Boccara F, Cohen A, Di Angelantonio E, Meuleman C, Ederhy S, Dufaitre G, Odi G, Teiger E, Barbarini G, Barbaro G
Department of Cardiology, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris and Université Paris VI, Paris, France.
Curr HIV Res. 2008 Jan;6(1):59-64. doi: 10.2174/157016208783571900.
Coronary artery disease (CAD) is an emerging complication in HIV-infected patients treated with highly active antiretroviral therapy. Immediate results and long-term outcome after coronary artery bypass graft (CABG) have not been yet evaluated in this population. Between January 1997 and December 2005, we compared baseline characteristics, immediate results and clinical outcome [Major Adverse Cardiac Events (MACE): death for cardiac cause, myocardial infarction (MI), coronary revascularization] at 41 months in 27 consecutive HIV-infected (HIV+) patients and 54 HIV-uninfected (HIV-) controls matched for age and gender (mean age of the cohort, 49+/-8 years; 96% male) who underwent CABG. Cardiovascular risk factors were well-balanced and nearly identical in both groups. In HIV+ group, mean preoperative CD4 was 502+/-192/mm(3) compared with 426.2+/-152.6/mm(3) postoperatively (p=0.004) without clinical manifestations at follow-up. At 30-day, the rate of post-operative death, MI, stroke, mediastinitis, re-intervention was identical in both groups. At follow-up [median: 41-months (range: 34-60)], rate of occurrence of 1(st) MACE was higher in HIV+ group compared with HIV- group (11, 42% versus 13, 25%, p=0.03), mostly due to the need of repeated revascularization using percutaneous coronary intervention of the native coronary arteries but not of the grafts in the HIV+ group [9 (35%) versus 6 (11%), p=0.02]. CABG is a feasible and safe revascularization procedure in HIV+ patients with multivessel CAD. Immediate postoperative outcome was similar compared to controls. However, long-term follow-up was significantly different, due to an increased rate of repeated revascularization procedure in the native coronary arteries of HIV+ patients.
冠状动脉疾病（CAD）是接受高效抗逆转录病毒治疗的HIV感染患者中一种新出现的并发症。冠状动脉旁路移植术（CABG）后的即时结果和长期预后在该人群中尚未得到评估。在1997年1月至2005年12月期间，我们比较了27例连续接受CABG的HIV感染（HIV+）患者和54例年龄和性别匹配的未感染HIV（HIV-）对照者在41个月时的基线特征、即时结果和临床结局[主要不良心脏事件（MACE）：心源性死亡、心肌梗死（MI）、冠状动脉血运重建]。两组的心血管危险因素平衡良好且几乎相同。在HIV+组中，术前平均CD4为502±192/mm³，术后为426.2±152.6/mm³（p=0.004），随访时无临床表现。在30天时，两组术后死亡、MI、中风、纵隔炎、再次干预的发生率相同。在随访[中位数：41个月（范围：34 - 60个月）]时，HIV+组1级MACE的发生率高于HIV-组（分别为11例，42% 对13例，25%，p=0.03），主要是因为HIV+组需要对自身冠状动脉而非移植血管反复进行经皮冠状动脉介入血运重建[9例（35%）对6例（11%），p=0.02]。CABG对于患有多支血管CAD的HIV+患者是一种可行且安全的血运重建手术。术后即时结果与对照组相似。然而，长期随访存在显著差异，因为HIV+患者自身冠状动脉反复血运重建手术的发生率增加。
