Presentation Abstract

Session: 019-Opportunistic Infections and Co-Morbid Conditions in HIV-I
Sunday, Sep 09, 2012, 11:30 AM - 1:30 PM
Presentation Title: H-228 - In-Hospital Mortality from Acute Myocardial Infarction: HIV Sero-positive vs. Sero-negative Individuals
Location: Halls A-C
Presentation Number: H-228
Pres. Time: Sunday, Sep 09, 2012, 11:30 AM - 1:30 PM
Category: H1
Keywords: acute myocardial infarction; HIV; in-hospital mortality
Author(s): D. D. Pearce, Other - Associate Clinical Professor1, C. Ani, MD, MPH - Assistant Professor 2, Y. Espinosa-Silva, BS - Student 3, R. Clark, BS - Student 3, K. Fatima, BS - Student 3, M. Rahman, BS - Student 3, E. Diebolt, DO - Resident 3, B. Ovbiagele, MD - Professor 4;
1Loma Linda Univ., Loma Linda, CA, 2Charles Drew Univ., Compton, CA, 3Western Univ. of Hlth. Sci., Coll. of Osteopathic Med. of the Pacific, Pomona, CA, 4Univ. of California, San Diego, San Diego, CA.
Financial Disclosures:  D. D. Pearce, None..
C. Ani, None..
Y. Espinosa-Silva, None..
R. Clark, None..
K. Fatima, None..
M. Rahman, None..
E. Diebolt, None..
B. Ovbiagele, None.
Abstract: Background: Few studies have explored hospitalization outcome differences among HIV sero-positives when compared to HIV sero-negatives with acute myocardial infarction (AMI). Methods: Secondary analysis of the Nationwide Inpatient Sample from 1997-2006. This sample allows for the approximation of all US hospitalizations. All AMI encounters with and without co-occurring HIV were identified using appropriate ICD and procedure codes. We then conducted descriptive and Cox proportional hazard analysis to estimate mortality differences among sero-positives compared to sero-negatives while adjusting for demographic, clinical, hospital, and care factors. Results: demonstrated unadjusted, higher AMI hospitalization mortality hazard among sero-positives when compared to sero-negatives (HR=1.43, 95% CI=1.07-1.90, sig<0.02). Mortality hazard remained high after adjustment for age, gender, and ethnicity (HR=1.64, 95% CI=1.20-2.25, sig=0.02). Similar results occurred after additional adjustment for medical co-morbidity and hospital type (HR=1.41) and medical comorbidity, hospital type and number of in-hospital procedures (HR=1.38). Stratified analysis demonstrated greater though not statistically significant mortality hazard for NSTEMI and STEMI among sero-positives vs. sero-negatives. Typical AMI care procedures occurred at significantly lower rates among sero-positives vs. sero-negatives, including: thrombolytic/anticoagulants (17.6% vs. 22.2%) coronary arteriography (48.0% vs. 62.5%), left cardiac catheterization (52.2% vs. 66.0%), coronary artery bypass graft (6.0% vs. 13.8%). Conclusions: Additional mortality burden and lower procedure rates occur for HIV sero-positives receiving AMI care. Healthcare providers should be alert to the increased mortality burden when treating sero-positives with AMI. Studies to evaluate factors associated with this differential outcome are required.

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