Mattia Peyracchia1, Giulia De Lio1, Chiara Montrucchio1, Pierluigi Omedè1, Gabriella d'Ettore2, Andrea Calcagno3, Vincenzo Vullo2, Enrico Cerrato4, Mauro Pennacchi5, Gennaro Sardella5, Pravin Manga6, Walter GrossoMarra1, Francesco Vullo7, Francesco Fedele5, Giuseppe Biondi-Zoccai8, Claudio Moretti3, Ahmed Vachiat6, Stefano Bonora3, Mauro Rinaldi1, Massimo Mancone9, Fabrizio D'Ascenzo10. 1. Division of Cardiology, Città Della Salute e Della Scienza "Molinette" Hospital, University of Turin, Turin, Italy. 2. Department of Infectious Disease "Sapienza" University of Rome, Policlinico Umberto I, Italy. 3. Division of Infectious Disease, University of Turin, Italy. 4. Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. 5. Department of Cardiovascular,Respiratory, Nephrology Anesthesiology, and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Italy. 6. University of Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Division of Cardiology, Italy. 7. Interventional Cardiology, Infermi Hospital, Rivoli and San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy; Department of Radiological, Oncological and Anatomo Pathological Sciences, Sapienza University of Rome, Italy. 8. Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome,Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. 9. Department of Cardiovascular,Respiratory, Nephrology Anesthesiology, and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Italy. Electronic address: massimo.mancone@uniroma1.it. 10. Division of Cardiology, Città Della Salute e Della Scienza "Molinette" Hospital, University of Turin, Turin, Italy. Electronic address: fabrizio.dascenzo@gmail.com.
Abstract
BACKGROUND AND AIMS: The risk of recurrence of myocardial infarction (MI) in HIV patients presenting with acute coronary syndrome (ACS) is well known, but there is limited evidence about potential differences in coronary plaques compared to non-HIV patients. METHODS: In this multicenter case-control study, HIV patients presenting with ACS, with intravascular-ultrasound (IVUS) data, enrolled between February 2015 and June 2017, and undergoing highly active antiretroviral therapy (HAART), were retrospectively compared to non-HIV patients presenting with ACS, before and after propensity score with matching, randomly selected from included centers. Primary end-point was the prevalence of multivessel disease. Secondary end-points were the prevalence of abnormal features at IVUS, the incidence of major-acute-cardiovascular-events (MACE), a composite end point of cardiovascular death, MI, target lesion revascularization (TLR), stent thrombosis (ST), non-cardiac death and target vessel revascularization (TVR). For each end-point, a subgroup analysis was conducted in HIV patients with CD4 cell count <200/mm3. RESULTS: Before propensity score, 66 HIV patients and 120 non-HIV patients were selected, resulting in 20 and 40 after propensity score. Patients with multivessel disease were 11 and 17, respectively (p = 0.56). IVUS showed a lower plaque burden (71% vs. 75%, p < 0.001) and a higher prevalence of hyperechoic non-calcified plaques (100% vs. 35%, p < 0.05) in HIV patients; a higher prevalence of hypoechoic plaques (7% vs. 0%, p < 0.05), a higher incidence of MACE (17.4% vs. 9.1% vs. l'8.0%, p < 0.05), MI recurrence (17.2% vs. 0.0% vs. 2.3%, p < 0.05), and ST (6.7% vs. 0.3% vs. 03%, p < 0.05) in HIV patients with CD4 < 200/mm3. CONCLUSIONS: Our study may provide a part of the pathophysiological basis of the differences in coronary arteries between HIV-positive and HIV-negative patients, suggesting that the former present with peculiar morphological features at IVUS, even after adjustment for clinical variables. Furthermore, we confirmed that an advanced HIV infection is associated with a high risk of non-calcific plaques and with a worse prognosis, including cardiovascular events and ACS recurrence.
BACKGROUND AND AIMS: The risk of recurrence of myocardial infarction (MI) in HIVpatients presenting with acute coronary syndrome (ACS) is well known, but there is limited evidence about potential differences in coronary plaques compared to non-HIVpatients. METHODS: In this multicenter case-control study, HIVpatients presenting with ACS, with intravascular-ultrasound (IVUS) data, enrolled between February 2015 and June 2017, and undergoing highly active antiretroviral therapy (HAART), were retrospectively compared to non-HIVpatients presenting with ACS, before and after propensity score with matching, randomly selected from included centers. Primary end-point was the prevalence of multivessel disease. Secondary end-points were the prevalence of abnormal features at IVUS, the incidence of major-acute-cardiovascular-events (MACE), a composite end point of cardiovascular death, MI, target lesion revascularization (TLR), stent thrombosis (ST), non-cardiac death and target vessel revascularization (TVR). For each end-point, a subgroup analysis was conducted in HIVpatients with CD4 cell count <200/mm3. RESULTS: Before propensity score, 66 HIVpatients and 120 non-HIVpatients were selected, resulting in 20 and 40 after propensity score. Patients with multivessel disease were 11 and 17, respectively (p = 0.56). IVUS showed a lower plaque burden (71% vs. 75%, p < 0.001) and a higher prevalence of hyperechoic non-calcified plaques (100% vs. 35%, p < 0.05) in HIVpatients; a higher prevalence of hypoechoic plaques (7% vs. 0%, p < 0.05), a higher incidence of MACE (17.4% vs. 9.1% vs. l'8.0%, p < 0.05), MI recurrence (17.2% vs. 0.0% vs. 2.3%, p < 0.05), and ST (6.7% vs. 0.3% vs. 03%, p < 0.05) in HIVpatients with CD4 < 200/mm3. CONCLUSIONS: Our study may provide a part of the pathophysiological basis of the differences in coronary arteries between HIV-positive and HIV-negative patients, suggesting that the former present with peculiar morphological features at IVUS, even after adjustment for clinical variables. Furthermore, we confirmed that an advanced HIV infection is associated with a high risk of non-calcific plaques and with a worse prognosis, including cardiovascular events and ACS recurrence.
Authors: Parker Foster; Lori Sokoll; Ji Li; Gary Gerstenblith; Elliot K Fishman; Thomas Kickler; Shaoguang Chen; Hong Tai; Hong Lai; Shenghan Lai Journal: Int J STD AIDS Date: 2018-10-31 Impact factor: 1.359
Authors: Megan M McLaughlin; Yifei Ma; Rebecca Scherzer; Smruti Rahalkar; Jeffrey N Martin; Claire Mills; Jeffrey Milush; Steven G Deeks; Priscilla Y Hsue Journal: JAMA Netw Open Date: 2020-10-01