Clinical characteristics of myocardial infarction in HIV-infected patients: results of a multicenter retrospective study

Aim. To compare the clinical characteristics of acute myocardial infarction (MI) in HIV-infected patients hospitalized in regional vascular centers.

Material and methods. This retrospective analysis included 5990 medical records of patients with MI, among which a group of 38 HIV-infected patients was identified. The control group of patients with MI without HIV infection (n=114) was formed randomly. The groups were compared for demographic data, cardiovascular risk factors (RF), clinical and paraclinical parameters characterizing MI. Associations of MI characteristics with HIV status were assessed using univariate and multivariate logistic regression adjusted for sex, age, body weight and cardiovascular RFs.

Results. Patients with HIV infection, in contrast to HIV-negative patients, were younger (median age 47 and 63 years, respectively). They had a lower body mass index (23,9 and 27,7 kg/m²), lower blood levels of total cholesterol (4,6 and 5,1 mmol/L), non-high-density lipoprotein cholesterol (3,4 and 3,9 mmol/L), glucose (5,8 and 7,1 mmol/L), high-sensitivity C-reactive protein (hsCRP) (5,6 and 24,9 mg/L) and hemoglobin (139,5 and 149,0 g/L), and higher levels of cardiac troponin I (8,0 and 4,1 pg/ml). In the HIV group, anterior MI (71,1% and 41,2%), left anterior descending artery (LAD) involvement (70,4% and 43,0%), left ventricular (LV) systolic dysfunction (36,8% and 20,2%), anemia (34,2% and 7,1%) were more common, while obesity (7,9% and 31,6%) and three-vessel disease (6,9% and 36,0%) were less common. HIV-positive patients underwent coronary angioplasty less often (68,4% and 93,9%). In the adjusted multivariable regression model, independent associations of HIV infection with anterior MI (odds ratio [95% confidence interval] 3,06 [1,05-8,88]), LAD involement (3,5 [1,09-11,29]), three-vessel disease (0,17 [0,03-0,92]), LV systolic dysfunction (4,55 [1,37-15,13]), anemia (8,51 [1,73-41,94]), and hsCRP >5 mg/L (0,08 [0,01-0,49]) were found.

Conclusion. In HIV-infected patients with MI treated in a regional vascular center, anterior MI, LAD disease, LV systolic dysfunction, anemia were more common, blood hsCRP levels were lower, and three-vessel disease was detected less often. Moreover, HIV-infected patients were younger and had fewer traditional cardiovascular risk factors, which suggests additional HIV-associated mechanisms of MI development.

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