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Akhtar Z, Götberg M, Erlinge D, Christiansen EH, Oldroyd KG, Motovska Z, Erglis A, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J, MacIntyre CR, Fröbert O. Optimal timing of influenza vaccination among patients with acute myocardial infarction - Findings from the IAMI trial. Vaccine 2023; 41:7159-7165. [PMID: 37925315 DOI: 10.1016/j.vaccine.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023]
Abstract
Influenza vaccination reduces the risk of adverse cardiovascular events.The IAMI trial randomly assigned 2571 patients with acute myocardial infarction (AMI) to receive influenza vaccine or saline placebo during their index hospital admission. It was conducted at 30 centers in 8 countries from October 1, 2016 to March 1, 2020. In this post-hoc exploratory sub-study, we compare the trial outcomes in patients receiving early season vaccination (n = 1188) and late season vaccination (n = 1344).The primary endpoint wasthe composite of all-cause death, myocardial infarction (MI), or stent thrombosis at 12 months. Thecumulative incidence of the primary and key secondary endpoints by randomized treatment and early or late vaccination was estimated using the Kaplan-Meier method. In the early vaccinated group, the primary composite endpoint occurred in 36 participants (6.0%) assigned to influenza vaccine and 49 (8.4%) assigned to placebo (HR 0.69; 95% CI 0.45 to 1.07), compared to 31 participants (4.7%) assigned to influenza vaccine and 42 (6.2%) assigned to placebo (HR 0.74; 95% CI 0.47 to 1.18) in the late vaccinated group (P = 0.848 for interaction on HR scale at 1 year). We observed similar estimates for the key secondary endpoints of all-cause death and CV death. There was no statistically significant difference in vaccine effectiveness against adverse cardiovascular events by timing of vaccination. The effect of vaccination on all-cause death at one year was more pronounced in the group receiving early vaccination (HR 0.50; 95% CI, 0.29 to 0.86) compared late vaccination group (HR 0.75; 35% CI, 0.40 to 1.40) but there was no statistically significant difference between these groups (Interaction P = 0.335). In conclusion,there is insufficient evidence from the trial to establish whether there is a difference in efficacy between early and late vaccinationbut regardless of vaccination timing we strongly recommend influenza vaccination in all patients with cardiovascular diseases.
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Affiliation(s)
- Zubair Akhtar
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Programme on Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | | | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia
| | - Ota Hlinomaz
- International Clinical Research Center, St. Anne University Hospital and Masaryk University, Brno, Czech Republic
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Engstrøm
- Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Oskar Angerås
- Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Gothenburg, Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | | | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka 1207, Bangladesh
| | - Fazila Malik
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Sohel Choudhury
- National Heart Foundation Hospital & Research Institute, Dhaka, Bangladesh
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Chandini R MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia; Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden; College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, USA; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Clinical Pharmacology, Aarhus University Hospital, Arhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Fröbert O, Götberg M, Erlinge D, Akhtar Z, Christiansen EH, MacIntyre CR, Oldroyd KG, Motovska Z, Erglis A, Moer R, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Stalby P, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J. Clinical impact of influenza vaccination after ST- and non-ST-segment elevation myocardial infarction - insights from the IAMI trial. Am Heart J 2023; 255:82-89. [PMID: 36279930 DOI: 10.1016/j.ahj.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/23/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
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 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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Affiliation(s)
- Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Örebro, Sweden.
