Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States.

Abstract

AIMS:

Limited data are available on prognostic indicators for HIV patients presenting with ACS.

METHODS AND RESULTS:

Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 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% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]).

CONCLUSIONS:

HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.

• Authors: Fabrizio D'Ascenzo, Enrico Cerrato, Darryn Appleton, Claudio Moretti, Andrea Calcagno, Nayef Abouzaki, George Vetrovec, Thibault Lhermusier, Didier Carrie, Barbara Das Neves, Javier Escaned, Salvatore Cassese, Adnan Kastrati, Alessandra Chinaglia, Riccardo Belli, Davide Capodanno, Corrado Tamburino, Francesca Santilli, Guido Parodi, Ahmed Vachiat, Pravin Manga, Luigi Vignali, Massimo Mancone, Gennaro Sardella, Francesco Fedele, James J DiNicolantonio, Pierluigi Omedè, Stefano Bonora, Fiorenzo Gaita, Antonio Abbate, Giuseppe Biondi Zoccai, Percutaneous coronary intervention and surgical revascularization in HIV Database (PHD) Study Investigators
• Journal: Thrombosis research (Thromb Res) Vol. 134 Issue 3 Pg. 558-64 (Sep 2014) ISSN: 1879-2472 [Electronic] United States
• PMID: 25064035 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.

Chemical References

• Reverse Transcriptase Inhibitors

Topics

• Acute Coronary Syndrome (diagnosis, etiology, mortality, therapy)
• Adult
• Aged
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• Cause of Death
• Europe
• Female
• HIV Infections (complications, diagnosis, drug therapy, mortality)
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (etiology, mortality)
• Percutaneous Coronary Intervention
• Proportional Hazards Models
• Recurrence
• Registries
• Retrospective Studies
• Reverse Transcriptase Inhibitors (therapeutic use)
• Risk Factors
• South Africa
• Thrombosis (diagnosis, etiology, mortality, therapy)
• Time Factors
• Treatment Outcome
• United States