Abstract 15792: HIV-Infected Patients Have an Increased Risk of Recurrent Ischemic Events as Compared to the General Population After an Acute Coronary Syndrome
Purpose: The PACS-HIV study was designed to determine the 3-year prognosis of acute coronary syndrome (ACS) in HIV-infected patients (HIV+) as compared to HIV-uninfected patients (HIV-) in a prospective observational study. We report the long term 3-year follow-up.
Methods: We enrolled consecutively 103 HIV-infected and 195 HIV-uninfected patients with a first episode of ACS 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. Secondary endpoints included the rate of heart failure (HF) defined as congestive heart requiring hospitalization and peripheral vascular disease (PVD) defined as any revascularization or amputation due to ischemia. Stratified univariate and multivariate Cox models were performed for evaluating the hazard ratio for the occurrence of events.
Results: The mean age at enrolment was 49.0 ± 9.4 years and 94% were men. At 3-year follow up, MACCE (Table) was not different between HIV+ and HIV- groups, however, recurrence of ACS was more frequent in HIV+ (univariate HR 3.4; 95% CI [1.3-8.8]) as HF (6 (5.9%) vs 3 (1.6%), univariate HR 6.2; 95% CI [1.2-31.3]). Stratified multivariable Cox model showed that HIV infection, total cholesterol and LDLc were the only predictors (time-dependent covariates) associated with the recurrence of ischemic events (HR 5.35; 95% CI 1.04-27.42, p= 0.044; HR 6.8; 95% CI 0.98-47.42, p= 0.053; HR 13.39; 95% CI 1.18-151.67, p= 0.036; respectively).
Conclusions: At long-term follow-up, HIV-infected patients had a higher rate of ACS recurrence as compared to HIV-uninfected patients. HIV infection is an independent predictor of recurrent ischemic events. Table. Major and minor Adverse Cardiac and Cerebral Events at 36-Month Follow-up. *CI : Confidence interval, Values expressed as n (%), †Kaplan-Meier estimates
- © 2011 by American Heart Association, Inc.