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Comparison of In-Hospital Mortality from Acute Myocardial Infarction in HIV Sero-Positive Versus Sero-Negative Individuals

      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.
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      References

        • Greenlund K.J.
        • Giles W.H.
        • Keenan N.L.
        • Malarcher A.M.
        • Zheng Z.J.
        • Casper M.L.
        • Heath G.W.
        • Croft J.B.
        Heart Disease and Stroke Mortality in the 20th Century.
        Oxford University Press, Oxford, United Kingdom2006
        • Minino A.M.
        • Anderson R.N.
        • Fingerhut L.A.
        • Boudreault M.A.
        • Warner M.
        Deaths: injuries 2002.
        Natl Vital Stat Rep. 2006; 54: 1-124
        • May M.T.
        • Sterne J.A.
        • Costagliola D.
        • Sabin C.A.
        • Phillips A.N.
        • Justice A.C.
        • Dabis F.
        • Gill J.
        • Lundgren J.
        • Hogg R.S.
        • de Wolf F.
        • Fatkenheuer G.
        • Staszewski S.
        • d'Arminio Monforte A.
        • Egger M.
        HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.
        Lancet. 2006; 368: 451-458
        • Smith C.
        Factors associated with specific causes of death amongst HIV-positive individuals in the D:A:D study.
        AIDS. 2010; 24: 1537-1548
        • Joshi V.V.
        • Pawel B.
        • Conner E.
        • Sharer L.
        • Oleske J.M.
        • Morrison S.
        • Marin-Garcia J.
        Arteriopathy in children with acquired immune deficiency syndrome.
        Pediatr Pathol. 1987; 7: 261-275
        • Torre D.
        • Pugliese A.
        Interleukin-18: a proinflammatory cytokine in HIV-1 infection.
        Curr HIV Res. 2006; 4: 423
        • Agency for Healthcare Research and Quality
        Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP).
        Agency for Healthcare Research and Quality, Bethesda, Maryland1997-2006
        • Ani C.
        • Pan D.
        • Martins D.
        • Ovbiagele B.
        Age- and sex-specific in-hospital mortality after myocardial infarction in routine clinical practice.
        Cardiol Res Pract. 2010; 2010: 752-765
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • Gold J.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Quan H.
        • Sundararajan V.
        • Halfon P.
        • Fong A.
        • Burnand B.
        • Luthi J.C.
        • Saunders L.D.
        • Beck C.A.
        • Feasby T.E.
        • Ghali W.A.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • Battegay M.
        • Elzi L.
        Morbidity and mortality in HIV-infected individuals—a shift towards comorbidities.
        Swiss Med Wkly. 2009; 139: 564-570
        • Matetzky S.
        • Domingo M.
        • Kar S.
        • Noc M.
        • Shah P.K.
        • Kaul S.
        • Daar E.
        • Cercek B.
        Acute myocardial infarction in human immunodeficiency virus-infected patients.
        Arch Intern Med. 2003; 163: 457-460
        • Sharma T.S.
        • Messiah S.
        • Fisher S.
        • Miller T.L.
        • Lipshultz S.E.
        Accelerated cardiovascular disease and myocardial infarction risk in patients with the human immunodeficiency virus.
        J Cardiometab Syndr. 2008; 3: 93-97
        • Triant V.A.
        • Lee H.
        • Hadigan C.
        • Grinspoon S.K.
        Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease.
        J Clin Endocrinol Metab. 2007; 92: 2506-2512
        • Boccara F.
        Cardiovascular complications and atherosclerotic manifestations in the HIV-infected population: type, incidence and associated risk factors.
        AIDS. 2008; 22: S19-S26
        • Worm S.W.
        • Sabin C.
        • Weber R.
        • Reiss P.
        • El-Sadr W.
        • Dabis F.
        • De Wit S.
        • Law M.
        • Monforte A.D.
        • Friis-Moller N.
        • Kirk O.
        • Fontas E.
        • Weller I.
        • Phillips A.
        • Lundgren J.
        Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study.
