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Coronary revascularization for acute myocardial infarction in the HIV population
Vikas Singh1, Rodrigo Mendirichaga2, Ghanshyambhai T Savani3
1Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
Patients with human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) experienced worse outcomes and disparities in care. Drug-eluting stents improved outcomes, yet HIV-infected individuals were less likely to receive them.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection is a known risk factor for accelerated atherosclerosis and acute myocardial infarction (AMI).
- Limited data exists on current trends and outcomes for HIV-infected individuals experiencing AMI in the United States.
Purpose of the Study:
- To analyze management trends and patient outcomes for individuals with HIV undergoing percutaneous coronary intervention (PCI) for AMI.
- To identify disparities in care and outcomes between HIV-infected and non-infected patients undergoing PCI for AMI.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project National Inpatient Sample database (2002-2013).
- Identified HIV-infected patients undergoing PCI for AMI.
- Employed multivariable logistic regression and propensity-score matching to analyze outcomes.
Main Results:
- Over 59,000 patients were analyzed; 13.3% were HIV-infected.
- HIV-infected patients were older, more likely to be male and white, and had higher comorbidity scores.
- HIV-infected individuals had lower PCI rates, less frequent drug-eluting stent use, longer hospital stays, higher costs, and increased in-hospital mortality compared to non-infected individuals post-propensity matching.
Conclusions:
- Significant disparities in management and outcomes persist for HIV-infected patients undergoing PCI for AMI in the U.S.
- Drug-eluting stents were associated with reduced complications and mortality, but underutilized in the HIV-infected population.
- Further research and interventions are needed to address these disparities.
Objective:
To analyze trends in management and outcomes of patients infected with the human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI) in the United States.
Background:
Infection with HIV is an independent risk factor for accelerated atherosclerosis associated with higher rates of AMI. Current trends and outcomes of HIV-infected individuals presenting with AMI in the United States remain unknown.
Methods:
Using the Healthcare Cost and Utilization Project National Inpatient Sample database we identified HIV-infected individuals who underwent PCI for an AMI from 2002 to 2013. Multivariable logistic regression and propensity-score matching were performed to analyze outcomes.
Results:
We identified a total of 59 194 patients of which 7841 underwent PCI during index hospitalization (13.3%). Most patients were men (71%), ≥50 years of age (82%), and white (74%). ST-elevation myocardial infarction was present in 21% of cases. Charlson comorbidity index (CCI) was 5.67 ± 0.4. Predictors of post-procedural complications included female sex, black race, higher CCI, and placement of a bare metal stent, whereas predictors of mortality included occurrence of a complication, ST-elevation myocardial infarction, age ≥70 years, and higher CCI. Conversely, placement of a drug-eluting stent was associated with a reduced risk of complications and mortality. After propensity-score matching, HIV-infected individuals were less likely to undergo PCI and receive a drug-eluting stent, while having longer length of stay, higher hospitalization costs, and higher in-hospital mortality when compared to non-infected individuals.
Conclusion:
Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.
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