OASIS

Presentation Abstract

Session Number:	019
	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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