title: Acute myocardial infarction in human immunodeficiency virus-infected patients.
abstract: BACKGROUND
  Patients infected with human immunodeficiency virus (HIV) are at an increased risk for premature coronary artery disease. However, the clinical outcome of HIV-infected patients who have had an acute myocardial infarction (AMI) is unknown.
  
  
  METHODS
  We studied 24 consecutive HIV-infected patients admitted because of AMI. During the hospital phase, the patients were examined for recurrent ischemia, congestive heart failure, arrhythmia, and death. Patients were followed up for an average of 15 months after discharge for reinfarction; recurrent angina; the need for any angioplasty, bypass surgery, or target vessel revascularization for restenosis and stent thrombosis; HIV-related complications; and death. For comparison, we included a matched control group of non-HIV-infected patients.
  
  
  RESULTS
  The HIV-infected patients with AMI were predominantly male (21 [88%]), 47 +/- 9 years of age. Twenty-two (92%) were receiving antiretroviral treatment; 17 (71%), protease inhibitors; and 13 (54%), lipid-lowering therapy. With aggressive therapy, the lipid profile was similar in HIV-infected patients treated with protease inhibitors and those who were not. Twenty-one (88%) of 24 patients underwent immediate angiography and 20 (83%) had angioplasty or bypass surgery. The HIV-infected patients with AMI had a benign in-hospital course, with no deaths or reinfarction. The admission characteristics, treatment strategy, and in-hospital outcome were similar in the matched uninfected patients with AMI. After discharge, HIV-infected patients had a higher incidence of reinfarction (4/20 [20%] vs 2/45 [4%]; P =.07), and 6 (43%) of 14 HIV-infected patients who had successful percutaneous coronary intervention and were available for follow-up required target vessel revascularization compared with 4 (11%) of 38 uninfected patients who had successful percutaneous coronary intervention and were available for follow-up (P =.02).
  
  
  CONCLUSIONS
  Patients infected with HIV sustain AMI at a young age and have a benign in-hospital course. Although HIV-infected patients have a higher incidence of postdischarge ischemic events, restenosis, and stent thrombosis, the intermediate-term mortality is low.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA.
authors.forename: Shlomo
authors.initials: S
authors.lastname: Matetzky
authors.forename: Michelle
authors.initials: M
authors.lastname: Domingo
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.forename: Prediman K
authors.initials: PK
authors.lastname: Shah
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kaul
authors.forename: Eric
authors.initials: E
authors.lastname: Daar
authors.forename: Bojan
authors.initials: B
authors.lastname: Cercek
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome