Liu Xiao, Zhang Jiayu, Liu Fuwei, Wu Yifan, Li Lin, Fan Ruoyun, Fang Changchang, Huang Jinyi, Zhang Deju, Yu Peng, Zhao Huilei
Department of Anesthesiology, The Third Hospital of Nanchang, Nanchang, Jiangxi, China; Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
Travel Med Infect Dis. 2025 Mar-Apr;64:102793. doi: 10.1016/j.tmaid.2024.102793. Epub 2024 Dec 20.
There is substantial epidemiological evidence demonstrating that influenza contributes to cardiovascular events in patients who already have cardiovascular diseases. However, the efficacy of influenza vaccination on the prognosis of patients with ischemic heart disease (IHD) is unclear.
We conducted a systematic search for eligible randomized controlled trials (RCTs) in PubMed, Cochrane, and Embase on September 13, 2024, to investigate the effects of the influenza vaccine on the prognosis of patients with IHD. The effect sizes were combined using random-effects models, and Trial Sequential Analysis (TSA) was used to assess the reliability and validity of the results.
Five RCTs with a total of 5659 patients (median age ranging from 57.1 to 66 years, 67.8% male) with IHD were included. The use of influenza vaccine reduced the risk of major adverse cardiovascular events (risk ratio [RR] = 0.67, 95% confidence interval [CI] 0.52-0.87, number-needed-to-treat [NNT] of 37, high certainty), cardiovascular death (RR = 0.55, 95% CI 0.35-0.87, moderate certainty), all-cause mortality (RR = 0.58, 95% CI 0.40-0.84, high certainty) and myocardial infarction (MI) (RR = 0.66, 95% CI 0.46-0.93, high certainty) in patients with IHD compared with control. The analysis revealed no significant benefit regarding hospitalization for heart failure (HF) (RR = 0.91, 95% CI 0.21-3.99, moderate certainty) and revascularization (RR = 0.59, 95% CI 0.10-3.45, moderate certainty). The NNT to avoid 1 event was 37 for major adverse cardiovascular events, 56 for cardiovascular death, 67 for MI, and 41 for all-cause death. TSA showed that the benefit of influenza vaccine in reducing MACE was conclusive, no more trials were necessary.
This study suggests high level of evidence that the use of influenza vaccine reduce the risk of major adverse cardiovascular events in patients with IHD.
有大量流行病学证据表明，流感会导致已有心血管疾病的患者发生心血管事件。然而，流感疫苗对缺血性心脏病（IHD）患者预后的疗效尚不清楚。
2024年9月13日，我们在PubMed、Cochrane和Embase中系统检索了符合条件的随机对照试验（RCT），以研究流感疫苗对IHD患者预后的影响。效应量采用随机效应模型合并，并使用试验序贯分析（TSA）评估结果的可靠性和有效性。
纳入了5项RCT，共5659例IHD患者（中位年龄57.1至66岁，67.8%为男性）。与对照组相比，使用流感疫苗降低了IHD患者发生主要不良心血管事件的风险（风险比[RR]=0.67，95%置信区间[CI]0.52-0.87，需治疗人数[NNT]为37，高确定性）、心血管死亡（RR=0.55，95%CI 0.35-0.87，中等确定性）、全因死亡率（RR=0.58，95%CI 0.40-0.84，高确定性）和心肌梗死（MI）（RR=0.66，95%CI 0.46-0.93，高确定性）。分析显示，在因心力衰竭（HF）住院（RR=0.91，95%CI 0.21-3.99，中等确定性）和血运重建（RR=0.59，95%CI 0.10-3.45，中等确定性）方面没有显著益处。避免1例主要不良心血管事件的NNT为37，心血管死亡为56，MI为67，全因死亡为41。TSA显示，流感疫苗在降低主要不良心血管事件方面的益处是确凿的，无需更多试验。
本研究表明，有高水平证据表明使用流感疫苗可降低IHD患者发生主要不良心血管事件的风险。
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