Abstract 17054: Similar Outcomes for HIV+ and HIV- Patients Within Three Years Following Hospitalization for Acute Coronary Syndrome
Background: HIV+ patients are at higher risk for cardiovascular disease (CVD). However, few studies have examined outcomes following acute coronary syndrome (ACS). In a large integrated health care system, we anticipated similar risk of post-ACS outcomes for HIV+ and HIV- patients, after accounting for CVD risk factors and HIV disease progression.
Methods: We identified all adult HIV+ (n=226) and HIV- (n=86,321) Kaiser Permanente Northern California members with a first known admission for ACS (STEMI, NSTEMI or unstable angina) between 1996-2010. Post-ACS outcomes were all-cause death and recurrent ACS ascertained over 3 years. Crude risks at 3 years by HIV status were assessed by Kaplan-Meier. Adjusted hazard ratios (HR) for HIV status and outcomes were obtained from Cox models with adjustment for age, sex, race, ACS diagnosis year, ACS type, smoking status, and LDL, HDL, and TG levels. We also compared HIV+ patients with higher (≥500 cells/ul) vs. lower CD4 counts with HIV- patients.
Results: HIV+ patients were younger (54.6 vs. 67.4 years), male (94.4% vs. 62.5%), and more likely to have a smoking history (71.5% vs. 55.3%) than HIV- patients. HIV+ were more likely than HIV- patients to be admitted with STEMI (37.0% vs. 26.8%) and less often unstable angina (28.1% vs. 39.1%). HIV+ status was associated with a higher risk of death but not recurrent ACS in adjusted models (Table). Mortality was only elevated for HIV+ patients with lower CD4 compared with HIV- patients (ref), with adjusted HRs of 0.7 (95% CI=0.2-2.1), 2.5 (95% CI=1.6-4.0) and 5.6 (95% CI=3.2-9.7), for CD4≥500, CD4 201-499 and CD4<200, respectively. Recurrent ACS was not elevated in HIV+ patients regardless of CD4, with HRs of 0.8 (95% CI=0.4-1.7), 1.1 (95% CI=0.6-1.8) and 1.3 (95% CI=0.7-2.5), for the same CD4 categories.
Conclusions: HIV+ status was independently associated with a higher risk of death after ACS but not recurrent ACS. However, the excess risk for death was only in HIV+ patients with lower CD4 counts.
- © 2013 by American Heart Association, Inc.