title: Improvements over time in short-term mortality following myocardial infarction in HIV-positive individuals.
abstract: Few studies have described mortality and clinical outcomes after myocardial infarction (MI) in the HIV-positive population. This study evaluated changes in short-term mortality after MI in HIV-positive individuals in the D:A:D Study, and investigated possible reasons for any changes seen.
  
  
  
  Prospective cohort study.
  
  
  
  Demographic, cardiovascular disease (CVD)/HIV-related characteristics and CVD-related interventions (invasive cardiovascular procedures and drug interventions) were summarized at the time of and following an MI. Associations between calendar year and mortality in the first month after MI were identified using logistic regression with adjustment for confounders, including interventions received in the first month after MI.
  
  
  
  One thousand and eight HIV-positive individuals experiencing an MI over the period 1999-2014 were included. The absolute number of MIs decreased from 214 (1999-2002) to 154 (2011-2014). Whilst the CVD risk profile remained high over time, the HIV status improved. The use of CVD-related interventions after MI appeared to increase over time. The proportion of individuals who died in the first month after MI dropped from 26.6% in 1999-2002 to 8.4% in 2011-2014. Later calendar year was associated with decreased short-term mortality; this effect was attenuated after adjusting for CVD-related interventions received in the first month after MI [odds ratio changed from 0.88 (95% confidence interval 0.83, 0.93) to 0.97 (0.91, 1.02)].
  
  
  
  Improvements in short-term survival after MI appear to be largely driven by improved medical management of CVD risk in HIV-positive individuals after MI. Efforts are still needed to treat CVD risk factors and increase access to CVD-related interventions.
authors.affiliation: aCHIP, Department of Infectious Diseases, Section 2100, Rigshospitalet, University of Copenhagen, Copenhagen, DenmarkbICAP-Columbia University and Harlem Hospital, New York, USAcResearch Department of Infection and Population Health, UCL, London, UKdDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandeAcademic Medical Center, Department of Global Health and Division of Infectious Diseases, University of Amsterdam, and HIV Monitoring Foundation, Amsterdam, The NetherlandsfDepartment of Public Health, Nice University Hospital, NicegUniversité de Bordeaux, ISPED, Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, FrancehThe Kirby Institute, UNSW Australia, Sydney, AustraliaiDipartimento di Scienze della Salute, Clinica di Malattie Infettive e Tropicali, Azienda Ospedaliera-Polo Universitario San Paolo, Milan, ItalyjDivision of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Camilla Ingrid
authors.initials: CI
authors.lastname: Hatleberg
authors.forename: Lene
authors.initials: L
authors.lastname: Ryom
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Eric
authors.initials: E
authors.lastname: Fontas
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Antonella d'Arminio
authors.initials: Ad
authors.lastname: Monforte
authors.forename: Stephane
authors.initials: S
authors.lastname: De Wit
authors.forename: Amanda
authors.initials: A
authors.lastname: Mocroft
authors.forename: Andrew
authors.initials: A
authors.lastname: Phillips
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Caroline
authors.initials: C
authors.lastname: Sabin
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011446:Prospective Studies; D016019:Survival Analysis