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European Heart Journal Advance Access originally published online on January 10, 2008
European Heart Journal 2008 29(11):1350-1358; doi:10.1093/eurheartj/ehm581
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study

Andrzej Ciszewski1,*, Zofia T. Bilinska1, Lidia B. Brydak2,3, Cezary Kepka1, Mariusz Kruk1, Magdalena Romanowska2, Ewa Ksiezycka1, Jakub Przyluski1, Walerian Piotrowski1, Renata Maczynska1 and Witold Ruzyllo1

1 Institute of Cardiology, Alpejska 42, 04-628 Warszawa, Poland
2 National Influenza Center, National Institute of Hygiene, Warsaw, Poland
3 Chair and Department of Family Medicine, Medical University of Warsaw, Poland

Received 24 January 2007; revised 19 November 2007; accepted 22 November 2007; online publish-ahead-of-print 10 January 2008.

* Corresponding author. Tel: +48 660510763, Fax: +48 228121346, E-mail: aciszewski{at}ikard.pl

Aims: To evaluate the effect of influenza vaccination on the coronary events in patients with confirmed coronary artery disease (CAD).

Methods and results: Randomized, double-blind, placebo controlled study. We included 658 optimally treated CAD patients; 477 men, mean age 59.9±10.3 years. Three hundred and twenty-five patients received the influenza vaccine, and 333 patients placebo. Median follow-up was 298 (interquartile range 263–317) days. Primary endpoint was the cardiovascular death. Its estimated 12-month cumulative event rate was 0.63% in the vaccine vs. 0.76% in controls (HR 1.06 95% CI: 0.15–7.56, P = 0.95). There were two secondary composite endpoints: (i) the MACE (cardiovascular death, myocardial infarction, coronary revascularization) tended to occur less frequently in the vaccine group vs. placebo with the event rate 3.00 and 5.87%, respectively (HR 0.54;95% CI: 0.24–1.21, P = 0.13). (ii) Coronary ischaemic event (MACE or hospitalization for myocardial ischaemia) estimated 12-month event rate was significantly lower in the vaccine group 6.02 vs. 9.97% in controls (HR 0.54; 95% CI: 0.29–0.99, P = 0.047).

Conclusion: In optimally treated CAD patients influenza vaccination improves the clinical course of CAD and reduces the frequency of coronary ischaemic events. Large-scale studies are warranted to evaluate the effect of influenza vaccination on cardiovascular mortality. (ClinicalTrials.gov: NCT 00371098).

Key Words: Coronary disease • Influenza • Infection • Prevention


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