Publikation
Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study
Wissenschaftlicher Artikel/Review - 22.02.2015
Carballo David, Calmy Alexandra, Ledergerber Bruno, Keller Pierre-Fréderic, Erne Paul, Fehr Jan, Cusini Alexia, Schmid Patrick, Fasel Dominique, Bernasconi Enos, Clerc Olivier, Hirschel Bernard, Radovanovic Dragona, Bähler Caroline, Carballo Sebastian, Delhumeau Cécile, Swiss HIV Cohort Study and AMIS registry
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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.