Abstract
Aims
To evaluate whether a strategy of double-dose influenza vaccination during hospitalization for an acute coronary syndrome (ACS) compared with standard-dose outpatient vaccination (as ...recommended by current guidelines) would further reduce the risk of major cardiopulmonary events.
Methods and results
Vaccination against Influenza to Prevent cardiovascular events after Acute Coronary Syndromes (VIP-ACS) was a pragmatic, randomized, multicentre, active-comparator, open-label trial with blinded outcome adjudication comparing two strategies of influenza vaccination following an ACS: double-dose quadrivalent inactivated vaccine before hospital discharge vs. standard-dose quadrivalent inactivated vaccine administered in the outpatient setting 30 days after randomization. The primary outcome was a hierarchical composite of all-cause death, myocardial infarction, stroke, unstable angina, hospitalization for heart failure, urgent coronary revascularization, and hospitalization for respiratory causes, analysed by the win ratio method. Patients were followed for 12 months. During two influenza seasons, 1801 participants were included at 25 centres in Brazil. The primary outcome was not different between groups, with 12.7% wins in-hospital double-dose vaccine group and 12.3% wins in the standard-dose vaccine group {win ratio: 1.02 95% confidence interval (CI): 0.79–1.32, P = 0.84}. Results were consistent for the key secondary outcome, a hierarchical composite of cardiovascular death, myocardial infarction and stroke win ratio: 0.94 (95% CI: 0.66–1.33), P = 0.72. Time-to-first event analysis for the primary outcome showed results similar to those of the main analysis hazard ratio 0.97 (95% CI: 0.75–1.24), P = 0.79. Adverse events were infrequent and did not differ between groups.
Conclusion
Among patients hospitalized with an ACS, double-dose influenza vaccination before discharge did not reduce cardiopulmonary outcomes compared with standard-dose vaccination in the outpatient setting.
Clinical Trial Registration
ClinicalTrials.gov number: NCT04001504
The FF-LYNX project aims at the definition of a flexible protocol that can handle both the distribution of Timing, Trigger and Control (TTC) signals and the data acquisition in future High Energy ...Physics (HEP) experiments. The implementation of this protocol in digital interfaces designed and produced in standard CMOS technologies (130 and/or 90
nm) and available as “IP cores” is also foreseen.
Prior to 1975, craniofacial injuries were the most frequent of all ice hockey injuries. Through the cooperative efforts of hockey administrators, health professionals, sports standards organizations, ...and the introduction of mandatory protective equipment playing rules craniofacial injuries in youth, high school, and college hockey players in the United States have been almost eliminated. Blind eye injuries, once a major problem, no longer occur in players wearing certified full face protectors. The saving in health care costs for treating eye injuries alone is estimated to be upwards of $10 million annually. Despite the phenomenal success of amateur hockey organizations in eliminating most craniofacial injuries, such injuries continue to occur in recreational, "Old Timers," major junior, and professional hockey players because of failure to use the most effective types of protective equipment. The system established in the United States for preventing craniofacial injuries in the sports of ice hockey that involves youth, high school, and college hockey associations along with standards setting and certification procedures can serve as a model for all amateur sports throughout the world.
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