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Post-Myocardial Infarction Survival in HIV-Positive Patients

By Satyajit Das

May/June 2013

Several posters also looked at clinical responses in HIV-positive people who experienced myocardial infarction (MI).

The D:A:D study reported dramatic improvements in short-term mortality outcomes post-MI over time in this important HIV cardiovascular study, that appeared to be related to a higher use of invasive CVD procedures (ICP).1

The study included 844 people with an MI, 84% of who were on ART and 61% had viral load <50 copies/mL. This group was 91% male, median age 50, median CD4 count 444 cells/mm3 (IQR 297, 666) and 66 (8%) had had a prior MI.

Over a median follow-up of 33 months, 88 (10%) patients experienced a further MI, and 281 (33%) patients died. There were 172 deaths during the first month after the MI (short-term mortality rate: 20.4%). At least one ICP in the first month was used by 419 patients (60% of those surviving >1 day) (31 bypass, 402 angioplasty, 1 carotid endarterectomy).

Over time, mortality rates in the first month dropped from 26.4% in 1999-2002 to 8.2% in 2009-2011 with use of early ICP increasing from 43% to 73% in the earlier vs later periods respectively.

A U.S. study concerned that HIV-positive people might have poorer access to the emergency services that are essential in ensuring rapid responses to MIs reported similarly positive outcomes irrespective of HIV status, though the numbers of HV positive patients was relatively low.2

In this registry 30/646 patients (4.5%) were HIV positive, with HIV-positive patients being younger (50 vs. 62 years,p<0.01), significantly more likely to use illegal drugs (43% vs 13%,p<0.01) and with a trend towards fewer traditional cardiovascular risk factors (hypertension, 34% vs 53%,p= 0.06 and dyslipidaemia, 14% vs. 30%,p= 0.09).

There were no differences in the rates of angioplasty, stent placement or in-hospital mortality between the two groups and after multivariate adjustment, HIV-positive patients were significantly more likely to use emergency services (OR 3.03, 95% CI: 1.16-7.88).

A second multivariate analysis from the VACS study reported that HIV-positive people had higher rates of heart failure compared to HIV-negative patients, and that this resulted in significantly higher hazard ratios, there was no difference in outcomes related to whether ejection fraction was preserved or reduced.3


Comment

The improved immediate survival over time after MI in HIV patients is helpful and encouraging for both health workers and HIV-positive patients.


References

Unless stated otherwise, all references are to the Programme and Abstracts of the 20th Conference on Retroviruses and Opportunistic Infections, 3-6 March 2013, Altanta, GA.

  1. Sabin C et al. Improvements in short-term mortality following myocardial infarction: the Data Collection on Adverse events of Anti-HIV Drugs Study. 20th CROI, 2013, Atlanta. Poster abstract 748.
  2. Cruz MD et al. Emergency medical service utilization and reperfusion times among HIV+ individuals presenting with ST-elevation myocardial infarction. 20th CROI, 2013, Atlanta. Poster abstract 751.
  3. Freiberg M et al. The risk of and survival with preserved vs reduced ejection fraction heart failure by HIV status. 20th CROI, 2013, Atlanta. Poster abstract 750.

Links to other websites are current at date of posting but not maintained.

Satyajit Das is with University Hospital Coventry.




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