Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS). Feinstein, M. J., Nance, R. M., Delaney, J. A. C., Heckbert, S. R., Budoff, M. J., Drozd, D. R., Burkholder, G. A., Willig, J. H., Mugavero, M. J., Mathews, W. C., Moore, R. D., Eron, J. J., Napravnik, S., Hunt, P. W., Geng, E., Hsue, P., Peter, I., Lober, W. B., Crothers, K., Grunfeld, C., Saag, M. S., Kitahata, M. M., Lloyd-Jones, D. M., & Crane, H. M. BMC medicine, 17(1):149, July, 2019.
Mortality following myocardial infarction among HIV-infected persons: the Center for AIDS Research Network Of Integrated Clinical Systems (CNICS) [link]Paper  doi  abstract   bibtex   
BACKGROUND: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. METHODS: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. RESULTS: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. CONCLUSIONS: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.
@article{feinstein_mortality_2019,
	title = {Mortality following myocardial infarction among {HIV}-infected persons: the {Center} for {AIDS} {Research} {Network} {Of} {Integrated} {Clinical} {Systems} ({CNICS})},
	volume = {17},
	issn = {1741-7015},
	shorttitle = {Mortality following myocardial infarction among {HIV}-infected persons},
	url = {https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-019-1385-7},
	doi = {10.1186/s12916-019-1385-7},
	abstract = {BACKGROUND: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown.
METHODS: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI.
RESULTS: Among the 596 out of 28,186 PWH who experienced MI (2.1\%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39\%, 52\%, and 62\%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15\%, 22\%, and 30\%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load.
CONCLUSIONS: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.},
	language = {eng},
	number = {1},
	journal = {BMC medicine},
	author = {Feinstein, Matthew J. and Nance, Robin M. and Delaney, J. A. Chris and Heckbert, Susan R. and Budoff, Matthew J. and Drozd, Daniel R. and Burkholder, Greer A. and Willig, James H. and Mugavero, Michael J. and Mathews, William C. and Moore, Richard D. and Eron, Joseph J. and Napravnik, Sonia and Hunt, Peter W. and Geng, Elvin and Hsue, Priscilla and Peter, Inga and Lober, William B. and Crothers, Kristina and Grunfeld, Carl and Saag, Michael S. and Kitahata, Mari M. and Lloyd-Jones, Donald M. and Crane, Heidi M.},
	month = jul,
	year = {2019},
	pmid = {31362721},
	pmcid = {PMC6668167},
	keywords = {Acquired Immunodeficiency Syndrome, Adult, Aged, Cardiovascular diseases, Cohort Studies, Community Networks, Comorbidity, Epidemiology, Female, HIV Infections, Human immunodeficiency virus, Humans, Male, Middle Aged, Mortality, Multicenter study, Myocardial Infarction, Myocardial infarction, Plaque, Atherosclerotic, United States},
	pages = {149},
}
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