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Review
. 2012 Apr;33(7):875-80.
doi: 10.1093/eurheartj/ehr456. Epub 2011 Dec 20.

Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy

Fabrizio D'Ascenzo  1 , Enrico Cerrato, Giuseppe Biondi-Zoccai, Claudio Moretti, Pierluigi Omedè, Filippo Sciuto, Mario Bollati, Maria Grazia Modena, Fiorenzo Gaita, Imad Sheiban
Affiliations
Review

Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy

Fabrizio D'Ascenzo et al. Eur Heart J. 2012 Apr.

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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Figures

Figure 1
Figure 1
Review profile.
Figure 2
Figure 2
In-hospital and long-term outcomes. *Up to 30 days. **Follow-up of 25.50 (11.25, 42 months, 95% CI).
See this image and copyright information in PMC

Comment in

References

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