Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Medicine, University of Kentucky, Lexington, KY, USA.
Curr Cardiol Rep. 2022 Oct;24(10):1327-1335. doi: 10.1007/s11886-022-01748-8. Epub 2022 Jul 25.
Influenza infection is a significant, well-established cause of cardiovascular disease (CVD) and CV mortality. Influenza vaccination has been shown to reduce major adverse cardiovascular events (MACE) and CV mortality. Therefore, major society guidelines have given a strong recommendation for its use in patients with established CVD or high risk for CVD. Nevertheless, influenza vaccination remains underutilized. Historically, influenza vaccination is administered to stable outpatients. Until recently, the safety and efficacy of influenza vaccination among patients with acute myocardial infarction (MI) had not been established.
The recently published Influenza Vaccination after Myocardial Infarction (IAMI) trial showed that influenza vaccination within 72 h of hospitalization for MI led to a significant 28% reduction in MACE and a 41% reduction in CV mortality, without any excess in serious adverse events. Additionally, we newly performed an updated meta-analysis of randomized clinical trials (RCTs) including IAMI and the recent Influenza Vaccine to Prevent Adverse Vascular Events (IVVE) trial. In pooled analysis of 8 RCTs with a total of 14,420 patients, influenza vaccine, as compared with control/placebo, was associated with significantly lower risk of MACE at follow-up [RR 0.75 (95%CI 0.57-0.97), I 56%]. The recent IAMI trial showed that influenza vaccination in patients with recent MI is safe and efficacious at reducing CV morbidity and mortality. Our updated meta-analysis confirms a 25% reduction in MACE. The influenza vaccine should be strongly encouraged in all patients with CVD and incorporated as an essential facet of post-MI care and secondary CVD prevention.
流感感染是心血管疾病（CVD）和心血管死亡率的一个重要且已确立的原因。流感疫苗已被证明可减少主要不良心血管事件（MACE）和心血管死亡率。因此，主要的社会指南强烈建议将其用于已患有 CVD 或 CVD 高危患者。然而，流感疫苗的使用率仍然很低。从历史上看，流感疫苗适用于稳定的门诊患者。直到最近，急性心肌梗死（MI）患者接种流感疫苗的安全性和有效性才得到证实。
最近发表的《心肌梗死后流感疫苗接种研究》（IAMI）表明，MI 住院后 72 小时内接种流感疫苗可使 MACE 显著降低 28%，心血管死亡率降低 41%，且无严重不良事件增加。此外，我们新进行了一项包含 IAMI 和最近的《流感疫苗预防不良血管事件研究》（IVVE）的随机临床试验（RCT）的更新荟萃分析。在总共纳入 8 项 RCT 且共 14420 例患者的汇总分析中，与对照组/安慰剂相比，流感疫苗与随访时较低的 MACE 风险相关[RR0.75（95%CI0.57-0.97），I 56%]。最近的 IAMI 试验表明，在近期发生 MI 的患者中接种流感疫苗安全且有效，可降低心血管发病率和死亡率。我们的更新荟萃分析证实 MACE 降低了 25%。应强烈鼓励所有 CVD 患者接种流感疫苗，并将其纳入 MI 后护理和二级 CVD 预防的基本内容。
