title: Types of Myocardial Infarction Among Human Immunodeficiency Virus-Infected Individuals in the United States.
abstract: The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown.
  
  
  
  To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs.
  
  
  
  This longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts adjudicated each event, categorizing each definite or probable MI as type 1 or type 2 and identifying the causes of type 2 MI.
  
  
  
  The number and proportion of type 1 vs type 2 MIs, demographic and clinical characteristics among those with type 1 vs type 2 MIs, and the causes of type 2 MIs.
  
  
  
  Among 571 patients (median age, 49 years [interquartile range, 43-55 years]; 430 men and 141 women) with definite or probable MIs, 288 MIs (50.4%) were type 2 and 283 (49.6%) were type 1. In analyses of type 1 MIs, 79 patients who underwent cardiac interventions, such as coronary artery bypass graft surgery, were also included, totaling 362 patients. Sepsis or bacteremia (100 [34.7%]) and recent use of cocaine or other illicit drugs (39 [13.5%]) were the most common causes of type 2 MIs. A higher proportion of patients with type 2 MIs were younger than 40 years (47 of 288 [16.3%] vs 32 of 362 [8.8%]) and had lower current CD4 cell counts (median, 230 vs 383 cells/µL), lipid levels (mean [SD] total cholesterol level, 167 [63] vs 190 [54] mg/dL, and mean (SD) Framingham risk scores (8% [7%] vs 10% [8%]) than those with type 1 MIs or who underwent cardiac interventions.
  
  
  
  Approximately half of all MIs among HIV-infected individuals were type 2 MIs caused by heterogeneous clinical conditions, including sepsis or bacteremia and recent use of cocaine or other illicit drugs. Demographic characteristics and cardiovascular risk factors among those with type 1 and type 2 MIs differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand MI outcomes and to guide prevention and treatment.
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Pathmaja
authors.initials: P
authors.lastname: Paramsothy
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Drozd
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Nance
authors.affiliation: Department of Medicine, University of Washington, Seattle2Department of Epidemiology, University of Washington, Seattle.
authors.forename: J A Chris
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: Department of Epidemiology, University of Washington, Seattle.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Medicine, University of California-Los Angeles.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Greer A
authors.initials: GA
authors.lastname: Burkholder
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: Department of Medicine, University of California-San Diego.
authors.forename: William C
authors.initials: WC
authors.lastname: Mathews
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.affiliation: Department of Medicine, The University of North Carolina at Chapel Hill.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
authors.affiliation: Department of Medicine, The University of North Carolina at Chapel Hill.
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.affiliation: Department of Medicine, University of California-San Francisco.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hunt
authors.affiliation: Department of Medicine, University of California-San Francisco.
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.affiliation: Department of Medicine, University of California-San Francisco.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Hsue
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Carla
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Inga
authors.initials: I
authors.lastname: Peter
authors.affiliation: Department of Medicine, University of Washington, Seattle10Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Barnes
authors.affiliation: Department of Medicine, University of Washington, Seattle10Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
authors.forename: Justin
authors.initials: J
authors.lastname: McReynolds
authors.affiliation: Department of Medicine, University of Washington, Seattle10Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle.
authors.forename: William B
authors.initials: WB
authors.lastname: Lober
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.affiliation: Department of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Feinstein
authors.affiliation: Department of Medicine, University of California-San Francisco.
authors.forename: Carl
authors.initials: C
authors.lastname: Grunfeld
authors.affiliation: Department of Medicine, University of Alabama at Birmingham.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.affiliation: Department of Medicine, University of Washington, Seattle.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Kitahata
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology