title: HIV, vascular surgery and cardiovascular outcomes: a South African cohort study.
abstract: Risk factors for peri-operative cardiac morbidity are poorly described in HIV-positive patients. This prospective observational study describes cardiovascular risk factors in a cohort of vascular surgical patients of known HIV status. We recruited 225 patients with 73 (32%) being HIV-positive. When compared with HIV-negative patients, the HIV-positive patients were younger (mean (SD) 56.4 (13.3) vs 40.5 (10.4) years, respectively, p < 0.01). They had fewer Revised Cardiac Risk Index cardiovascular risk factors (median (range [IQR]) 1 (0-5 [0-2]) vs 0 (0-2 [0-0]), respectively, p < 0.001), with the exception of congestive cardiac failure (p = 0.23) and renal dysfunction (p = 0.32), and so were of a significantly lower Revised Cardiac Risk Index risk category (p < 0.01). HIV-positive and -negative patients had similar outcomes in: 30-day mortality (p = 0.78); three-day postoperative troponin leak (p = 0.66); and a composite outcome of mortality and troponin release (p = 0.69). We conclude that although HIV-positive patients have fewer cardiovascular risk factors, they have similar peri-operative major adverse cardiac events to HIV-negative patients. Research should focus on why this is the case, and if alternative clinical risk predictors can be developed for HIV patients.
authors.affiliation: Entabeni Hospital, Durban, KwaZulu-Natal, South Africa.
authors.forename: L A
authors.initials: LA
authors.lastname: Redman
authors.forename: P
authors.initials: P
authors.lastname: Naidoo
authors.forename: B M
authors.initials: BM
authors.lastname: Biccard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*
chemical_list: D014336:Troponin