title: Increased mortality after a first myocardial infarction in human immunodeficiency virus-infected patients; a nested cohort study.
abstract: OBJECTIVE
  HIV infection may be associated with an increased recurrence rate of myocardial infarction. Our aim was to determine whether HIV infection is a risk factor for worse outcomes in patients with coronaray artery disease.
  
  
  METHODS
  We compared data aggregated from two ongoing cohorts: (i) the Acute Myocardial Infarction in Switzerland (AMIS) registry, which includes patients with acute myocardial infarction (AMI), and (ii) the Swiss HIV Cohort Study (SHCS), a prospective registry of HIV-positive (HIV+) patients. We included all patients who survived an incident AMI occurring on or after 1st January 2005. Our primary outcome measure was all-cause mortality at one year; secondary outcomes included AMI recurrence and cardiovascular-related hospitalisations. Comparisons used Cox and logistic regression analyses, respectively.
  
  
  RESULTS
  There were 133 HIV+, (SHCS) and 5,328 HIV-negative [HIV-] (AMIS) individuals with incident AMI. In the SHCS and AMIS registries, patients were predominantly male (72% and 85% male, respectively), with a median age of 51 years (interquartile range [IQR] 46-57) and 64 years (IQR 55-74), respectively. Nearly all (90%) of HIV+ individuals were on successful antiretroviral therapy. During the first year of follow-up, 5 (3.6%) HIV+ and 135 (2.5%) HIV- individuals died. At one year, HIV+ status after adjustment for age, sex, calendar year of AMI, smoking status, hypertension and diabetes was associated with a higher risk of death (HR 4.42, 95% CI 1.73-11.27). There were no significant differences in recurrent AMIs (4 [3.0%] HIV+ and 146 [3.0%] HIV- individuals, OR 1.16, 95% CI 0.41-3.27) or in hospitalization rates (OR 0.68 [95% CI 0.42-1.11]).
  
  
  CONCLUSIONS
  HIV infection was associated with a significantly increased risk of all-cause mortality one year after incident AMI.
authors.affiliation: Department of Cardiology, University Hospital, Geneva, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Carballo
authors.affiliation: HIV Metabolic Clinic, University Hospital, Geneva, Switzerland.
authors.forename: Cécile
authors.initials: C
authors.lastname: Delhumeau
authors.affiliation: General Internal Medicine, University Hospital, Geneva, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Carballo
authors.affiliation: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bähler
authors.affiliation: AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Dragona
authors.initials: D
authors.lastname: Radovanovic
authors.affiliation: HIV Metabolic Clinic, University Hospital, Geneva, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Hirschel
authors.affiliation: Infectious Diseases, University Hospital Center, Lausanne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Clerc
authors.affiliation: Infectious Diseases, Regional Hospital, Lugano, Switzerland.
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.affiliation: HIV Unit, Infectious diseases, University Hospital, Basel, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Fasel
authors.affiliation: Infectious Diseases, University Hospital, Sankt Gallen, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.affiliation: Infectious Diseases, University Hospital, Bern, Switzerland.
authors.forename: Alexia
authors.initials: A
authors.lastname: Cusini
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zürich, University of Zurich, Zürich, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Fehr
authors.affiliation: Cardiology Department, Peripherique Hospital, Lucern, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
authors.affiliation: Department of Cardiology, University Hospital, Geneva, Switzerland ; Centre médical Ziggurat, Rue du Jura 11, 2900 Porrentruy, Switzerland.
authors.forename: Pierre-Fréderic
authors.initials: PF
authors.lastname: Keller
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zürich, University of Zurich, Zürich, Switzerland.
authors.forename: Bruno
authors.initials: B
authors.lastname: Ledergerber
authors.affiliation: HIV Metabolic Clinic, University Hospital, Geneva, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
keywords: Coronary artery disease; Fatal outcome; HIV infection; Myocardial infarction