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

Fröbert, O. et al. (2023) Clinical impact of influenza vaccination after ST- and non-ST-segment elevation myocardial infarction insights from the IAMI trial. American Heart Journal, 255, pp. 82-89. (doi: 10.1016/j.ahj.2022.10.005) (PMID:36279930)

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.

• Item Type: Articles
• Additional Information: Funded by a grant from the Swedish Heart-Lung Foundation (project number 20150284), the Danish Heart Foundation (grant number 16-R107-A6596–22958), ALF Grants, and Nyckelfonden, Region Örebro, Sweden and by an unrestricted grant from Sanofi Pasteur, Lyon, France, who also provided the study vaccine.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Oldroyd, Dr Keith

Creator Roles

Oldroyd, K. G.: Supervision, Writing – review and editing, Investigation

• Authors: Fröbert, O., Götberg, M., Erlinge, D., Akhtar, Z., Christiansen, E. H., MacIntyre, C. R., Oldroyd, K. G., Motovska, Z., Erglis, A., Moer, R., Hlinomaz, O., Jakobsen, L., Engstrøm, T., Jensen, L. O., Fallesen, C. O., Jensen, S. E., Angerås, O., Calais, F., Kåregren, A., Lauermann, J., Mokhtari, A., Nilsson, J., Persson, J., Stalby, P., Islam, A. K.M.M., Rahman, A., Malik, F., Choudhury, S., Collier, T., Pocock, S. J., and Pernow, J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: American Heart Journal
• Publisher: Elsevier
• ISSN: 0002-8703
• ISSN (Online): 1097-6744
• Published Online: 21 October 2022
• Copyright Holders: Copyright © 2022 Elsevier Inc.
• First Published: First published in American Heart Journal 255:82-89
• Publisher Policy: Reproduced in accordance with the publisher copyright policy