流感疫苗预防卒中史患者死亡和主要心血管事件：vip-acs试验的亚分析

IF 8.7 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2025-09-19 DOI:10.1177/17474930251383626

Henrique Andrade Fonseca, Gisele Sampaio Silva, Frederico Monfardini, José Carlos Nicolau, Luiz Vicente Rizzo, Otávio Berwanger

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引用次数: 0

摘要

背景：院内双剂量流感疫苗接种策略对既往脑卒中患者预防重大心血管事件（MACE）的效果仍不确定。本研究是急性冠状动脉综合征（VIP-ACS）试验后预防流感疫苗避免心血管事件的预先指定分析。方法：VIP-ACS试验是一项随机、实用、多中心、开放标签的试验，终点为盲判。急性冠脉综合征（ACS）住院≤7天的成年患者在随机分组后30天随机接受住院双剂量四价灭活流感疫苗或标准剂量疫苗。主要终点是全因死亡、心肌梗死（MI）、中风、不稳定型心绞痛、因心力衰竭住院、紧急冠状动脉血运重建术和因呼吸原因住院的分层复合，通过win ratio （WR）方法进行分析。次要终点是由CV死亡、MI和卒中（MACE）组成的分层复合。每个流感季节对患者随访12个月。结果：该试验纳入了1801例患者（31%为女性）。共有67例患者有中风史。在主要分级终点上，两组间无显著差异：无卒中史的双剂量疫苗组中有11.4%的患者胜出，而标准剂量疫苗组中有12.1%的患者胜出（WR:0.97; 95% CI:0.72-1.24； P=0.69）。然而，住院双剂量疫苗更有利于有中风史的个体（WR:2.62; 95% CI:1.10-6.25； P=0.03; 43.9% vs. 16.8%）。分层MACE结果一致（WR:3.01; 95%CI:1.15-7.88； P=0.02; 41.3% vs 13.7%），支持院内双剂量疫苗接种。结论：在ACS发生后，与标准剂量疫苗接种相比，住院双剂量流感疫苗可预防住院和死亡。

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INFLUENZA VACCINATION FOR PREVENTION OF DEATH AND MAJOR CARDIOVASCULAR EVENTS IN PATIENTS WITH A HISTORY OF STROKE: A SUBANALYSIS OF THE VIP-ACS TRIAL.

Background: An in-hospital double-dose influenza vaccination strategy's effect on preventing major cardiovascular events (MACE) in patients with previous stroke is still uncertain. This study is a prespecified analysis of the vaccine against influenza to avoid cardiovascular events after the Acute Coronary Syndrome (VIP-ACS) trial.

Methods: The VIP-ACS trial was a randomized, pragmatic, multicenter, open-label trial with blinded-adjudication endpoints. Adult patients with acute coronary syndrome (ACS) ≤ seven days of hospitalization were randomized to an in-hospital double-dose quadrivalent inactivated influenza vaccine or a standard-dose vaccine at 30 days post-randomization. The primary endpoint was a hierarchical composite of all-cause death, myocardial infarction (MI), stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analyzed by the win ratio (WR) method. The secondary endpoint was a hierarchical composite consisting of CV death, MI and stroke (MACE). Patients were followed for 12 months each influenza season.

Results: The trial enrolled 1,801 patients (31% female). A total of 67 patients had a history of stroke. There were no significant differences between groups on the primary hierarchical endpoint: 11.4% wins in the double-dose vaccine group vs 12.1% wins in the standard-dose vaccination group (WR:0.97; 95% CI:0.72-1.24; P=0.69) without a history of stroke. However, in-hospital double-dose vaccination favored individuals with previous stroke (WR:2.62; 95% CI:1.10-6.25; P=0.03; 43.9% wins vs. 16.8% wins). Results were consistent for hierarchical MACE (WR:3.01; 95%CI:1.15-7.88; P=0.02; 41.3% wins vs 13.7% wins) in favor of in-hospital double-dose vaccination.

Conclusions: After an ACS, in-hospital double-dose influenza vaccination prevents hospitalizations and death compared with standard-dose vaccination at 12 months in individuals with previous strokes.

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.