22. European Stroke Conference 13 Etiology of stroke and risk factors B 17:00 - 17:10 Influenza vaccination was not associated with reduction of major cardiovascular events in patients with recent TIA and stroke P.C. Lavallée1, J Labreuche2, P. Amarenco3 On behalf the PERFORM, OPTIC and AMISTAD investigators INSERM U-698, department of neurology and stroke center, AP-HP, Bichat-Claude Bernard Hospital, Univ Paris Diderot, Sorbonne Paris Cité, F-75018,, Paris, FRANCE1,INSERM U-698, Department of neurology and stroke center, AP-HP, Bi-chat- Claude Bernard Hospital, Univ Paris Diderot, Sorbonne Paris Cité, F-75018,, Paris, FRANCE2, INSERM U-698, department of neurology and stroke center, AP-HP, Bichat-Claude Bernard Hospital, Univ Paris Diderot, Sorbonne Paris Cité, F-75018,, Paris, FRANCE3 Background: Numerous studies have suggested a link between influenza and major vascular events, including stroke but the potential protective effect of influenza vaccination on cardio-vascular and cerebrovascular diseases remains controversial. We tested the a priori hypothesis that influenza vaccination might reduce the risk of major vascular events in patients with recent ischemic stroke in the PERFORM trial (n=19120), the OPTIC registry (n=3637) and the AM-SITAD study (n=405). Methods: Influenza vaccination status was determined in 23 110 patients with a recent transient ischemic attack or ischemic stroke enrolled. The primary endpoint was a composite of nonfatal myocardial infarction (MI), nonfatal stroke or cardiac death. Secondary outcomes were MI and stroke separately. Because of significant differences in baseline characteristics between patients who have been vaccinated against influenza (V) during the previous vaccination campaign and those not vaccinated (NV), we used propensity score matching to assemble a cohort of 5084 NV and 5084 V patients in which all baseline characteristics were well balanced across groups. Results: Influenza vaccination had no effect on the primary endpoint, in the matching co-hort (HR, 0.97; 95%CI, 0.85-1.11; p=0.67) as well as in the whole cohort (HR, 1.00; 95%CI, 0.89-1.12; p=0,986) after adjusting on the propensity score. Similarly the risk of stroke and myocardial infarction was not different in the V group and in the NV group; in the matching cohort, the HR was 1.01 for stroke (95%CI, 0.88-1.17 p=0.89) and 0.84 for MI (95%CI, 0.59- 1.18;p=0.30). Conclusion:Influenza vaccination was not associated with reduced outcome events in patients with recent ischemic stroke after taking into account all baseline characteristics (including con-comitant medications) associated with influenza vaccination. Table: Inflammatory markers and MMPs circulating levels according to death Baseline P value 24 hourafter thrombolysis P value Baseline values Median and inter-quartile range Survivor (n=299) Death 3m (n=28) Survi-vor (n=299) Death 3m (n=28) C Reactive pro-tein (mg/l) 2.96 (1.44- 8.35) 8.25 (2.17- 8.25) 0.008 11.64 (3.56- 24.1) 28.3 (13.9-53.7) <0.0001 Haptoglobin (mg/ ml) 1.78 (0.79- 3.69) 3.12 (1.24- 10.7) 0.020 1.92 (0.81- 4.62) 5.81 (2.2-14.2) <0.0001 Alpha2-macroglo-bulin (mg/ml) 1.78 (1.24- 2.60) 2.26 (1.83- 4.23) 0.001 1.67 (1.17- 2.48) 2.47 (1.94-3.89) <0.0001 IL-6 (pg/ml) 4.01 (2.16-7.9) 6.25 (4.16- 11.53) 0.004 7.75 (3.60- 16.74) 17.51 (9.61-17.5) <0.0001 IL-10 (pg/ml) 9.8 (2.99- 23.1) 3.58 (1.16- 16.7) 0.036 5.99 (1.96- 17.6) 5.50 (1.63-15.8) 0.603 IL-12p70 (pg/ml) 24.2 (11.7- 52.9) 18.2 (9.3-42.1) 0.027 12.1 (7.4- 44.1) 11.0 (6.2-36.7) 0.109 VEGF (ng/ml) 105.8 (56.4- 203.7) 82.2 (43.7- 130.5) 0.067 90.6 (39.0- 152.8) 69.0 (33.5-102) 0.127 Delta values Median and inter-quartile range Survi-vors (n=299) Death 3m (n=28) p MMP-1 0.01 (-0.34 – 1.80) -0.14 (-0.50 – 0.10) 0.048 MMP-8 0.46 (-0.27 – 1.44) -0.09 (-0.51 – 0.35) 0.011 MMP-9 0.37 (-0.36 – 1.03) -0.17 (-0.52 – 0.38) 0.007 TIMP-1 0.17 (-0.14 – 0.74) -0.02 (-0.14 – 0.17) 0.011 74 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
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