Longitudinal management and outcomes of acute coronary syndrome in persons living with HIV infection

Abstract

Aims Persons living with HIV (PLWH) have increased cardiovascular mortality, which may in part be due to differences in the management of acute coronary syndromes (ACS). The purpose of this study was to compare the in-hospital and post-discharge management and outcomes of ACS among persons with and without HIV. Methods and Results This was a retrospective cohort study using data from Symphony Health, a data warehouse. All patients admitted between 1/1/2014–12/31/2016 with ACS were identified by ICD billing codes. Multivariate logistic regression models were used to examine in-hospital, 30-day and 12-month event rates between groups. 1,125,126 individuals were included, 6,612 (0.59%) with HIV. PLWH were younger (57.4 ± 10.5 vs 67.4 ± 12.9 years, p<.0001) and had more medical comorbidities. ACS type did not differ significantly with HIV status. PLWH were less likely to undergo coronary angiography (35.2% vs 37.2%, adjusted OR 0.87, 95% CI 0.83-0.92, p <.0001), and those with both HIV and STEMI underwent fewer drug eluting stents (60.1% vs 68.5%, adjusted OR 0.81, 95% CI 0.68-0.96, p = 0.016). PLWH had higher adjusted rates of inpatient mortality (OR 1.29, 95% CI 1.15-1.44, p <.0001), 30-day readmission (OR 1.18, 95% CI 1.09-1.27, p <.0001) and 12-month mortality (OR 1.32, 95% CI 1.22-1.44, p <.0001). 12 months following discharge, PLWH filled cardiac medications at lower rates. Conclusion In a contemporary cohort of persons hospitalized for ACS, PLWH received less guideline-supported interventional and medical therapies and had worse clinical outcomes. Strategies to optimize care are warranted in this unique population.

Clinical Characteristics and Outcomes Among People Living With HIV Undergoing Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program

“… 12 These and other claims‐based studies have also consistently shown that PLWH are less likely to receive drug‐eluting stents than controls. 14 In contrast, in the present study which includes procedural registry‐based data through 2019, we observed similar rates of PCI, CABG, and medical therapy alone between the HIV and control groups, and found no differences in important PCI procedural metrics such as arterial access site, use of drug‐eluting stents, intravascular imaging, and appropriate P2Y12 antiplatelet therapy. Indeed, our data suggest that contemporary practice on management of obstructive CAD among PLWH has evolved over time and that PLWH undergoing PCI are treated in a similar fashion to the general population.…”

“…Prior studies of clinical outcomes after PCI in PLWH have largely been short‐term (ie, in‐hospital) and confined to the AMI setting. 9 , 10 , 11 , 12 , 13 , 14 Our study expands upon these studies by analyzing the impact of HIV serostatus on longer‐term outcomes at 5 years following PCI in an unselected population with well‐controlled HIV disease and lower risk (less than half with acute coronary syndrome). In a propensity‐weighted PCI cohort balanced for patient and procedural factors, we found that HIV infection was still associated with a 21% increased risk of all‐cause mortality at 5 years.…”

“… 13 A more recent claims‐based analysis of patients presenting with acute coronary syndrome similarly found that PLWH were less likely to undergo coronary angiography, receive drug‐eluting stents, and had a higher in‐hospital and 1‐year mortality than controls. 14 Data about important anatomical and procedural factors, such as vascular access site, antiplatelet therapy, and use of intravascular imaging are not available in these data sets and may significantly influence any findings.…”

Plasma CD16+Extracellular Vesicles Associate with Carotid Artery Intima-Media Thickness in HIV+Adults on Combination Antiretroviral Therapy

“…HIV-infected individuals have a 2-fold-increased risk of cardiovascular disease (CVD) compared with the general population ( 1 , 2 ). Potentially contributing factors include HIV-related risk factors, such as the direct effect of HIV, the proinflammatory impact of residual virus despite combination antiretroviral therapy (cART), potential adverse effects of antiretroviral therapy (ART), and inflammation, and traditional risk factors, such as diabetes mellitus and smoking ( 3 , 4 ).…”

Cardiovascular health among persons with HIV without existing atherosclerotic cardiovascular disease

“…This cross-sectional study used routine electronic health record (EHR) data and included PWH age at least 40 years or older seen at three HIV clinics in an academic tertiary referral hospital and county safety-net hospital in San Francisco between September 1, 2019, and December 15, 2022. HIV was defined by ICD-10 (10th revision of the International Statistical Classification of Diseases) code and at least one recorded viral load (Supplementary Table 1, http://links.lww.com/QAD/C937) [17,18]. We excluded patients with ICD-10 codes for ASCVD.…”