Coronary revascularization for acute myocardial infarction in the HIV population

Vikas Singh, Rodrigo Mendirichaga, Ghanshyambhai T. Savani, Alexis P. Rodriguez, Nitika Dabas, Anish Munagala, Carlos E Alfonso, Mauricio G Cohen, Sammy Elmariah, Igor F. Palacios

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: 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. Background: 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. Methods: 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. Results: 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. Conclusion: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.

Original languageEnglish (US)
Pages (from-to)405-414
Number of pages10
JournalJournal of Interventional Cardiology
Volume30
Issue number5
DOIs
StatePublished - Oct 1 2017

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Percutaneous Coronary Intervention
Myocardial Infarction
HIV
Population
Comorbidity
Propensity Score
Drug-Eluting Stents
Hospitalization
Mortality
Hospital Mortality
Health Care Costs
Stents
Inpatients
Length of Stay
Atherosclerosis
Logistic Models
Metals
Databases
Costs and Cost Analysis
Infection

Keywords

  • acute myocardial infarction
  • human immunodeficiency virus
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Singh, V., Mendirichaga, R., Savani, G. T., Rodriguez, A. P., Dabas, N., Munagala, A., ... Palacios, I. F. (2017). Coronary revascularization for acute myocardial infarction in the HIV population. Journal of Interventional Cardiology, 30(5), 405-414. https://doi.org/10.1111/joic.12433

Coronary revascularization for acute myocardial infarction in the HIV population. / 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.

In: Journal of Interventional Cardiology, Vol. 30, No. 5, 01.10.2017, p. 405-414.

Research output: Contribution to journalArticle

Singh, V, Mendirichaga, R, Savani, GT, Rodriguez, AP, Dabas, N, Munagala, A, Alfonso, CE, Cohen, MG, Elmariah, S & Palacios, IF 2017, 'Coronary revascularization for acute myocardial infarction in the HIV population', Journal of Interventional Cardiology, vol. 30, no. 5, pp. 405-414. https://doi.org/10.1111/joic.12433
Singh V, Mendirichaga R, Savani GT, Rodriguez AP, Dabas N, Munagala A et al. Coronary revascularization for acute myocardial infarction in the HIV population. Journal of Interventional Cardiology. 2017 Oct 1;30(5):405-414. https://doi.org/10.1111/joic.12433
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. / Coronary revascularization for acute myocardial infarction in the HIV population. In: Journal of Interventional Cardiology. 2017 ; Vol. 30, No. 5. pp. 405-414.
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abstract = "Objective: 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. Background: 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. Methods: 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. Results: 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. Conclusion: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.",
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AU - Savani, Ghanshyambhai T.

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AU - Dabas, Nitika

AU - Munagala, Anish

AU - Alfonso, Carlos E

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AU - Palacios, Igor F.

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N2 - Objective: 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. Background: 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. Methods: 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. Results: 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. Conclusion: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.

AB - Objective: 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. Background: 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. Methods: 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. Results: 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. Conclusion: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.

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