1. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
Differences by HIV Serostatus in Coronary Artery Disease Severity and Likelihood of Percutaneous Coronary Intervention following Stress Testing
Matthew J. Feinstein MD1,2,4; Brian Poole MD1; Pedro Engel Gonzalez MD1; Anna E Pawlowski MBA5; Daniel Schneider MS5; Tim S. Provias MD1,2; Frank J. Palella MD1,3; Chad J. Achenbach MD MPH1,3; Donald M. Lloyd-Jones MD ScM1,2,4
From the Northwestern University Feinberg School of Medicine1: Division of Cardiovascular Diseases2 and Division of Infectious Diseases3, Department of Medicine; and the Department of Preventive Medicine4, Northwestern University Feinberg School of Medicine; and the Northwestern Medicine Enterprise Data Warehouse5
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2. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
BACKGROUND
1-HIV-infected persons develop coronary artery disease (CAD) more commonly and earlier than uninfected patients
2-The degree to which existing risk prediction tools are valid among HIV-infected persons is unclear because the few studies evaluating them in HIV-infected populations have involved relatively few individuals, used inadequate assessment of endpoints, or been derived in relatively homogenous cohorts
3-The role of noninvasive testing to stratify CAD risk in this population is not well-defined.
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3. METHODS Study type: Retrospective study of a frequency-matched cohort.
Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
METHODS
Study type:
Retrospective study of a frequency-matched cohort.
Study subjects: HIV+ patients and uninfected controls with abnormal echocardiographic or nuclear stress testing who subsequently underwent coronary angiography were included.
Study endpoints:
Primary end point(s): (1) severe CAD (≥70% stenosis of at least one coronary artery) and (2) performance of PCI.
Secondary end point(s): (1) ≥50% stenosis of at least one coronary artery on angiography; (2) ≥50% stenosis of the left main artery or of ≥3 arteries
Study variables: HIV status (main exposure); Demographics and CVD risk factors were included as covariates
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4. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
Model 1*
Model 2**
Model 3***
HIV+
(N=189)
Uninfected
(N=319)
Odds Radio (95% CI)
P Value
Moderate CAD:
≥50% Stenosis (%) 99
(52.4%)
160 (50.2%)
1.09 ( )
0.63
1.14 ( )
0.49
1.14 ( )
0.56
Severe CAD: ≥70% Stenosis
81 (42.9%)
132 (41.4%)
1.06 ( )
0.74
1.09 ( )
1.02 ( )
0.92
3 Vessel CAD or L Main
35 (18.5%)
52 (16.3%)
1.17 ( )
0.52
1.24 ( )
0.39
1.20 ( )
PCI Performed
48 (25.4%)
1.75 ( )
0.01
1.86 ( )
<0.001
1.85 ( )
0.02
*Model 1: Unadjusted
**Model 2: Adjusted for age, sex, race
***Model 3: Adjusted for age, sex, race, hypertension, diabetes, total cholesterol, HDL cholesterol, antihypertensive use, statin use, stress modality performed, and previous percutaneous coronary intervention or coronary artery bypass grafting
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5. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
CONCLUSIONS
1- Following abnormal cardiovascular stress testing, HIV-infected patients may be more likely than to have significant coronary artery disease on angiography and are significantly more likely to undergo percutaneous coronary intervention. 2- This may reflect an elevated burden of “true” ischemia for HIV-infected persons undergoing stress testing, compared with uninfected persons undergoing stress testing who have similar clinical characteristics and CVD risk factors. 3- Further study is needed to confirm these findings, evaluate differences in coronary ischemia on quantitative coronary angiography by HIV serostatus, and refine cardiovascular risk assessment tools for HIV-infected persons.
Copyright American Society of Nuclear Cardiology