Optimal timing of influenza vaccination among patients with acute myocardial infarction - Findings from the IAMI trial

Authors	AKHTAR Zubair GOTBERG Matthias ERLINGE David CHRISTIANSEN Evald H OLDROYD Keith G MOTOVSKA Zuzana ERGLIS Andrejs HLINOMAZ Ota JAKOBSEN Lars ENGSTROM Thomas JENSEN Lisette O FALLESEN Christian O JENSEN Svend E ANGERAS Oskar CALAIS Fredrik KAREGREN Amra LAUERMANN Jorg MOKHTARI Arash NILSSON Johan PERSSON Jonas ISLAM Abu K M M RAHMAN Afzalur MALIK Fazila CHOUDHURY Sohel COLLIER Timothy POCOCK Stuart J PERNOW John MACINTYRE Chandini R FROBERT Ole
Year of publication	2023
Type	Article in Periodical
Magazine / Source	Vaccine
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S0264410X23012112?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.vaccine.2023.10.028
Keywords	Influenza vaccination; Optimal timing; Vaccine effectiveness; Percutaneous coronary intervention; Myocardial infarction
Description	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 was the composite of all-cause death, myocardial infarction (MI), or stent thrombosis at 12 months. The cumulative 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 vaccination but regardless of vaccination timing we strongly recommend influenza vaccination in all patients with cardiovascular diseases.