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D'Ascenzo F, Cerrato E, Appleton D, Moretti C, Calcagno A, Abouzaki N, Vetrovec G, Lhermusier T, Carrie D, Das Neves B, Escaned J, Cassese S, Kastrati A, Chinaglia A, Belli R, Capodanno D, Tamburino C, Santilli F, Parodi G, Vachiat A, Manga P, Vignali L, Mancone M, Sardella G, Fedele F, DiNicolantonio JJ, Omedè P, Bonora S, Gaita F, Abbate A, Zoccai GB. Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States. Thromb Res 2014; 134:558-64. [PMID: 25064035 DOI: 10.1016/j.thromres.2014.05.037] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 02/08/2023]
Abstract
AIMS Limited data are available on prognostic indicators for HIV patients presenting with ACS. METHODS AND RESULTS Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]). CONCLUSIONS HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Enrico Cerrato
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy; Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | | | | | | | - Didier Carrie
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | | | - Javier Escaned
- Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Alessandra Chinaglia
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Riccardo Belli
- Division of Cardiology, Maria VittoriaHospital, Turin, Italy
| | | | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy
| | - Francesca Santilli
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy
| | - Guido Parodi
- Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy; Division of Cardiology, Careggi Hospital, Florence, Italy
| | - Ahmed Vachiat
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Pravin Manga
- University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology
| | - Luigi Vignali
- Department of Cardiology, University of Parma, Italy
| | - Massimo Mancone
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Gennaro Sardella
- Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy
| | - Francesco Fedele
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | - Stefano Bonora
- Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy
| | | | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
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Lorgis L, Cottenet J, Molins G, Benzenine E, Zeller M, Aube H, Touzery C, Hamblin J, Gudjoncik A, Cottin Y, Quantin C. Outcomes After Acute Myocardial Infarction in HIV-Infected Patients. Circulation 2013; 127:1767-74. [DOI: 10.1161/circulationaha.113.001874] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
We aimed to assess in-hospital case fatality and 1-year prognosis in HIV-infected patients with acute myocardial infarction.
Methods and Results—
From the PMSI (Program de Medicalisation des Systèmes d’informatique) database, data from 277 303 consecutive acute myocardial infarction patients hospitalized from January 1, 2005, to December 31, 2009, were analyzed. Surviving patients were followed up for 1 year after discharge. HIV-infected patients were compared with uninfected patients. Among the cohort, HIV-infected patients (n=608) accounted for 0.22%. All-cause hospital and 1-year mortality rates were lower in the HIV-infected group than in uninfected patients (3.1% versus 8.1% [
P
<0.001] and 1.4% versus 5.5% [
P
<0.001], respectively). From the database, we then analyzed a cohort derived from a matching procedure, with 1 HIV patient matched with 2 patients without HIV, based on age and sex (n=1824). Ischemic cardiomyopathy was more frequent in the HIV group (7.6% versus 4.2%,
P
=0.003). Hospitalization and 1-year mortality rates were similar in the 2 groups (3.1% versus 2.1% [
P
=0.168] and 1.4% versus 1.7% [
P
=0.642], respectively). However, at 12 months, hospitalizations for episodes of heart failure were significantly more frequent in HIV-infected than in uninfected patients (3.3% versus 1.4%, respectively;
P
=0.020). HIV infection, diabetes mellitus, history of ischemic cardiomyopathy, and undergoing percutaneous coronary intervention were associated in univariate analysis with occurrence of heart failure. By multivariable analysis, HIV infection (odds ratio 2.82, 95% confidence interval 1.32–6.01), diabetes mellitus, and undergoing percutaneous coronary intervention remained independent predictors of heart failure.
Conclusions—
The present study demonstrates that after acute myocardial infarction, HIV status influences long-term risk, although the short-term risk in HIV patients is comparable to that in uninfected patients.
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Affiliation(s)
- Luc Lorgis
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Jonathan Cottenet
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Guillaume Molins
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Eric Benzenine
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Marianne Zeller
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Hervé Aube
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Claude Touzery
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Joelle Hamblin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Aurélie Gudjoncik
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Yves Cottin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
| | - Catherine Quantin
- From the Department of Cardiology (L.L., G.M., C.T., J.H., A.G., Y.C.) and Division of Medical Informatics (J.C., E.B., H.A., C.Q.), University Hospital, Dijon, France; and Laboratory of Cardiometabolic Physiopathology and Pharmacology, INSERM U866, University of Burgundy, Dijon, France (L.L., M.Z., A.G., Y.C.)
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D'Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omedè P, Sciuto F, Bollati M, Modena MG, Gaita F, Sheiban I. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J 2011; 33:875-80. [PMID: 22187508 DOI: 10.1093/eurheartj/ehr456] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. METHODS AND RESULTS MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). CONCLUSION Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy.
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Barros ZM, de Alencar Ximenes RA, Miranda-Filho DB, de Albuquerque MDFPM, Melo HRL, Carvalho EH, Gelenske T, Diniz G, Bandeira F. Comparison between the Framingham and prospective cardiovascular of Münster scores for risk assessment of coronary heart disease in human immunodeficiency virus-positive patients in Pernambuco, Brazil. Metab Syndr Relat Disord 2010; 8:489-97. [PMID: 20973693 DOI: 10.1089/met.2009.0100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Framingham score is used in most studies on human immunodeficiency virus (HIV)-positive patients to estimate the risk for coronary heart disease; however, it may have some limitations for detecting risk among these individuals. OBJECTIVE The aim of this study was to evaluate the agreement between the Framingham and Prospective Cardiovascular of Münster (PROCAM) scores among HIV-positive individuals and to investigate the factors associated with disagreement between the two scores. METHOD A cross-sectional study was conducted in a population of HIV/acquired immunodeficiency syndrome (AIDS) patients attending the outpatient's clinics of two reference centers for HIV/AIDS in Pernambuco, Brazil. Agreement between the Framingham and PROCAM scores was evaluated using the kappa index. From this analysis, a variable called "disagreement between scores" was created, and univariate and multivariate analysis were performed to investigate the factors associated with this variable. RESULTS The prevalence of low, moderate, and high risk were, respectively, 78.7%, 13.5%, and 7.8% by Framingham score and 88.5%, 4.3%, and 7.2% by PROCAM (kappa = 0.64, P ≤ 0.0001). Agreement in the subgroup with metabolic syndrome by the International Diabetes Federation (IDF) (kappa = 0.51, P ≤ 0.0001) and the National Cholesterol Education Program (NCEP) (kappa = 0.59, P ≤ 0.0001) criteria was moderate. The Framingham score identified greater proportion of women with moderate risk. Factors independently associated with disagreement were: smoking, sex, age, low-density lipoprotein cholesterol, diastolic blood pressure, and metabolic syndrome. CONCLUSION There was a good agreement between the Framingham and PROCAM scores in HIV-positive patients, but a higher proportion of moderate-high risk was identified by the Framingham score. This disagreement should be evaluated in cohort studies to observe clinical outcomes over the course of time.
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Affiliation(s)
- Zoraya Medeiros Barros
- Departamento de Medicina Clínica, Universidade de Pernambuco, Recife, Pernambuco, Brazil.
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