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In-hospital and long-term outcomes of HIV-positive patients undergoing PCI according to kind of stent

a meta-analysis

Peyracchia, Mattiaa; Verardi, Robertoa; Rubin, Sergio Raposeirasb; Abu-Assi, Emadc; Montrucchio, Chiarad; Perl, Leore,*; Grossomarra, Waltera; Calcagno, Andread; Omedè, Pierluigia; Montefusco, Antonioa; Bonora, Stefanod; Moretti, Claudioa; D’Amico, Maurizioa; Mauro, Rinaldia; D’Ascenzo, Fabrizioa

Journal of Cardiovascular Medicine: May 2019 - Volume 20 - Issue 5 - p 321–326
doi: 10.2459/JCM.0000000000000767
Research articles: Coronary artery disease
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Background 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).

Methods 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.

Findings 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.

Interpretation 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: peyracchia@gmail.com

Received 11 October, 2018

Revised 4 December, 2018

Accepted 1 January, 2019

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© 2019 Italian Federation of Cardiology. All rights reserved.