012 Acute coronary syndrome in HIV-infected patients: characteristics and prognosis

Abstract

Natural history and prognosis of ACS in HIV-infected patients remain to be determined. The aim of our study was to compare coronary risk factors, angiographic features, acute results of PCI, in-hospital outcomes, and prespecified 1and 3-year prognosis of HIV-infected and HIV-uninfected patients with ACS. HIV-infected and HIV-uninfected patients with a first episode of ACS were matched for age (± 5 years), sex, and type of ACS. The primary endpoint was the rate of major adverse cardiac and cerebral events (MACCE), comprising cardiac death, recurrent ACS, recurrent coronary revascularization, and stroke. Overall 103 HIV-infected and 195 HIV-uninfected patients were enrolled (mean age 49.0 ± 9.4 years, 94% men). Coronary risk factors were well balanced, but HIV-infected patients more frequently used illicit drugs (23% vs 6%, P = 0.001) and had higher triglyceride level (246 ± 189 vs 170 ± 139 mg/dl, P = 0.002) compared with HIV-uninfected patients. Angiographic features of CAD was similar (multivessel disease 41% vs 39%, p = 0.96; ACC/AHA type culprit lesion ≥ B2, both 77%, P = 0.83). At 1 year, the rate of occurrence of first MACCE did not differ between groups (hazard ratio [HR:] 1.4; 95% CI: 0.6 to 3.0). Recurrent ACS was more frequent in HIV-infected patients (HR: 4.6; 95% CI: 1.4 to 15.0) with no difference in the rate of clinical restenosis. These results suggest that acute management of ACS in HIV-infected patients can routinely be the same as that of HIV-uninfected patients but that specific secondary prevention measures are needed to alleviate this increased risk of recurrent ACS. The 3-year follow up will be obtained and analyzed before the end of 2010.