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Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy.

Abstract

AIMS

Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients.

METHODS AND RESULTS

MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI).

CONCLUSION

Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.

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  • Authors+Show Affiliations

    ,

    Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy. fabrizio.dascenzo@gmail.com

    , , , , , , , ,

    Source

    European heart journal 33:7 2012 Apr pg 875-80

    MeSH

    Acute Coronary Syndrome
    Angioplasty, Balloon, Coronary
    Anti-HIV Agents
    Epidemiologic Methods
    Female
    HIV Infections
    HIV Protease Inhibitors
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Prognosis

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    22187508

    Citation

    D'Ascenzo, Fabrizio, et al. "Acute Coronary Syndromes in Human Immunodeficiency Virus Patients: a Meta-analysis Investigating Adverse Event Rates and the Role of Antiretroviral Therapy." European Heart Journal, vol. 33, no. 7, 2012, pp. 875-80.
    D'Ascenzo F, Cerrato E, Biondi-Zoccai G, et al. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J. 2012;33(7):875-80.
    D'Ascenzo, F., Cerrato, E., Biondi-Zoccai, G., Moretti, C., Omedè, P., Sciuto, F., ... Sheiban, I. (2012). Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. European Heart Journal, 33(7), pp. 875-80. doi:10.1093/eurheartj/ehr456.
    D'Ascenzo F, et al. Acute Coronary Syndromes in Human Immunodeficiency Virus Patients: a Meta-analysis Investigating Adverse Event Rates and the Role of Antiretroviral Therapy. Eur Heart J. 2012;33(7):875-80. PubMed PMID: 22187508.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. AU - D'Ascenzo,Fabrizio, AU - Cerrato,Enrico, AU - Biondi-Zoccai,Giuseppe, AU - Moretti,Claudio, AU - Omedè,Pierluigi, AU - Sciuto,Filippo, AU - Bollati,Mario, AU - Modena,Maria Grazia, AU - Gaita,Fiorenzo, AU - Sheiban,Imad, Y1 - 2011/12/20/ PY - 2011/12/22/entrez PY - 2011/12/22/pubmed PY - 2012/6/16/medline SP - 875 EP - 80 JF - European heart journal JO - Eur. Heart J. VL - 33 IS - 7 N2 - AIMS: Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. METHODS AND RESULTS: MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). CONCLUSION: Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors. SN - 1522-9645 UR - https://www.unboundmedicine.com/medline/citation/22187508/full_citation L2 - https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehr456 DB - PRIME DP - Unbound Medicine ER -