title: Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States.
abstract: OBJECTIVE
  Limited data are available on prognostic indicators for HIV patients presenting with ACS.
  
  
  RESULTS
  Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016]).
  
  
  CONCLUSIONS
  HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability.
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy.
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy; Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain.
authors: Enrico
authors: E
authors: Cerrato
authors: VCU Pauley Heart Center, Richmond, VA, USA.
authors: Darryn
authors: D
authors: Appleton
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy.
authors: Claudio
authors: C
authors: Moretti
authors: Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Andrea
authors: A
authors: Calcagno
authors: VCU Pauley Heart Center, Richmond, VA, USA.
authors: Nayef
authors: N
authors: Abouzaki
authors: VCU Pauley Heart Center, Richmond, VA, USA.
authors: George
authors: G
authors: Vetrovec
authors: Department of Cardiology, Rangueil Hospital, Toulouse, France.
authors: Thibault
authors: T
authors: Lhermusier
authors: Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
authors: Didier
authors: D
authors: Carrie
authors: Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain.
authors: Barbara
authors: B
authors: Das Neves
authors: Division of Cardiology, Hospital Clinico San Carlos, Madrid, Spain.
authors: Javier
authors: J
authors: Escaned
authors: Deutsches Herzzentrum, Munich, Germany.
authors: Salvatore
authors: S
authors: Cassese
authors: Deutsches Herzzentrum, Munich, Germany.
authors: Adnan
authors: A
authors: Kastrati
authors: Division of Cardiology, Maria VittoriaHospital, Turin, Italy; Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Alessandra
authors: A
authors: Chinaglia
authors: Division of Cardiology, Maria VittoriaHospital, Turin, Italy.
authors: Riccardo
authors: R
authors: Belli
authors: Department of Cardiology, Rangueil Hospital, Toulouse, France.
authors: Davide
authors: D
authors: Capodanno
authors: Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
authors: Corrado
authors: C
authors: Tamburino
authors: Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy.
authors: Francesca
authors: F
authors: Santilli
authors: Division of Cardiology, Università degli Studi 'G. d'Annunzio' Chieti e Pescara, Italy; Division of Cardiology, Careggi Hospital, Florence, Italy.
authors: Guido
authors: G
authors: Parodi
authors: University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology.
authors: Ahmed
authors: A
authors: Vachiat
authors: University of Witwatersrand Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology.
authors: Pravin
authors: P
authors: Manga
authors: Department of Cardiology, University of Parma, Italy.
authors: Luigi
authors: L
authors: Vignali
authors: Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy.
authors: Massimo
authors: M
authors: Mancone
authors: Department of Cardiovascular and Pulmonary Sciences, Policlinico Umberto I "Sapienza", University of Rome, Italy.
authors: Gennaro
authors: G
authors: Sardella
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy.
authors: Francesco
authors: F
authors: Fedele
authors: Wegmans Pharmacy, Ithaca, NY.
authors: James J
authors: JJ
authors: DiNicolantonio
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy.
authors: Pierluigi
authors: P
authors: Omedè
authors: Division of Infectious Disease, Amedeo di Savoia Hospital, Turin, Italy.
authors: Stefano
authors: S
authors: Bonora
authors: Division of Cardiology, Città della Salute e della Scienza "Molinette" Hospital, University of Turin, Turin, Italy.
authors: Fiorenzo
authors: F
authors: Gaita
authors: VCU Pauley Heart Center, Richmond, VA, USA. Electronic address: abbatea@yahoo.com.
authors: Antonio
authors: A
authors: Abbate
authors: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy. Electronic address: gbiondizoccai@gmail.com.
authors: Giuseppe Biondi
authors: GB
authors: Zoccai
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D005060:Europe; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013019:South Africa; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D018894:Reverse Transcriptase Inhibitors
keywords: Acute coronary syndrome; Coronary artery disease; Human immunodeficiency virus; Prognosis