Abstract Body (Do not enter title and authors here):

Background: Pneumococcal and influenza vaccination have shown cardioprotective effects by reducing adverse cardiovascular events among high-risk patients. However, the effectiveness of combined pneumococcal and influenza vaccinations compared to influenza vaccination alone in patients with coronary artery disease (CAD) has not been thoroughly established to date.
Objective: This study aims to investigate the cardiovascular events in patients with CAD following combined pneumococcal and influenza vaccination compared to influenza vaccination alone.
Method: The TriNeTX US Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2005 to April 2021. Patients were divided into two groups, one with pneumococcal and influenza vaccination and a control group with influenza vaccination only. Patients were followed for one year. Propensity score-matched analysis (1:1, Figure 1) was conducted based on age, sex, race, body mass index, hypertension, diabetes mellitus, and chronic kidney disease. The main outcome was major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, heart failure and ischemic stroke. Secondary outcomes included all-cause mortality, acute myocardial infarction, heart failure and ischemic stroke.
Results: After propensity score matching, the study cohort comprised 132,646 patients in the pneumococcal and influenza vaccination group and 132,646 patients in the influenza alone group. The mean age of patients was 79.2 years. Patients who received pneumococcal and influenza vaccinations had a significantly lower risk of MACE (RR, 0.925 (95%CI: 0.896-0.955), P<0.001), all-cause mortality (RR, 0.947 (95%CI: 0.916-0.979), P=0.001), acute myocardial infarction (RR, 0.946 (95%CI: 0.897-0.997), P=0.039), and heart failure (RR, 0.937 (95%CI: 0.903-0.973), P=0.001) when compared with CAD patients with influenza vaccine alone. However, the risk of ischemic stroke was comparable between both groups (RR, 0.943 (95%CI: 0.893-1.004), P=0.067).
Conclusions: In patients with coronary artery disease, those who received both pneumococcal and influenza vaccinations showed significantly lower risk of MACE and all-cause mortality compared to those who received only influenza vaccine.