Department of Internal Medicine, Loma Linda University, California, USA.
Am J Cardiol. 2012 Oct 15;110(8):1078-84. doi: 10.1016/j.amjcard.2012.05.045. Epub 2012 Jul 3.
Few studies have explored hospitalization outcome differences between patients who are seropositive for human immunodeficiency virus (HIV) compared to HIV-seronegative patients with acute myocardial infarctions (AMIs). The aim of this study was to explore in-hospital AMI mortality risk in seropositive and seronegative patients. A secondary analysis of the Nationwide Inpatient Sample from 1997 to 2006 was conducted. This sample allows the approximation of all United States hospitalizations. All AMI encounters with and without co-occurring HIV were identified using appropriate International Classification of Diseases and procedure codes. Descriptive and Cox proportional-hazards analyses were then conducted to estimate mortality differences between seropositive and seronegative patients while adjusting for demographic, clinical, hospital, and care factors. The results demonstrated higher AMI hospitalization mortality hazard in seropositive compared to seronegative patients after adjustment for age, gender, ethnicity, medical co-morbidities, hospital type, and number of in-hospital procedures (HR 1.38, 95% confidence interval 1.01 to 1.87, p = 0.04). Stratified analysis demonstrated greater although not statistically significant mortality hazard for non-ST-segment elevation myocardial infarction and ST-segment elevation myocardial infarction in seropositive compared to seronegative patients. Typical AMI care procedures occurred at significantly lower rates in seropositive versus seronegative patients, including thrombolytic and anticoagulant agents (18% vs 22%), coronary arteriography (48% vs 63%), left cardiac catheterization (52% vs 66%), and coronary artery bypass graft (6% vs 14%). In conclusion, additional mortality burden and lower procedure rates occur for HIV-seropositive patients receiving AMI care. Health care providers should be alert to the increased mortality burden when treating seropositive patients with AMI.
很少有研究探讨过人类免疫缺陷病毒（HIV）阳性患者与急性心肌梗死（AMI）HIV 血清阴性患者住院结局的差异。本研究旨在探讨 HIV 血清阳性和血清阴性患者住院期间 AMI 死亡风险。对 1997 年至 2006 年全国住院患者样本进行了二次分析。该样本可近似所有美国住院患者。使用适当的国际疾病分类和手术代码识别所有 AMI 伴或不伴 HIV 共存的病例。然后进行描述性和 Cox 比例风险分析，以估计在调整人口统计学、临床、医院和护理因素后，HIV 血清阳性和血清阴性患者之间的死亡率差异。结果表明，在调整年龄、性别、种族、合并症、医院类型和住院期间的操作数量后，HIV 血清阳性患者的 AMI 住院死亡率比血清阴性患者高（HR 1.38，95%置信区间 1.01-1.87，p=0.04）。分层分析显示，在非 ST 段抬高型心肌梗死和 ST 段抬高型心肌梗死患者中，HIV 血清阳性患者的死亡率虽然没有统计学意义，但更高。与 HIV 血清阴性患者相比，HIV 血清阳性患者接受典型的 AMI 护理的操作率显著较低，包括溶栓和抗凝药物（18%对 22%）、冠状动脉造影（48%对 63%）、左心导管检查（52%对 66%）和冠状动脉旁路移植术（6%对 14%）。总之，HIV 血清阳性患者接受 AMI 治疗时，死亡率增加，且操作率较低。当治疗 HIV 血清阳性的 AMI 患者时，医疗保健提供者应注意到死亡率增加的风险。
