1. Coronary revascularization for acute myocardial infarction in the HIV population.
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Singh, Vikas, Mendirichaga, Rodrigo, Savani, Ghanshyambhai T., Rodriguez, Alexis P., Dabas, Nitika, Munagala, Anish, Alfonso, Carlos E., Cohen, Mauricio G., Elmariah, Sammy, and Palacios, Igor F.
- Subjects
REVASCULARIZATION (Surgery) ,HIV ,MYOCARDIAL infarction treatment ,PERCUTANEOUS coronary intervention ,MEDICAL care costs - Abstract
Objective: To analyze trends in management and outcomes of patients infected with the human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI) in the United States.Background: Infection with HIV is an independent risk factor for accelerated atherosclerosis associated with higher rates of AMI. Current trends and outcomes of HIV-infected individuals presenting with AMI in the United States remain unknown.Methods: Using the Healthcare Cost and Utilization Project National Inpatient Sample database we identified HIV-infected individuals who underwent PCI for an AMI from 2002 to 2013. Multivariable logistic regression and propensity-score matching were performed to analyze outcomes.Results: We identified a total of 59 194 patients of which 7841 underwent PCI during index hospitalization (13.3%). Most patients were men (71%), ≥50 years of age (82%), and white (74%). ST-elevation myocardial infarction was present in 21% of cases. Charlson comorbidity index (CCI) was 5.67 ± 0.4. Predictors of post-procedural complications included female sex, black race, higher CCI, and placement of a bare metal stent, whereas predictors of mortality included occurrence of a complication, ST-elevation myocardial infarction, age ≥70 years, and higher CCI. Conversely, placement of a drug-eluting stent was associated with a reduced risk of complications and mortality. After propensity-score matching, HIV-infected individuals were less likely to undergo PCI and receive a drug-eluting stent, while having longer length of stay, higher hospitalization costs, and higher in-hospital mortality when compared to non-infected individuals.Conclusion: Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States. [ABSTRACT FROM AUTHOR]- Published
- 2017
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