EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2016 Nov 15() pii 10.4244/EIJ-D-15-00409
Patients with human immunodeficiency virus (HIV) infection have an increased risk of acute myocardial infarction (MI) and 6.5 -15% of mortality in this population is attributable to cardiovascular disease. However, the angiographic pattern of coronary artery disease (CAD) in patients with HIV undergoing percutaneous coronary intervention (PCI) remains unknown. We sought to assess and describe the angiographic features and burden of CAD in patients with HIV as compared to those without HIV infection.
This is a retrospective, single-center study comparing 93 patients with HIV infection who underwent PCI between 2003-2011 with 93 control patients without HIV infection matched for age (± 3 years), gender, diabetes, and year of PCI (± 2 years). Quantitative coronary angiography (QCA) was performed for all treated lesions at baseline and following PCI in both groups. 1- Year clinical outcomes post-PCI were also analyzed and compared.
The mean age for both study populations was 57 years and patients with HIV were more likely to present with ST-segment elevation myocardial infarction (STEMI). Patients had similar extent of CAD as measured by presence of multi-vessel disease as well as SYNTAX score; however patients with HIV were more likely to have lesions in the proximal segment of the respective coronary artery. While both groups mostly displayed none/mild calcified lesions, HIV+ patients had longer and fewer stenotic lesions. Clinical outcomes at one year were similar.
While HIV+ patients were more likely to present with STEMI, detailed coronary angiographic analysis reveals less complex lesions and favorable anatomy. This paradox may suggest alterations in genesis and progression of atherosclerosis in this clinical setting.