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Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested
David Carballo1, Cécile Delhumeau2, Sebastian Carballo3
1Department of Cardiology, University Hospital, Geneva, Switzerland.
Insights
HIV infection significantly increases mortality risk after myocardial infarction (MI). This study found a 4.42-fold higher risk of death within one year for HIV-positive patients post-MI compared to HIV-negative individuals.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Coronary artery disease (CAD) outcomes in HIV-positive individuals are not fully understood.
- Previous studies suggest potential links between HIV and cardiovascular events.
Purpose of the Study:
- To investigate if HIV infection is an independent risk factor for adverse outcomes following acute myocardial infarction (AMI).
- To compare one-year all-cause mortality, recurrent AMI, and cardiovascular hospitalizations between HIV-positive and HIV-negative patients.
Main Methods:
- A comparative analysis of two Swiss cohorts: the Acute Myocardial Infarction in Switzerland (AMIS) registry and the Swiss HIV Cohort Study (SHCS).
- Inclusion of patients surviving incident AMI from January 2005 onwards.
- Primary endpoint: one-year all-cause mortality. Secondary endpoints: AMI recurrence and cardiovascular hospitalizations. Statistical analysis using Cox and logistic regression.
Main Results:
- 133 HIV-positive and 5,328 HIV-negative patients with incident AMI were analyzed.
- HIV-positive patients were younger (median 51 vs. 64 years) and predominantly male.
- Adjusted analysis revealed a significantly higher one-year all-cause mortality risk for HIV-positive individuals (HR 4.42, 95% CI 1.73-11.27). No significant differences in AMI recurrence or hospitalization rates were observed.
Conclusions:
- HIV infection is independently associated with a substantially increased risk of all-cause mortality one year after an acute myocardial infarction.
- While not increasing recurrence or hospitalization, HIV status poses a significant mortality risk post-AMI.
Aims:
HIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease.
Methods:
We compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively.
Results:
There were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46-57) and 64 years (IQR 55-74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]).
Conclusions:
HIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.
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