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

DAscenzo, F; Cerratoa, 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; Omede, P; Bonora, S; Gaita, F; Abbate, A; Zoccai, GB

journal article

Title:: 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
Document type:: Article
Author(s):: DAscenzo, F; Cerratoa, 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; Omede, P; Bonora, S; Gaita, F; Abbate, A; Zoccai, GB
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. (C) 2014 Elsevier Ltd. All rights reserved.
Journal title abbreviation:: Thromb Res
Year:: 2014
Journal volume:: 134
Journal issue:: 3
Pages contribution:: 558-564
Language:: eng
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/25064035
Print-ISSN:: 0049-3848
TUM Institution:: I. Medizinische Klinik und Poliklinik (Kardiologie); Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2014

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2014