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

Fröbert, Ole ; Götberg, Matthias LU ; Erlinge, David LU orcid ; Akhtar, Zubair ; Christiansen, Evald H. ; MacIntyre, Chandini R. ; Oldroyd, Keith G. ; Motovska, Zuzana ; Erglis, Andrejs and Moer, Rasmus , et al. (2023) In American Heart Journal 255. p.82-89
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.... (More)

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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type
Contribution to journal
publication status
published
subject
in
American Heart Journal
volume
255
pages
8 pages
publisher
Mosby-Elsevier
external identifiers
  • pmid:36279930
  • scopus:85141247086
ISSN
0002-8703
DOI
10.1016/j.ahj.2022.10.005
language
English
LU publication?
yes
id
1cf25578-39ca-4558-ae00-22a6c541ad1f
date added to LUP
2023-01-24 08:57:22
date last changed
2024-04-18 04:30:44
@article{1cf25578-39ca-4558-ae00-22a6c541ad1f,
  abstract     = {{<p>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.</p>}},
  author       = {{Fröbert, Ole and Götberg, Matthias and Erlinge, David and Akhtar, Zubair and Christiansen, Evald H. and MacIntyre, Chandini R. and Oldroyd, Keith G. and Motovska, Zuzana and Erglis, Andrejs and Moer, Rasmus and Hlinomaz, Ota and Jakobsen, Lars and Engstrøm, Thomas and Jensen, Lisette O. and Fallesen, Christian O. and Jensen, Svend E. and Angerås, Oskar and Calais, Fredrik and Kåregren, Amra and Lauermann, Jörg and Mokhtari, Arash and Nilsson, Johan and Persson, Jonas and Stalby, Per and Islam, Abu K.M.M. and Rahman, Afzalur and Malik, Fazila and Choudhury, Sohel and Collier, Timothy and Pocock, Stuart J. and Pernow, John}},
  issn         = {{0002-8703}},
  language     = {{eng}},
  pages        = {{82--89}},
  publisher    = {{Mosby-Elsevier}},
  series       = {{American Heart Journal}},
  title        = {{Clinical impact of influenza vaccination after ST- and non-ST-segment elevation myocardial infarction - insights from the IAMI trial}},
  url          = {{http://dx.doi.org/10.1016/j.ahj.2022.10.005}},
  doi          = {{10.1016/j.ahj.2022.10.005}},
  volume       = {{255}},
  year         = {{2023}},
}