Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy

作者：D' Ascenzo Fabrizio; Cerrato Enrico; Biondi Zoccai Giuseppe; Moretti Claudio; Omede Pierluigi; Sciuto Filippo; Bollati Mario; Modena Maria Grazia; Gaita Fiorenzo; Sheiban Imad

来源：European Heart Journal, 2012, 33(7): 875-880.

DOI：10.1093/eurheartj/ehr456

• Acute coronary syndromes
• HIV
• Mortality
• Antiretroviral therapy
• Meta-analysis
• Observational registries

Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. %26lt;br%26gt;MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95 confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95 CI]. Rates of in-hospital death were 8.00 (2.8, 12.5; 95 CI), ascribable to cardiovascular events for 7.90 (2.43, 13.37; 95 CI), with 2.31 (0.60, 4.01; 95 CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95 CI), no deaths were recorded, with an incidence of 9.42 of acute myocardial infarction (2.68, 16.17; 95 CI) and of 20.18 (9.84, 30.51; 95 CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95 CI). %26lt;br%26gt;Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.

• 出版日期2012-4