TY - JOUR
T1 - Mortality following myocardial infarction among HIV-infected persons
T2 - The Center for AIDS Research Network of Integrated Clinical Systems (CNICS)
AU - Feinstein, Matthew J.
AU - Nance, Robin M.
AU - Delaney, J. A.Chris
AU - Heckbert, Susan R.
AU - Budoff, Matthew J.
AU - Drozd, Daniel R.
AU - Burkholder, Greer A.
AU - Willig, James H.
AU - Mugavero, Michael J.
AU - Mathews, William C.
AU - Moore, Richard D.
AU - Eron, Joseph J.
AU - Napravnik, Sonia
AU - Hunt, Peter W.
AU - Geng, Elvin
AU - Hsue, Priscilla
AU - Peter, Inga
AU - Lober, William B.
AU - Crothers, Kristina
AU - Grunfeld, Carl
AU - Saag, Michael S.
AU - Kitahata, Mari M.
AU - Lloyd-Jones, Donald M.
AU - Crane, Heidi M.
N1 - Funding Information:
This work was supported by several grants from the National Institutes of Health [R24 AI067039, R24S AI067039, R01 HL126538, P30 AI027757, P30AI117943] and the American Heart Association [16FTF31200010 to M.J.F].
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/7/31
Y1 - 2019/7/31
N2 - Background: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. Methods: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. Results: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. Conclusions: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.
AB - Background: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. Methods: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. Results: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. Conclusions: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.
KW - Cardiovascular diseases
KW - Comorbidity
KW - Epidemiology
KW - Human immunodeficiency virus
KW - Mortality
KW - Multicenter study
KW - Myocardial infarction
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U2 - 10.1186/s12916-019-1385-7
DO - 10.1186/s12916-019-1385-7
M3 - Article
C2 - 31362721
AN - SCOPUS:85070839809
SN - 1741-7015
VL - 17
JO - BMC medicine
JF - BMC medicine
IS - 1
M1 - 149
ER -