Study on the Effect of Influenza Vaccination After Heart Attack on Future Cardiovascular Prognosis (IAMI)
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|ClinicalTrials.gov Identifier: NCT02831608|
Recruitment Status : Recruiting
First Posted : July 13, 2016
Last Update Posted : July 23, 2018
Background. For more than a century a causal link between influenza and cardiovascular disease has been suspected. It is conceivable that influenza may precipitate plaque rupture, increase cytokines with central roles in plaque destabilization and trigger the coagulation cascade. Accordingly, registry studies, case control studies and a few small randomized trials, all underpowered for clinical endpoints, have demonstrated that the risk for acute myocardial infarction (AMI) is increased following respiratory infection and that the risk of stroke and AMI in patients with established cardiovascular disease seem to be reduced following influenza vaccination. In May 2015 a Cochrane review concluded that influenza vaccination may reduce cardiovascular mortality and cardiovascular events but bias and inconsistent results in prior studies require higher-quality evidence to confirm these findings. High costs and little commercial interest in conducting a randomized trial on influenza vaccine in cardiovascular disease stand in the way.
Objective. The objective is to document whether influenza vaccination protects against cardiovascular events and death after an AMI.
Methods. Population: 4400 patients with ST-elevation (STEMI) or non-ST elevation myocardial infarction (NSTEMI) are randomized 1:1 in a blinded fashion using an RRCT design and followed up via registries and two telephone calls. Intervention: Influenza vaccination. Control: Placebo (saline). Outcome: The primary endpoint is a composite of death, myocardial infarction and stent thrombosis till 1 year in patients with STEMI/NSTEMI undergoing coronary angiography/PCI. Patients will be included in the study in all of Sweden's 7 university hospitals and 2 general hospitals, 4 university hospitals and 1 general hospital in Denmark, in 1 specialized heart center in Norway, 3 university hospitals in Czech Republic, 5 hospitals in Scotland and 1 university hospital in Latvia. Secondary endpoints are time to all-cause death, time to stent thrombosis, time to revascularization, time to myocardial infarction, time to stroke or time to rehospitalization for heart failure till 1 year, 2 years, 3 years and 5 years. Furthermore, an extensive health-economic analysis will be conducted. The trial has been approved by the ethical committee system (Dnr 2014/264) and the Medical Products Agency (EudraCTnr -2014-001354-42) in Sweden.
Perspectives. If a clinical benefit can be demonstrated in this prospective trial influenza vaccination may become an important novel in-hospital therapy for patients with cardiovascular disease and the accompanying direct and indirect societal gains will be profound. IAMI will be the first placebo-controlled RRCT conducted.
|Condition or disease||Intervention/treatment||Phase|
|Myocardial Infarction Influenza, Human Influenza Vaccines Heart Failure Stroke||Biological: Influenza vaccine Biological: Placebo||Phase 4|
Show Detailed Description
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||4400 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)|
|Official Title:||Influenza Vaccination After Myocardial Infarction (IAMI Trial): A Multicenter, Prospective, Randomized Controlled Clinical Trial Based on the Swedish Angiography and Angioplasty Registry (SCAAR) Platform|
|Study Start Date :||October 2016|
|Estimated Primary Completion Date :||March 2019|
|Estimated Study Completion Date :||August 2020|
Experimental: Drug: influenza vaccine
Standard influenza vaccine administered as a deep subcutaneous injection at one occasion per subject.
Biological: Influenza vaccine
Other Name: Vaxigrip, Vaxigrip Tetra
Placebo Comparator: Drug: placebo
Saline administered as a deep subcutaneous injection at one occasion per subject.
- The number of participants with death, a new myocardial infarction or stent thrombosis (first occurring) according to ICD-10 codes. [ Time Frame: 1 year ]Composite endpoint of time to all-cause death, a new myocardial infarction or stent thrombosis (first occurring).
- The number of participants with stroke according to ICD-10 codes. [ Time Frame: 1 year ]Time to stroke will be registered.
- The number of participants with hospitalization for heart failure according to ICD-10 codes. [ Time Frame: 1 year ]Time to hospitalization for heart failure will be assessed.
- Length of hospital stay per participant. [ Time Frame: Pertains only to hospital stay at baseline. Realistic time frame: till 2 weeks ]Assessed by e-health records.
- The number of participants with: death, a new myocardial infarction or stent thrombosis assessed separately for each diagnosis according ICD-10 codes. [ Time Frame: 1 year ]Death, a new myocardial infarction or stent thrombosis will be reported as separate secondary endpoints.
- The number of participants with: cardiovascular death. [ Time Frame: 1 year ]Cardiovascular death will be reported as a separate secondary endpoint.
- The primary and secondary outcomes assessed beyond 1 year [ Time Frame: 5 years ]These outcomes will be considered exploratory only.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02831608
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