Clinical profile, anatomical features, and long-term outcome of acute coronary syndromes in HIV-infected patients.
Intern Med J. 2020 Jan 06;:
Authors: Postigo A, Díez-Delhoyo F, Devesa C, Bruña V, Clavero-Olmos M, Vicent L, Juárez M, Sousa I, Fernández-Avilés F, Martínez-Sellés M
BACKGROUND: Long-term prognosis of acute coronary syndromes (ACS) in HIV-infected patients is unknown.
AIMS: We sought to compare outcomes after ACS in HIV-infected and uninfected patients.
METHODS: Retrospective observational study. HIV cases were matched with two HIV-uninfected controls for age, sex, and type of ACS.
RESULTS: In 92 HIV patients (mean age 51.3 ± 9.0 years, 7.6% women), the prevalence of cardiovascular risk factors was high (smoking 71.7%; hypertension 41.3%; diabetes 14.1%); dyslipidemia was more frequent (53 (57.6%) vs. 79 (42.9), p = 0.02) and obesity less common (8 (8.7%) vs 41 (22.3%), p = 0.002) than in controls. 87 HIV patients (94.6%) had undetectable viral load and 85 (92.4%) were under antiretroviral therapy. Multivessel disease was more common in HIV patients than in controls (44 (47.8%) vs. 71 (39.1%); p = 0.05) as was Killip class 3-4 on admission (9 (9.8%) vs 6 (3.3%); p = 0.04). The rate of in-hospital mortality was similar in both groups (2%), and there were no significant differences in 3-year mortality (10.2% vs. 5.7%; p = 0,27). Non-cardiovascular readmissions at 3 years were more frequent in HIV patients than in controls (36.5% vs. 7.4%; p < 0.001). Multivariate analysis identified previous coronary artery disease as the strongest predictor of mortality in HIV patients (hazard ratio 4.7, 95% confidence interval 1.4-15.7, p = 0.01), whereas HIV infection was not associated with prognosis.
CONCLUSION: HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, inhospital and long-term mortality was similar in both groups. Non-cardiovascular rehospitalizations were more common in HIV patients. This article is protected by copyright. All rights reserved.
PMID: 31908110 [PubMed - as supplied by publisher]