Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS)
Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS)
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DOI：
10.1186/s12916-019-1385-7
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发表时间：
2019-07-31
期刊：
影响因子：
9.3
通讯作者：
Crane, Heidi M.
中科院分区：
文献类型：
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作者：
Feinstein, Matthew J.;Nance, Robin M.;Crane, Heidi M.
背景人类免疫缺陷病毒（HIV）感染者发生心肌梗死（MI）的危险性高于普通人群。这在一定程度上是由HIV感染者（PWH）中较高的2型MI（T2 MI，由于冠状动脉供需不匹配）率驱动的。在一般人群中，T2 MI的死亡率高于1型MI（T1 MI，自发性，通常是由于斑块破裂和血栓形成）。PWH有更大的合并症负担，因此在T2 MI的情况下可能有更大的并发症和死亡的额外风险。然而，T1 MI和T2 MI后的死亡率模式在HIV.MethodsWe分析MI后死亡率PWH之间的多中心，美国艾滋病研究中心网络的综合临床系统（CNICS）队列（N=28,186）。1996年1月1日至2014年12月31日期间发生的MI事件被集中裁定并分类为T1 MI或T2 MI。我们首先比较了PWH中T1 MI与T2 MI的死亡率。然后使用考克斯生存分析和贝叶斯模型平均值来评估与T1 MI和T2 MI后死亡率相关的MI前协变量。结果在28，186名经历MI的PWH中的596名中（2.1%; 293例T1 MI和303例T2 MI），T2 MI后死亡率显著更高（22.2/100人-年; 1年、3年和5年死亡率分别为39%、52%和62%）高于T1 MI（8.2/100人-年; 1年、3年和5年死亡率分别为15%、22%和30%）。T1 MI后的显著死亡率预测因子是较高的HIV病毒载量、肾功能不全和年龄较大。T2心肌梗死后死亡率的显着预测低体重指数（BMI）和可检测到的HIV病毒load.ConclusionsMortality是高MI PWH和T2心肌梗死后比T1心肌梗死大得多。MI后死亡的预测因素因MI类型而异，这加强了与每种MI类型相关的不同临床情况以及单独考虑MI类型的重要性。
BackgroundPersons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown.MethodsWe analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N=28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI.ResultsAmong the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load.ConclusionsMortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.