Background: Acute Coronary Syndromes (ACS) represent a common cause of death among patients with human immunodeficiency virus (HIV), yet limited data are available on their prognostic features. Methods: Data on consecutive patients with HIV infection receiving standard Highly Active Antiretroviral Therapy (HAART) presenting with ACS between January 2001 and September 2012 were retrospectively collected. Cardiac death and myocardial infarction were the main end-points. Results: 201 patients were included, with 179 (89%) males, median age of 53 (47-62) years. Admission for ST-elevation myocardial infarction occurred in 96 (48%), with multivessel or left main disease in 101 (51%), percutaneous revascularization in 154 (77%) and left ventricular systolic dysfunction (LVSD) at discharge in 28 (14%). CD4+ counts less than 200 cells/mm3 were reported in 18 (9%), and 136 (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 (10-41) months, 30 (15%) patients died, 12 (6%) for cardiac reasons, 20 (10%) suffered a myocardial infarction, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% confidence interval 2.1-46: p=0.03); a CD4 cell count below 200 cells/mm3 (hazard ratio=5.9 [95% confidence interval 1.4-25: p=0.016]) was the only predictor of myocardial infarction. Conclusions: HIV patients presenting with ACS are at significantly increased risk for myocardial infarction if they are not immunosuppressed, suggesting that the stage of HIV disease may contribute to cardiovascular instability.
CD4+ lymphocyte count predicts recurrent thrombotic events in HIV-infected patients with acute coronary syndromes
D'ASCENZO, FABRIZIO;GAITA, Fiorenzo
2013-01-01
Abstract
Background: Acute Coronary Syndromes (ACS) represent a common cause of death among patients with human immunodeficiency virus (HIV), yet limited data are available on their prognostic features. Methods: Data on consecutive patients with HIV infection receiving standard Highly Active Antiretroviral Therapy (HAART) presenting with ACS between January 2001 and September 2012 were retrospectively collected. Cardiac death and myocardial infarction were the main end-points. Results: 201 patients were included, with 179 (89%) males, median age of 53 (47-62) years. Admission for ST-elevation myocardial infarction occurred in 96 (48%), with multivessel or left main disease in 101 (51%), percutaneous revascularization in 154 (77%) and left ventricular systolic dysfunction (LVSD) at discharge in 28 (14%). CD4+ counts less than 200 cells/mm3 were reported in 18 (9%), and 136 (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 (10-41) months, 30 (15%) patients died, 12 (6%) for cardiac reasons, 20 (10%) suffered a myocardial infarction, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% confidence interval 2.1-46: p=0.03); a CD4 cell count below 200 cells/mm3 (hazard ratio=5.9 [95% confidence interval 1.4-25: p=0.016]) was the only predictor of myocardial infarction. Conclusions: HIV patients presenting with ACS are at significantly increased risk for myocardial infarction if they are not immunosuppressed, suggesting that the stage of HIV disease may contribute to cardiovascular instability.
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