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Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of

Matthew J Feinstein1, Robin M Nance2, J A Chris Delaney3

  • 1Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. matthewjfeinstein@northwestern.edu.

BMC Medicine
|August 1, 2019
PubMed

Insights

Mortality after myocardial infarction (MI) is high for people with HIV (PWH). Type 2 MI (T2MI) carries a substantially greater mortality risk than type 1 MI (T1MI) in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Epidemiology

Background:

  • Persons with human immunodeficiency virus (HIV) have elevated risks for myocardial infarction (MI) compared to the general population.
  • Type 2 MI (T2MI), caused by coronary supply-demand mismatch, is more prevalent in persons with HIV (PWH) and associated with higher mortality in the general population.
  • The specific mortality patterns and predictors following T1MI versus T2MI in PWH remain largely unknown.

Purpose of the Study:

  • To investigate and compare mortality rates after T1MI and T2MI in a large cohort of PWH.
  • To identify distinct predictors of mortality following T1MI and T2MI in PWH.
  • To inform clinical management strategies for MI in the context of HIV.

Main Methods:

  • Analysis of incident MIs adjudicated and classified as T1MI or T2MI in 28,186 PWH from the CNICS cohort (1996-2014).
  • Comparison of mortality rates between T1MI and T2MI using Cox survival analyses and Bayesian model averaging.
  • Evaluation of pre-MI covariates associated with mortality for each MI type.

Main Results:

  • Among 596 PWH experiencing MI, T2MI had significantly higher mortality rates (22.2/100 person-years) than T1MI (8.2/100 person-years).
  • 1-, 3-, and 5-year mortality rates for T2MI were 39%, 52%, and 62%, respectively, compared to 15%, 22%, and 30% for T1MI.
  • Predictors of mortality post-T1MI included higher HIV viral load, renal dysfunction, and older age; post-T2MI predictors were low BMI and detectable HIV viral load.

Conclusions:

  • Mortality following MI is substantial in PWH, with T2MI posing a significantly greater risk than T1MI.
  • The distinct predictors for T1MI and T2MI highlight the importance of considering these MI types separately in clinical practice for PWH.
  • Understanding these differences can guide targeted interventions and improve outcomes for PWH experiencing MI.
Abstract

Keywords:
Cardiovascular diseasesComorbidityEpidemiologyHuman immunodeficiency virusMortalityMulticenter studyMyocardial infarction

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