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In-Hospital Mortality With Acute MI Higher With Than Without HIV
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52nd ICAAC, September 9-12, 2012, San Francisco
Mark Mascolini
HIV-positive people in the United States have about a 50% higher risk of in-hospital death from acute myocardial infarction (MI) than do US patients without HIV, according to analysis of a nationwide hospital database [1]. HIV-positive people in this cohort received standard MI procedures less often than people without HIV.
Compared with HIV-negative people, men and especially women with HIV ran a significantly higher risk of acute MI in a prior analysis that adjusted for age, gender, race, hypertension, diabetes, and dyslipidemia [2]. But risk of death when admitted to the hospital with acute MI had not been compared in people with and without HIV until this analysis of the Nationwide Inpatient Sample from 1997 through 2006--the first decade of the combination antiretroviral era [1].
Researchers at four California universities used that database to identify all acute MIs in people with and without HIV. Then they used descriptive and Cox proportional hazard analysis to gauge mortality differences between HIV-positive and negative people. They also calculated rates at which people received standard MI procedures and medications.
The analysis focused on 1,428,146 people between 18 and 65 years old who spent at least 1 day in the hospital during the study period because of an acute MI. This group included 5984 people with HIV. Most MIs occurred in whites, men, privately insured people, and those at least 55 years old. Hospital stays averaged 5.3 days, and the most common comorbidities were hypertension (51%), diabetes without complications (23.6%), congestive heart failure (19.7%), and chronic pulmonary disease (15.7%). A higher proportion of HIV-positive people than HIV-negative people died in the hospital (4.3% versus 2.4%).
Unadjusted analysis determined that HIV-positive people with acute MI had more than a 40% higher risk of death than HIV-negative people (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.07 to 1.90, P < 0.02). Mortality risk with HIV was even higher, at almost 65%, after statistical adjustment for age, gender, and race or ethnicity (HR 1.64, 95% CI 1.20 to 2.25, P < 0.001). The same analysis determined that men had a 25% higher death risk than women (HR 1.25, 95% CI 1.17 to 1.28, P < 0.001). HIV infection remained independently associated with about a 50% higher risk of death from acute MI after additional adjustment for comorbidities (HR 1.53, 95% CI 1.12 to 2.09, P < 0.01).
Bivariate analysis indicated that HIV-positive people were younger than HIV negatives (under 54 versus under 64), more often men (84.9% versus 72.0%), and more often insured by Medicare or Medicaid (62.3% versus 24.9%). The HIV group had a higher prevalence of congestive heart failure (26.2% versus 19.7%), kidney disease (13.3% versus 5.0%), and mild liver disease (8.4% versus 1.2%). But other classic cardiovascular risk factors--such as hypertension, diabetes, and cardiac arrhythmias--were less prevalent in the HIV group.
Compared with HIV-negative acute MI patients, those with HIV received standard procedures less often, including coronary arteriography (48.0% versus 62.5%), left cardiac catheterization (52.2% versus 66.0%), and angiography of left heart structures (43.7% versus 56.3%).
The researchers advised clinicians to "be alert to the increased mortality burden when treating sero-positives with acute MI." They called for further study to pinpoint factors that make acute MI in-hospital mortality more frequent in HIV-positive people.
References
1. Pearce DD, Ani C, Espinosa-Silva Y, et al. In-hospital mortality from acute myocardial infarction: HIV sero-positive vs. sero-negative individuals. 52nd Interscience Conference on Antimicrobials and Chemotherapy (ICAAC). September 9-12, 2012. San Francisco. Abstract H-228.
2. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506-2512. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763385/?tool=pubmed
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