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Multicenter Study
. 2019 Jul 31;17(1):149.
doi: 10.1186/s12916-019-1385-7.

Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS)

Matthew J Feinstein  1 , Robin M Nance  2 , J A Chris Delaney  3 , Susan R Heckbert  3 , Matthew J Budoff  4 , Daniel R Drozd  2 , Greer A Burkholder  5 , James H Willig  5 , Michael J Mugavero  5 , William C Mathews  6 , Richard D Moore  7 , Joseph J Eron  8 , Sonia Napravnik  8 , Peter W Hunt  9 , Elvin Geng  9 , Priscilla Hsue  9 , Inga Peter  10 , William B Lober  3 , Kristina Crothers  2 , Carl Grunfeld  9 , Michael S Saag  5 , Mari M Kitahata  2 , Donald M Lloyd-Jones  11 , Heidi M Crane  2
Affiliations
Multicenter Study

Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS)

Matthew J Feinstein et al. BMC Med. .

Abstract

Background: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown.

Methods: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI.

Results: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load.

Conclusions: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.

Keywords: Cardiovascular diseases; Comorbidity; Epidemiology; Human immunodeficiency virus; Mortality; Multicenter study; Myocardial infarction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Survival following type 1 and type 2 myocardial infarction among HIV-infected patients
Fig. 2
Fig. 2
Survival following type 1 myocardial infarction, type 2 myocardial infarction due to sepsis, and type 2 myocardial infarction not due to sepsis among HIV-infected patients
See this image and copyright information in PMC

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