Singh Vikas, Mendirichaga Rodrigo, Savani Ghanshyambhai T, Rodriguez Alexis P, Dabas Nitika, Munagala Anish, Alfonso Carlos E, Cohen Mauricio G, Elmariah Sammy, Palacios Igor F
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
J Interv Cardiol. 2017 Oct;30(5):405-414. doi: 10.1111/joic.12433. Epub 2017 Aug 22.
To analyze trends in management and outcomes of patients infected with the human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI) in the United States.
Infection with HIV is an independent risk factor for accelerated atherosclerosis associated with higher rates of AMI. Current trends and outcomes of HIV-infected individuals presenting with AMI in the United States remain unknown.
Using the Healthcare Cost and Utilization Project National Inpatient Sample database we identified HIV-infected individuals who underwent PCI for an AMI from 2002 to 2013. Multivariable logistic regression and propensity-score matching were performed to analyze outcomes.
We identified a total of 59 194 patients of which 7841 underwent PCI during index hospitalization (13.3%). Most patients were men (71%), ≥50 years of age (82%), and white (74%). ST-elevation myocardial infarction was present in 21% of cases. Charlson comorbidity index (CCI) was 5.67 ± 0.4. Predictors of post-procedural complications included female sex, black race, higher CCI, and placement of a bare metal stent, whereas predictors of mortality included occurrence of a complication, ST-elevation myocardial infarction, age ≥70 years, and higher CCI. Conversely, placement of a drug-eluting stent was associated with a reduced risk of complications and mortality. After propensity-score matching, HIV-infected individuals were less likely to undergo PCI and receive a drug-eluting stent, while having longer length of stay, higher hospitalization costs, and higher in-hospital mortality when compared to non-infected individuals.
Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.
分析美国因急性心肌梗死（AMI）接受经皮冠状动脉介入治疗（PCI）的人类免疫缺陷病毒（HIV）感染者的管理趋势和治疗结果。
HIV感染是加速动脉粥样硬化的独立危险因素，与较高的AMI发生率相关。美国HIV感染合并AMI患者的当前趋势和治疗结果尚不清楚。
利用医疗成本与利用项目国家住院患者样本数据库，我们确定了2002年至2013年因AMI接受PCI的HIV感染者。进行多变量逻辑回归和倾向得分匹配以分析治疗结果。
我们共确定了59194例患者，其中7841例在首次住院期间接受了PCI（13.3%）。大多数患者为男性（71%），年龄≥50岁（82%），且为白人（74%）。21%的病例存在ST段抬高型心肌梗死。查尔森合并症指数（CCI）为5.67±0.4。术后并发症的预测因素包括女性、黑人种族、较高的CCI以及裸金属支架置入，而死亡的预测因素包括并发症的发生、ST段抬高型心肌梗死、年龄≥70岁以及较高的CCI。相反，药物洗脱支架置入与并发症和死亡风险降低相关。倾向得分匹配后，与未感染个体相比，HIV感染个体接受PCI和药物洗脱支架的可能性较小，住院时间更长，住院费用更高，院内死亡率更高。
在美国，显著差异继续影响着因AMI接受PCI的HIV感染个体。
