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HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction
Aiham Albaeni1, Che Harris, Shaker M Eid
1aDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland bDepartment of Medicine, WellSpan York Hospital, York, Pennsylvania, USA.
Insights
HIV-positive patients with ST-segment elevation myocardial infarctions (STEMIs) are as likely to receive percutaneous coronary intervention (PCI) but less likely to get drug-eluting stents (DES) and more likely to receive bare-metal stents (BMS). This highlights a gap in optimal stent selection for this population.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Drug-eluting stents (DES) are superior to bare-metal stents (BMS) in reducing revascularization after percutaneous coronary intervention (PCI).
- Limited data exists on stent utilization in HIV-positive patients experiencing ST-elevation myocardial infarctions (STEMIs).
Purpose of the Study:
- To investigate stent type utilization in HIV-positive versus HIV-negative patients with STEMI.
- To analyze temporal trends in percutaneous coronary intervention (PCI), DES, and BMS use based on HIV status.
Main Methods:
- Analysis of the 2003-2013 National Inpatient Sample database.
- Inclusion of adult patients (≥18 years) presenting with STEMI.
- Comparative evaluation of stent types (DES vs. BMS) and PCI rates between HIV-positive and HIV-negative cohorts.
Main Results:
- HIV-positive patients (0.3% of STEMI cohort) had similar PCI rates compared to HIV-negative patients.
- HIV-positive patients were less likely to receive DES (AOR: 0.83) and more likely to receive BMS (AOR: 1.26).
- While PCI rates increased for both groups, significant shifts towards DES and away from BMS were observed only in HIV-negative patients.
Conclusions:
- Despite similar PCI rates, HIV-positive STEMI patients received less DES and more BMS over an 11-year period.
- Practice patterns for stent selection did not significantly evolve for HIV-positive patients.
- Further attention to optimal stent selection for all STEMI patients, including those with HIV, is warranted.
Background:
Drug-eluting stents (DES) outperform bare-metal stents (BMS) in reducing target vessel revascularization following a percutaneous coronary intervention (PCI). Little is known about the types of stents placed in HIV-positive patients presenting with ST-segment elevation myocardial infarctions (STEMIs).
Methods:
We used the 2003-2013 National Inpatient Sample to identify adults of 18 years or older presenting with STEMI. We evaluated differences in stent type placed following STEMIs on the basis of HIV status. Temporal trends in the use of PCI, DES, and BMS were studied on the basis of HIV status.
Results:
Of 1 695 947 patients with STEMI, 5887 (0.3%) were HIV-positive patients. Following STEMIs, HIV-positive patients were equally likely to have PCI compared with HIV-negative patients [adjusted odds ratio (AOR): 1.04, 95% confidence interval (CI): 0.89-1.21, P=0.63]. However, HIV-positive patients were less likely to have DES (AOR: 0.83, 95% CI: 0.73-0.94, P=0.003) and more likely to have BMS (AOR: 1.26, 95% CI: 1.11-1.45, P=0.001). Over the 11-year period observed, there were increases in PCI following STEMIs in both HIV-positive and HIV-negative patients (all Ptrend<0.001). There were significant increases in the use of DES in HIV-negative patients [adjusted odds ratio (AOR) per year: 1.07, 95% CI: 1.06-1.09, Ptrend<0.001] and significant decreases in the use of BMS (AOR per year: 0.93, 95% CI: 0.92-0.94, Ptrend<0.001). Significant trends showing changed practice patterns in the use of DES and BMS among HIV-positive patients were not observed.
Conclusion:
Over a decade, there were significant increases in the use of PCI following STEMIs in both HIV-negative and HIV-positive patients. Although HIV-positive patients presenting with STEMIs were as likely as HIV-negative patients to undergo PCI, they were less likely to be treated with DES and more likely to receive BMS. Highlighting these observations will hopefully bring renewed attention to best practices for all STEMI patients.
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