Pathogenesis of cardiovascular disease in HIV-positive patients is related to the interaction between traditional and HIV-specific factors. Limited data are available regarding the prognosis of HIV-positive patients undergoing percutaneous coronary intervention (PCI).
All observational studies evaluating the prognosis of HIV-positive patients treated with PCI were included. In-hospital and long-term major adverse cardiac events (MACE) [composite endpoint of all-cause death or myocardial infarction (MI)] were the primary endpoints, whereas in-hospital and long-term all-cause death, cardiovascular death, MI, stent thrombosis, target vessel revascularization (TVR), target lesion revascularization (TLR), and bleeding complications were the secondary ones.
In all, 1243 patients in nine studies were included, with a mean age of 54 years. Among them, 12% were female and 91% were admitted for acute coronary syndromes. In-hospital MACE occurred in 6.0% (5.4–6.6), death in 4.2% (2.6–5.9), and MI in 1.3% (0–2.8), whereas major bleeding occurred in 2.0% (1.7–2.3) of the patients. After 2 years (1.6–3.1), long-term MACE occurred in 17.4% (11.9–22.3), all-cause death in 8.7% (3.2–14.2), and MI in 7.8% (5.5–10.1) of the patients, whereas stent thrombosis and TVR in 3.4% (1.5–5.3) and 10.5% (7.5–13.4), respectively. In patients treated with drug-eluting stents (DES), the rate of long-term MACE was 22.3% (10.1–34.4), with an incidence of 4.9% (0.0–11.4) of MI and 5.7% (2.3–13.7, all 95% confidence intervals of TLR.
HIV-positive patients have a high risk of in-hospital and long-term MACE after PCI, partially reduced by the use of DES. Further studies on the risk of recurrent ischemic events with current generation stents are needed, to offer a tailored therapy in this high-risk population.
aDivision of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, University of Turin, Turin, Italy
bDepartment of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña
cDepartment of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain
dDivision of Infectious Disease, University of Turin, Turin, Italy
eCardiology Department, Rabin Medical Center, Petach-Tikva and the “Sackler” Faculty of Medicine, Tel-Aviv University, Israel
Correspondence to Mattia Peyracchia, MD, Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy Tel: +39 03461772656; e-mail: firstname.lastname@example.org
Received 11 October, 2018
Revised 4 December, 2018
Accepted 1 January, 2019
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jcardiovascularmedicine.com).