Influence of Human Immunodeficiency Virus Infection on the Management and Outcomes of Acute Myocardial Infarction with Cardiogenic Shock.

BACKGROUND: There are limited data on the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS).

SETTING: 20% sample of all United States hospitals METHODS:: A retrospective cohort of AMI-CS during 2000-2017 from the National Inpatient Sample was evaluated for concomitant HIV and AIDS. Outcomes of interest included in-hospital mortality and use of cardiac procedures. A sub-group analysis was performed for those with and without AIDS within the HIV cohort.

RESULTS: A total 557,974 AMI-CS admissions were included, with HIV and AIDS in 1,321 (0.2%) and 985 (0.2%), respectively. The HIV cohort was younger (54.1 vs. 69.0 years), more often male, of non-white race, uninsured, from a lower socio-economic status and with higher comorbidity (all p<0.001). The HIV cohort had comparable multiorgan failure (37.8% vs. 39.0%) and cardiac arrest (28.7% vs. 27.4%) (p>0.05). The cohorts with and without HIV had comparable rates of coronary angiography (70.2% vs. 69.0%; p=0.37), but less frequent early coronary angiography (hospital day zero) (39.1% vs. 42.5%; p<0.001). The cohort with HIV had higher unadjusted but comparable adjusted in-hospital mortality compared to those without (26.9% vs. 37.4%; adjusted odds ratio 1.04 [95% confidence interval 0.90-1.21]; p=0.61). In the HIV cohort, AIDS was associated with higher in-hospital mortality (28.8% vs. 21.1%; adjusted odds ratio 4.12 [95% confidence interval 1.89-9.00]; p<0.001).

CONCLUSIONS: The cohort with HIV had comparable rates of cardiac procedures and in-hospital mortality; however those with AIDS had higher in-hospital mortality.