Influenza vaccination and cardiovascular risk in patients with recent TIA and stroke.
OBJECTIVE
To determine whether current influenza vaccination is associated with reduced risk of major vascular events in patients with recent ischemic stroke or TIA of mainly atherothrombotic origin.


METHODS
Data were pooled from 2 prospective cohort studies, the OPTIC Registry (n = 3,635) and the AMISTAD Study (n = 618), and from the randomized PERFORM Trial (n = 19,120), all of which included patients with recent ischemic stroke or TIA. Influenza vaccination status was determined in 23,110 patients. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or vascular death up to 2 years. Secondary outcomes were myocardial infarction and stroke separately.


RESULTS
Influenza vaccination had no association with the primary outcome in the propensity score-matched cohort (hazard ratio 0.97, 95% confidence interval [CI] 0.85-1.11; p = 0.67) or in the propensity score-adjusted cohort (hazard ratio 1.00, 95% CI 0.89-1.12; p = 0.99). Similarly, the risk of stroke and myocardial infarction did not differ between the vaccinated group and the unvaccinated group; in the matched cohort, the hazard ratio was 1.01 (95% CI 0.88-1.17; p = 0.89) for stroke and 0.84 (95% CI 0.59-1.18; p = 0.30) for myocardial infarction.


CONCLUSIONS
Influenza vaccination was not associated with reduced outcome events in patients with recent atherothrombotic ischemic stroke after considering all baseline characteristics (including concomitant medications) associated with influenza vaccination.
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Philippa C
PC
Lavallée
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Julien
J
Labreuche
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Kim M
KM
Fox
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Pablo
P
Lavados
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Heinrich
H
Mattle
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland.
Philippe Gabriel
PG
Steg
From INSERM U 698 and Paris-Diderot University (P.C.L., J.L., P.G.S., P.A.), Sorbonne Paris Cité; Department of Neurology and Stroke Centre (P.C.L., J.L., P.A.) and Department of Cardiology (P.G.S.), AP-HP, Bichat University Hospital, Paris, France; NHLI Imperial College (K.M.F.), ICMS, Royal Brompton Hospital, London, UK; Unidad de Tratamiento de Ataque Cerebrovascular (P.L.), Clínica Alemana de Santiago Universidad del Desarrollo, Santiago, Chile; Neurologische Klinik und Poliklinik (H.M.), Universität Bern, Inselspital, Switzerland. pierre.amarenco@bch.aphp.fr.
Pierre
P
Amarenco
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014611:Vaccination
D007252:Influenza Vaccines