Publications (4)29.58 Total impact
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Article: Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study.
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ABSTRACT: We have previously reported a significant benefit of vaccination against flu on the incidence of a single and composite end-point of death, myocardial infarction or recurrent ischaemia in patients with myocardial necrosis and planned percutaneous coronary interventions. To determine whether the observed benefits of vaccination against flu were maintained beyond the winter season a 1-year follow-up was conducted. During the winter season, we enrolled prospectively 200 myocardial infarction patients admitted in the first 72 h, and 101 planned angioplasty/stent patients (PCI) without unstable coronary artery disease, prior by-pass surgery, angioplasty or tissue necrosis. Only four patients failed to meet the inclusion criteria. Participants were randomly allocated to receive flu vaccination or remain unvaccinated on top of standard medication (control group). The study was conducted in hospitalized patients with the aim to test the potential beneficial effect of flu vaccination in a secondary prevention scenario. Under intention to treat analysis the incidence of the primary end-point cardiovascular death at 1 year was significantly lower among patients receiving vaccination, 6% as compared with controls, 17% (relative risk with vaccine as compared with controls, 0.34; 95% confidence interval (CI), 0.17 to 0.71; P=0.002). The triple composite end-point occurred in 22% of the patients in the vaccine group vs 37% in controls, hazard ratio 0.59, 95% CI 0.4 to 0.86) P=0.004. The beneficial effect was mainly detected in acute myocardial infarction patients (four events in the active arm vs 21 in the control group, P=0.0002 [95% CI 0.19, 0.07-0.53]), and Cox regression analyses revealed that there was a greater benefit with flu vaccination in patients at high risk according with the TIMI score, and those with non-ST-segment deviation myocardial infarction (95% CI: 0.13 [0.03-0.52]) Influenza vaccination may reduce the risk of death and ischaemic events in patients suffering from infarction and post-angioplasty during flu season. This effect was significantly evident at 1-year follow-up. Larger confirmatory studies are needed to evaluate the real impact on flu vaccination on outcome after acute coronary syndromes.European Heart Journal 02/2004; 25(1):25-31. · 10.48 Impact Factor -
Article: Two-year follow-up of the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Registry.
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ABSTRACT: We have previously determined that there is a significant benefit of vaccination against influenza in patients hospitalized due to an acute coronary event. The purpose of this study is to determine whether the observed benefits of vaccination were maintained over a 2-year follow-up among those who were re-vaccinated during the subsequent winter season. During the winter season of 2001, a total of 301 acute coronary patients were prospectively enrolled within 72 hours of the onset of symptoms. Follow-up was conducted at 6 and 12 months. Patients who survived participated in a registry 1 year after the 2nd influenza vaccination period (winter 2002), as a cohort of chronic and stable coronary patients. The incidence of the primary endpoint cardiovascular death at 1 year was significantly lower in patients receiving vaccination than in controls (6% vs 17%, respectively) by intention-to-treat analysis. The relative risk with vaccination in comparison with controls was 0.34; 95% confidence interval, 0.17-0.71; P = 0.002. In the winter of 2002, 116 patients were vaccinated according to their physicians' instructions, and 114 subjects remained unvaccinated. The combined endpoints of total death plus myocardial infarction 1 year later were 4 (3.4%) in the vaccinated group vs 11 (9.7%) among those who were not vaccinated (P = 0.05). Influenza vaccination may reduce the risk of death and ischemic events in patients admitted with acute coronary syndromes. There is also a beneficial trend in the quiescent phase of ischemia.Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2004; 31(1):28-32. · 0.65 Impact Factor -
Article: Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension.
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ABSTRACT: Primary pulmonary hypertension (PPH) is a fatal illness. In advanced stages only transplantation is able to increase survival. Echocardiography is useful for the assessment of these patients, but there is limited information about its prognostic value. With this goal, 25 consecutive patients, age: 36.7 +/- 12.7 years, were studied and followed up for a mean period of 29 months (range: 0.2-84). Eleven echocardiographic parameters of cardiac anatomy, function, and hemodynamics were assessed. Age and sex were also analyzed. Death and heart-lung transplantation were considered end-points. Thirteen events (Death: 8; transplantation: 5) occurred in the follow-up (11 of 13 in the first year). Kaplan-Meier estimated survival free from transplantation at 5 years was 40% (95% CI: 23%-70%). In the univariate analysis, RAA (HR: 1.1, P =.0004), TR (HR: 2.7, P =.02), and RVET (HR: 0.98, P =.02) showed statistically significant relation with survival free from transplantation. Multivariate analysis showed that RAS (HR: 1.10, 95% CI: 1.04-1.17, P =.001) and TR (HR: 2.52, 95% CI: 1.01-6.3, P =.047) were independent risk factors of transplantation and death. The use of these findings on the management of patients with PPH should be tested in larger studies.Journal of the American Society of Echocardiography 11/2002; 15(10 Pt 2):1160-4. · 3.71 Impact Factor -
Article: Influenza vaccine pilot study in acute coronary syndromes and planned percutaneous coronary interventions: the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Study.
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ABSTRACT: Recent reports have detected an increase in the number of patients with acute coronary syndromes during the flu season. In addition, the World Health Organization recommended vaccination against influenza infection for the Southern hemisphere in the winter of 2001. We evaluated the preventive impact of vaccination on subsequent ischemic events in myocardial infarction patients and in subjects undergoing planned percutaneous coronary angioplasty. We included 200 myocardial infarction patients admitted in the first 72 hours and 101 planned angioplasty/stent (PCI) patients without unstable coronary artery disease, prior bypass surgery, angioplasty, or tissue necrosis, in a prospective, multicenter log during the winter season. Infarct patients received a standard therapy and were then randomly allocated in a single-blind manner to either a unique intramuscular influenza vaccination or a control group. Similarly, PCI patients were allocated to either vaccination or control groups. Combined end points (death, reinfarction, and rehospitalization for ischemia) were assessed at 6 months' follow-up. The first primary outcome, cardiovascular death, occurred in 2% of the patients in the vaccine group compared with 8% in the control group (relative risk with vaccine as compared with controls, 0.25; 95% CI 0.07 to 0.86; P=0.01). The triple composite end point occurred in 11% of the patients in the vaccine group compared with 23% in controls (P=0.009). Influenza vaccination may reduce the risk of death and ischemic events in patients suffering from infarction and those recovering from angioplasty during flu season. This response could be related to a humoral immune response with positive consequences during flu seasons.Circulation 06/2002; 105(18):2143-7. · 14.74 Impact Factor
