Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS)
Year: 2019
Type: article
Study design: Observational Study
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.
Source: BMC Medicine
Authors: Matthew J. Feinstein, Robin M. Nance, J. A. Chris Delaney, Susan R. Heckbert, Matthew J. Budoff, Daniel R. Drozd, Greer A. Burkholder, James H. Willig, Michael J. Mugavero, William C. Mathews, Richard D. Moore, Joseph J. Eron, Sonia Napravnik, Peter W. Hunt, Elvin Geng, Priscilla Hsue, Inga Peter, William B. Lober, Kristina Crothers, Carl Grunfeld, Michael S. Saag, Mari M. Kitahata, Donald M. Lloyd-Jones, Heidi M. Crane
Institutions: Northwestern University, University of Washington, University of California, Los Angeles, University of Alabama, University of Alabama at Birmingham, UAB Medicine, University of California San Diego Medical Center, Johns Hopkins University, University of North Carolina at Chapel Hill, University of California, San Francisco, Icahn School of Medicine at Mount Sinai
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,170
Funders: American Heart Association, University of Washington, Johns Hopkins University, National Institutes of Health, University of California, Los Angeles, Center for AIDS Research, University of Washington, National Heart, Lung, and Blood Institute, National Human Genome Research Institute, National Institute of Allergy and Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill
Awards: G1531094742, G1752886923, Mechanistic Epidemiology of Myocardial Disease in HIV: Myocardial Fibrosis and Mechanics, G2127051194, G2213881162, G2814642886, G2970457639, Role of Hematopoietic System and Proteomics in HIV-Associated CardiovascularDisease, G378552126, G3985073149, G4575219416, G5886955022, G5934524914, G6625095162, G7791962275, G867868940, G9000026354, G9000081321, G9000132981, G9000186388, G9000189727, G9000231798, The University of North Carolina Center for AIDS Research, G97119092
OpenAlex ID: W2966741099