        J Infect Dis. 2010; 201: 318-330
        • Zhou H.
        • Pandak Jr, W.M.
        • Lyall V.
        • Natarajan R.
        • Hylemon P.B.
        HIV protease inhibitors activate the unfolded protein response in macrophages: implication for atherosclerosis and cardiovascular disease.
        Mol Pharmacol. 2005; 68: 690-700
        • Paton P.
        • Tabib A.
        • Loire R.
        • Tete R.
        Coronary artery lesions and human immunodeficiency virus infection.
        Res Virol. 1993; 144: 225-231
        • Guillevin L.
        Vasculitides in the context of HIV infection.
        AIDS. 2008; 22: S27-S33
        • Shahmanesh M.
        • Das S.
        • Stolinski M.
        • Shojaee-Moradie F.
        • Jackson N.C.
        • Jefferson W.
        • Cramb R.
        • Nightingale P.
        • Umpleby A.M.
        Antiretroviral treatment reduces very-low-density lipoprotein and intermediate-density lipoprotein apolipoprotein B fractional catabolic rate in human immunodeficiency virus-infected patients with mild dyslipidemia.
        J Clin Endocrinol Metab. 2005; 90: 755-760
        • Burdo T.H.
        • Lo J.
        • Abbara S.
        • Wei J.
        • DeLelys M.E.
        • Preffer F.
        • Rosenberg E.S.
        • Williams K.C.
        • Grinspoon S.
        Soluble CD163, a novel marker of activated macrophages, is elevated and associated with noncalcified coronary plaque in HIV-infected patients.
        J Infect Dis. 2011; 204: 1227-1236
        • Burkhalter J.E.
        • Springer C.M.
        • Chhabra R.
        • Ostroff J.S.
        • Rapkin B.D.
        Tobacco use and readiness to quit smoking in low-income HIV-infected persons.
        Nicotine Tob Res. 2005; 7: 511
        • Carr A.
        • Samaras K.
        • Thorisdottir A.
        • Kaufmann G.R.
        • Chisholm D.J.
        • Cooper D.A.
        Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study.
        Lancet. 1999; 353: 2093-2099
        • Carey J.W.
        • Mejia R.
        • Bingham T.
        • Ciesielski C.
        • Gelaude D.
        • Herbst J.H.
        • Sinunu M.
        • Sey E.
        • Prachand N.
        • Jenkins R.A.
        • Stall R.
        Drug use, high-risk sex behaviors, and increased risk for recent HIV infection among men who have sex with men in Chicago and Los Angeles.
        AIDS Behav. 2009; 13: 1084-1096
        • Lansky A.J.
        • Hochman J.S.
        • Ward P.A.
        • Mintz G.S.
        • Fabunmi R.
        • Berger P.B.
        • New G.
        • Grines C.L.
        • Pietras C.G.
        • Kern M.J.
        • Ferrell M.
        • Leon M.B.
        • Mehran R.
        • White C.
        • Mieres J.H.
        • Moses J.W.
        • Stone G.W.
        • Jacobs A.K.
        Percutaneous coronary intervention and adjunctive pharmacotherapy in women: a statement for healthcare professionals from the American Heart Association.
        Circulation. 2005; 111: 940-953
        • Masoomi H.
        • Mills S.D.
        • Dolich M.O.
        • Dang P.
        • Carmichael J.C.
        • Nguyen N.T.
        • Stamos M.J.
        Outcomes of laparoscopic and open appendectomy for acute appendicitis in patients with acquired immunodeficiency syndrome.
        Am Surg. 2011; 77: 1372-1376
        • Morrison C.A.
        • Wyatt M.M.
        • Carrick M.M.
        Effects of human immunodeficiency virus status on trauma outcomes: a review of the national trauma database.
        Surg Infect. 2010; 11: 41-47
        • McDavid Harrison K.
        • Ling Q.
        • Song R.
        • Hall H.I.
        County-level socioeconomic status and survival after HIV diagnosis, United States.
        Ann Epidemiol. 2008; 18: 919-927