Iskhakov David, Deleger Julie N, Plutzky Jorge, Triant Virginia A, Hyle Emily P
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Curr Cardiol Rep. 2025 Apr 14;27(1):84. doi: 10.1007/s11886-024-02186-4.
Over the past twenty-five years, a growing body of research has investigated outcomes after an acute coronary syndrome (ACS) event in persons with HIV (PWH). In this scoping review, we assessed the published literature on outcomes after a prior ACS event in PWH compared to persons without HIV (PWoH) in the US and Europe.
Of 27 studies of secondary prevention of cardiovascular disease, 15 studies found a greater incidence of recurrent ACS, heart failure, in-stent thrombosis, revascularization, restenosis, and mortality in PWH after a prior ACS event compared to PWoH. PWH were more likely to present with STEMI, less likely to receive percutaneous coronary intervention, and more likely to exhibit an active inflammatory state. The remaining 12 studies found no significant difference in outcomes after a prior ACS event. PWH may face an increased risk of adverse outcomes after ACS that differ in presentation and management compared with PWoH. Larger observational studies are needed to assess outcomes after a prior ACS event in PWH compared to PWoH and improve clinical management.
在过去二十五年中，越来越多的研究对感染人类免疫缺陷病毒（HIV）的患者（PWH）发生急性冠状动脉综合征（ACS）事件后的结局进行了调查。在本范围综述中，我们评估了美国和欧洲已发表的关于PWH与未感染HIV的人（PWoH）相比，既往ACS事件后结局的文献。
在27项心血管疾病二级预防研究中，15项研究发现，与PWoH相比，PWH在既往ACS事件后发生复发性ACS、心力衰竭、支架内血栓形成、血运重建、再狭窄和死亡的发生率更高。PWH更易出现ST段抬高型心肌梗死（STEMI），接受经皮冠状动脉介入治疗的可能性较小，且更易表现出活跃的炎症状态。其余12项研究发现既往ACS事件后的结局无显著差异。与PWoH相比，PWH在ACS后可能面临不良结局风险增加，且在表现和管理方面存在差异。需要开展更大规模的观察性研究，以评估PWH与PWoH相比既往ACS事件后的结局，并改善临床管理。
