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HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction.
Coron Artery Dis 2017; 28(3):239-245CA

Abstract

BACKGROUND

Drug-eluting stents (DES) outperform bare-metal stents (BMS) in reducing target vessel revascularization following a percutaneous coronary intervention (PCI). Little is known about the types of stents placed in HIV-positive patients presenting with ST-segment elevation myocardial infarctions (STEMIs).

METHODS

We used the 2003-2013 National Inpatient Sample to identify adults of 18 years or older presenting with STEMI. We evaluated differences in stent type placed following STEMIs on the basis of HIV status. Temporal trends in the use of PCI, DES, and BMS were studied on the basis of HIV status.

RESULTS

Of 1 695 947 patients with STEMI, 5887 (0.3%) were HIV-positive patients. Following STEMIs, HIV-positive patients were equally likely to have PCI compared with HIV-negative patients [adjusted odds ratio (AOR): 1.04, 95% confidence interval (CI): 0.89-1.21, P=0.63]. However, HIV-positive patients were less likely to have DES (AOR: 0.83, 95% CI: 0.73-0.94, P=0.003) and more likely to have BMS (AOR: 1.26, 95% CI: 1.11-1.45, P=0.001). Over the 11-year period observed, there were increases in PCI following STEMIs in both HIV-positive and HIV-negative patients (all Ptrend<0.001). There were significant increases in the use of DES in HIV-negative patients [adjusted odds ratio (AOR) per year: 1.07, 95% CI: 1.06-1.09, Ptrend<0.001] and significant decreases in the use of BMS (AOR per year: 0.93, 95% CI: 0.92-0.94, Ptrend<0.001). Significant trends showing changed practice patterns in the use of DES and BMS among HIV-positive patients were not observed.

CONCLUSION

Over a decade, there were significant increases in the use of PCI following STEMIs in both HIV-negative and HIV-positive patients. Although HIV-positive patients presenting with STEMIs were as likely as HIV-negative patients to undergo PCI, they were less likely to be treated with DES and more likely to receive BMS. Highlighting these observations will hopefully bring renewed attention to best practices for all STEMI patients.

Authors+Show Affiliations

aDepartment of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland bDepartment of Medicine, WellSpan York Hospital, York, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28288008

Citation

Albaeni, Aiham, et al. "HIV Status and Type of Coronary Stent Placed in Patients Presenting With ST-elevation Myocardial Infarction." Coronary Artery Disease, vol. 28, no. 3, 2017, pp. 239-245.
Albaeni A, Harris C, Eid SM, et al. HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction. Coron Artery Dis. 2017;28(3):239-245.
Albaeni, A., Harris, C., Eid, S. M., Abougergi, M. S., & Wright, S. M. (2017). HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction. Coronary Artery Disease, 28(3), pp. 239-245. doi:10.1097/MCA.0000000000000488.
Albaeni A, et al. HIV Status and Type of Coronary Stent Placed in Patients Presenting With ST-elevation Myocardial Infarction. Coron Artery Dis. 2017;28(3):239-245. PubMed PMID: 28288008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV status and type of coronary stent placed in patients presenting with ST-elevation myocardial infarction. AU - Albaeni,Aiham, AU - Harris,Che, AU - Eid,Shaker M, AU - Abougergi,Marwan S, AU - Wright,Scott M, PY - 2017/3/14/pubmed PY - 2018/5/9/medline PY - 2017/3/14/entrez SP - 239 EP - 245 JF - Coronary artery disease JO - Coron. Artery Dis. VL - 28 IS - 3 N2 - BACKGROUND: Drug-eluting stents (DES) outperform bare-metal stents (BMS) in reducing target vessel revascularization following a percutaneous coronary intervention (PCI). Little is known about the types of stents placed in HIV-positive patients presenting with ST-segment elevation myocardial infarctions (STEMIs). METHODS: We used the 2003-2013 National Inpatient Sample to identify adults of 18 years or older presenting with STEMI. We evaluated differences in stent type placed following STEMIs on the basis of HIV status. Temporal trends in the use of PCI, DES, and BMS were studied on the basis of HIV status. RESULTS: Of 1 695 947 patients with STEMI, 5887 (0.3%) were HIV-positive patients. Following STEMIs, HIV-positive patients were equally likely to have PCI compared with HIV-negative patients [adjusted odds ratio (AOR): 1.04, 95% confidence interval (CI): 0.89-1.21, P=0.63]. However, HIV-positive patients were less likely to have DES (AOR: 0.83, 95% CI: 0.73-0.94, P=0.003) and more likely to have BMS (AOR: 1.26, 95% CI: 1.11-1.45, P=0.001). Over the 11-year period observed, there were increases in PCI following STEMIs in both HIV-positive and HIV-negative patients (all Ptrend<0.001). There were significant increases in the use of DES in HIV-negative patients [adjusted odds ratio (AOR) per year: 1.07, 95% CI: 1.06-1.09, Ptrend<0.001] and significant decreases in the use of BMS (AOR per year: 0.93, 95% CI: 0.92-0.94, Ptrend<0.001). Significant trends showing changed practice patterns in the use of DES and BMS among HIV-positive patients were not observed. CONCLUSION: Over a decade, there were significant increases in the use of PCI following STEMIs in both HIV-negative and HIV-positive patients. Although HIV-positive patients presenting with STEMIs were as likely as HIV-negative patients to undergo PCI, they were less likely to be treated with DES and more likely to receive BMS. Highlighting these observations will hopefully bring renewed attention to best practices for all STEMI patients. SN - 1473-5830 UR - https://www.unboundmedicine.com/medline/citation/28288008/HIV_status_and_type_of_coronary_stent_placed_in_patients_presenting_with_ST_elevation_myocardial_infarction_ L2 - http://dx.doi.org/10.1097/MCA.0000000000000488 DB - PRIME DP - Unbound Medicine ER -