320. Post-Acute Coronary Syndrome Heart Failure in HIV-infected Patients
Session: Poster Abstract Session: HIV Co-morbidities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_HIVCM_FINAL_9 24 rev.pdf (561.7 kB)
  • Background: The presence or persistence of inflammation is believed to contribute to the development of heart failure (HF) after acute coronary syndrome (ACS).  HIV-infected patients are at risk for ACS, however treatment and outcomes in the post-ACS period are not well described.

     Methods: Utilizing our comprehensive electronic medical record, a cross-sectional cohort (1998-2011) was created of HIV+ subjects with ACS and a HIV-negative control cohort matched (4:1) to age, gender, and year (y) of ACS event. ACS was defined as unstable angina, ST-elevation myocardial infarction (STEMI) non-STEMI.  Pre-existing HF was excluded.

     Results: Over 12 y,  we recorded 5,152 ACS-events; 27 men with HIV+ACS+ and matched 108 HIV-ACS+ male controls were identified.  Among ACS+, mean age 54.0 ±6.2y with 75.6% >age 50y (102/135).  All-cause mortality was 9.6%, with 46.2% dying ≤1y post-ACS.  All cause, in-hospital and 1y mortality were not significantly different. Compared to controls, there was a non-significant trend for HF among HIV+ patients (13.0% vs 18.5% p=0.50) with no difference in the mean time to HF (4.7y±5.3vs 4.5y±4.2, p=0.93).  There was a trend for fewer HIV+ post-ACS patients with HF to have undetectable VL or be on ARVs at event (20.0% vs. 52.4% and 60.0% vs. 81.8%, respectively). ACS treatment included percutaneous coronary intervention (PCI) in 73/135 (54.1%); 24/135 (17.8%) had coronary bypass grafting. Among those who underwent PCI, HF was more common in HIV+ACS+ compared to controls (31.3% vs. 8.8%, p=0.02). All HIV-post ACS HF patients required PCI  during ACS event compared to 5/14 (35.7%) without HF (p=0.03).

    Conclusion: The post-ACS period is associated with significant mortality and morbidity, including the development of HF.  PCI was a common treatment modality. We found no significant difference in the development of post-ACS HF between HIV+ and HIV-controls despite a trend for fewer HIV+ post-ACS HF subjects to have been on ARVs or with virologic suppression. Interestingly, in HIV+ACS+ subjects the treatment with PCI was correlated with HF development. Starting or maintaining ARVs to mitigate inflammation may be important in the care of HIV-infected patients in the post-ACS period, particularly among those who require PCI. 

    Philip Lam, MD1, John Meriwether, MD1, Vasilios Papademetriou, MD2 and Angelike P. Liappis, MD3, (1)Georgetown University Medical Center, Washington, DC, (2)Washington DC Veterans Affairs Medical Center and Georgetown University Medical Center, Washington, DC, (3)Washington DC Veterans Affairs Medical Center and The George Washington University Medical Center, Washington, DC

    Disclosures:

    P. Lam, None

    J. Meriwether, None

    V. Papademetriou, None

    A. P. Liappis, None

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