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In ACS, patients with symptomatic HIV less likely to undergo invasive CV procedures
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PHILADELPHIA — Among patients with ACS, patients with symptomatic HIV appear to be less aggressively treated with diagnostic catheterization, PCI and CABG compared with patients with no or asymptomatic HIV, according to findings presented at the American College of Cardiology Scientific Sessions.
Researchers found that patients with symptomatic HIV had lower procedural rates for diagnostic catheterization (OR = 0.62; 95% CI, 0.52-0.73), PCI (OR = 0.8; 95% CI, 0.67-0.96) and CABG (OR = 0.7; 95% CI, 0.52-0.93), compared with a control group of patients without HIV.
Moreover, patients with asymptomatic HIV experienced similar procedural rates of catheterization (OR = 0.9, 95% CI, 0.78-1.05), PCI (OR = 1.13; 95% CI, 1-1.26) and CABG (OR = 0.87; 95% CI, 0.72-1.04), compared with the control group.
“We found that asymptomatic HIV patients have a nonsignificant disparity in revascularization procedural rates and regardless of the type of the procedure,” Claire Huang Lucas, MD, PhD, from Mount Sinai St Luke's-West Hospital, said during her presentation. “Therefore, HIV status does not appear to be a predictor for proceeding with revascularization procedures. On the contrary, symptomatic HIV patients received significantly less revascularization procedures after ACS. Those patients tend to develop earlier onset ACS and lower access to revascularization might increase their long-term morbidity and mortality.”
Researchers reviewed a nationwide sample of 515,016 patients with ACS (0.4% with HIV) between 2013 and 2016, with the aim of assessing procedural rate disparities between patients with HIV, symptomatic HIV and a control group.
“This leads us to a couple of potential future research ideas,” Lucas said in her presentation. “One would be to evaluate the long-term impact of medical management vs. revascularization procedures in symptomatic HIV patients after ACS. The second would be to seek a better understanding of the underlying mechanism of premature atherosclerosis in HIV patients or knowledge of coronary lesions in order to improve revascularization. The third may be the creation of an adjusted risk stratification tool that would review the patient's HIV status in order to provide more personalized, optimal prevention in the future” – by Scott Buzby
Reference:
Lucas CH, et al. Presentation 140. ACS & Interventional Oral Abstracts. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosures: One of the authors reports receiving honoraria from Bristol-Myers Squibb, Lantheus, Pfizer and Zoll. Lucas and the other authors report no relevant financial disclosures.