Clinical profile, anatomical features, and long‐term outcome of acute coronary syndromes in human immunodeficiency virus-infected patients

Abstract

Background Long‐term prognosis of acute coronary syndromes (ACS) in HIV‐infected patients is unknown.

Aims We sought to compare outcomes after ACS in HIV‐infected and uninfected patients.

Methods Retrospective observational study. HIV cases were matched with two HIV‐uninfected controls for age, sex, and type of ACS.

Results In 92 HIV patients (mean age 51.3 ± 9.0 years, 7.6% women), the prevalence of cardiovascular risk factors was high (smoking 71.7%; hypertension 41.3%; diabetes 14.1%); dyslipidemia was more frequent (53 (57.6%) vs. 79 (42.9), p = 0.02) and obesity less common (8 (8.7%) vs 41 (22.3%), p = 0.002) than in controls. 87 HIV patients (94.6%) had undetectable viral load and 85 (92.4%) were under antiretroviral therapy. Multivessel disease was more common in HIV patients than in controls (44 (47.8%) vs. 71 (39.1%); p = 0.05) as was Killip class 3–4 on admission (9 (9.8%) vs 6 (3.3%); p = 0.04). The rate of in‐hospital mortality was similar in both groups (2%), and there were no significant differences in 3‐year mortality (10.2% vs. 5.7%; p = 0,27). Non‐cardiovascular readmissions at 3 years were more frequent in HIV patients than in controls (36.5% vs. 7.4%; p < 0.001). Multivariate analysis identified previous coronary artery disease as the strongest predictor of mortality in HIV patients (hazard ratio 4.7, 95% confidence interval 1.4–15.7, p = 0.01), whereas HIV infection was not associated with prognosis.

Conclusion HIV patients with ACS had more frequent multivessel disease and heart failure than matched controls. However, inhospital and long‐term mortality was similar in both groups. Non‐cardiovascular rehospitalizations were more common in HIV patients.