P5420HIV and acute coronary syndromes: a 10-year analysis from a single centre prospective registry

Background: Human immunodeficiency virus (HIV) infection and associated anti-retroviral therapy are accepted risk factors for coronary atherosclerosis and major cardiovascular (CV) events. We sought to characterize the risk profile and outcomes of an HIV population presenting with acute coronary syndromes (ACS). Methods: Single-centre retrospective study of 5071 consecutive patients admitted to a tertiary high-volume centre with a diagnosis of ACS between February 2006 and October 2017. HIV status was defined as known follow-up in our institution or referring hospitals' HIV outpatient clinic. Traditional CV risk factors were collected from the institution's prospective registry. ROC curve analysis and c-statistics were obtained to discriminate the occurrence of CV mortality and a composite of CV mortality, stroke and myocardial infarction (MACCE) according to HIV status. Results: In the whole ACS population, 27 (0.5%) patients had previously known and treated HIV infection. In these patients, the most frequent presentation was STEMI (n=18) and all underwent revascularization (23 PCI, 4 CABG). In-hospital mortality was 7.4% (2 patients, 1 CV death) and in a mean follow up of 3.1±2.9 years 8.0% (n=2) died from CV causes. When compared to the non-HIV patients, HIV-patients were younger, more frequently male, had increase prevalence of hyperlipidaemia or tobacco use and presented more frequently with STEMI (Table). Lower last CD4 count [c-statistic 0.884 (CI 95% 0.726–1.00); c-statistic 0.672 (CI 95% 0.421–0.923)], lower nadir CD4 count [c-statistic 0.841 (CI 95% 0.688–0.994); c-statistic 0.715 (CI 95% 0.432–0.938)], higher last viral copy count [c-statistic 0.952 (CI 95% 0.861–1.00); c-statistic 0.673 (CI 95% 0.430–0.916)] and lower duration of HIV-infection [c-statistic 0.855 (CI 95% 0.635–1.00); c-statistic 0.791 (CI 95% 0.614.0.967)] were significantly associated with increased CV mortality and MACCE, respectively. GRACE score did not differ significantly among survivors vs. non-survivor or in those with MACCE vs. without MACCE (p=0.689, p=0.386).