
Document type Randomized Controlled Trial, Journal Article
NLK
ProQuest Central
from 2002-01-01 to 2 months ago
Nursing & Allied Health Database (ProQuest)
from 2002-01-01 to 2 months ago
Health & Medicine (ProQuest)
from 2002-01-01 to 2 months ago
Health Management Database (ProQuest)
from 2002-01-01 to 2 months ago
Public Health Database (ProQuest)
from 2002-01-01 to 2 months ago
- MeSH
- Influenza, Human * complications prevention & control MeSH
- Non-ST Elevated Myocardial Infarction * complications MeSH
- ST Elevation Myocardial Infarction * therapy complications MeSH
- Myocardial Infarction * complications MeSH
- Humans MeSH
- Risk Factors MeSH
- Influenza Vaccines * MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
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.
Department of Cardiology Aarhus University Hospital Aarhus Aarhus Denmark
Department of Cardiology Karlstad Central Hospital Karlstad Värmland Sweden
Department of Cardiology Odense University Hospital Odense Odense Denmark
International Centre for Diarrhoeal Disease Research Bangladesh Dhaka Dhaka Bangladesh
LHL sykehuset Gardermoen Oslo Ostiandet Norway
National Heart Foundation Hospital and Research Institute Dhaka Dhaka Bangladesh
National Institute of Cardiovascular Diseases Sher e Bangla Nagar Dhaka Dhaka Bangladesh
Örebro University Faculty of Health Department of Cardiology Örebro Örebro Sweden
Pauls Stradins Clinical University Hospital University of Latvia Riga Riga Latvia
Rigshospitalet University of Copenhagen Copenhagen Copenhagen Denmark
The Kirby Institute UNSW Medicine University of New South Wales Sydney New South Wales Australia
References provided by Crossref.org
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- $a Fröbert, Ole $u Örebro University, Faculty of Health, Department of Cardiology, Örebro, Örebro, Sweden. Electronic address: ole.frobert@regionorebrolan.se
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- $a 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.
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