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden
| | - Zubair Akhtar
- 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
| | | | - Chandini R MacIntyre
- The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Keith G Oldroyd
- 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
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic and University Hospital Kralovske Vinohrady, Prague, Bohemia, Czech Republic
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Riga, Latvia
| | - Rasmus Moer
- LHL-sykehuset Gardermoen, Oslo, Ostiandet, Norway
| | - Ota Hlinomaz
- nternational clinical research center, St. Anne University Hospital and Masaryk University, Brno, South Moravian, Czech Republic
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Aarhus , Denmark
| | - Thomas Engstrøm
- Rigshospitalet, University of Copenhagen, Copenhagen, Copenhagen, Denmark
| | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Odense, Odense, Denmark
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark and Department of Clinical Medicine, Aalborg University, Aalborg, Kommune, Denmark
| | - Oskar Angerås
- Sahlgrenska University Hospital, Gothenburg, Sweden and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Gothenburg, Västergötland , Sweden
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Örebro, Sweden
| | - Amra Kåregren
- Västmanlands sjukhus Västerås, Västerås, Västmanland, Sweden
| | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Linköping, Östergötland, Sweden
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Scania, Sweden
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umea, Västerbotten län, Sweden
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Södermanland and Uppland, Sweden
| | - Per Stalby
- Department of Cardiology, Karlstad Central Hospital, Karlstad, Värmland, Sweden
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Dhaka, Bangladesh
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Dhaka, Bangladesh
| | - Fazila Malik
- National Heart Foundation Hospital & Research Institute, Dhaka, Dhaka, Bangladesh
| | - Sohel Choudhury
- National Heart Foundation Hospital & Research Institute, Dhaka, Dhaka, Bangladesh
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, London, United Kingdom
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, London, United Kingdom
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Stockholm, Sweden
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Fröbert O, Götberg M, Erlinge D, Akhtar Z, Christiansen EH, MacIntyre CR, Oldroyd KG, Motovska Z, Erglis A, Moer R, Hlinomaz O, Jakobsen L, Engstrøm T, Jensen LO, Fallesen CO, Jensen SE, Angerås O, Calais F, Kåregren A, Lauermann J, Mokhtari A, Nilsson J, Persson J, Stalby P, Islam AKMM, Rahman A, Malik F, Choudhury S, Collier T, Pocock SJ, Pernow J. Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation 2021; 144:1476-1484. [PMID: 34459211 DOI: 10.1161/circulationaha.121.057042] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. METHODS We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. RESULTS Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39-0.89]; P=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50-1.46]; P=0.57) in the influenza vaccine and placebo groups, respectively. CONCLUSIONS Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02831608.
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Affiliation(s)
- Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Sweden (O.F., F.C.)
| | - Matthias Götberg
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - David Erlinge
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka (Z.A.)
| | | | - Chandini R MacIntyre
- The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, Australia (C.R.M.)
| | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, 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, United Kingdom (K.G.O.)
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.M.)
| | - Andrejs Erglis
- Pauls Stradins Clinical University Hospital, University of Latvia, Riga (A.E.)
| | - Rasmus Moer
- LHL-sykehuset Gardermoen, Oslo, Norway (R.M.)
| | - Ota Hlinomaz
- International clinical research center, St. Anne University Hospital and Masaryk University, Brno, Czech Republic (O.H.)
| | - Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Denmark (E.H.C., L.J.)
| | | | - Lisette O Jensen
- Department of Cardiology, Odense University Hospital, Denmark (L.O.J., C.O.F.)
| | | | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Denmark (S.E.J.)
| | - Oskar Angerås
- Sahlgrenska University Hospital and Institute of Medicine, Department of molecular and clinical medicine, Gothenburg University, Sweden (O.A.)
| | - Fredrik Calais
- Örebro University, Faculty of Health, Department of Cardiology, Sweden (O.F., F.C.)
| | | | - Jörg Lauermann
- Department of Cardiology, Jönköping, Region Jönköping County, and Department of Health, Medicine and Caring, Linköping University, Sweden (J.L.)
| | - Arash Mokhtari
- Department of Cardiology, Skane University Hospital, Clinical Sciences, Lund University, Sweden (M.G., D.E., A.M.)
| | - Johan Nilsson
- Cardiology, Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Sweden (J.N.)
| | - Jonas Persson
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden (J. Persson)
| | - Per Stalby
- Department of Cardiology, Karlstad Central Hospital, Sweden (P.S.)
| | - Abu K M M Islam
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Bangladesh (A.K.K.M.I., A.R.)
| | - Afzalur Rahman
- National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Bangladesh (A.K.K.M.I., A.R.)
| | - Fazila Malik
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh (F.M., S.C.)
| | - Sohel Choudhury
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh (F.M., S.C.)
| | - Timothy Collier
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (T.C., S.J.P.)
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom (T.C., S.J.P.)
| | - John Pernow
- Cardiology Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden (J. Pernow)
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Fallesen CO, Thayssen P, Pedersen KE, Junker A, Hansen KN, Hansen HS, Veien KT, Jensen LO. TCT-492 Stent Thrombosis With Ticagrelor Versus Clopidogrel After Percutaneous Coronary Intervention and Ticagrelor or Clopidogrel in Patients With Acute Coronary Syndromes in a Real World Setting. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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