Author + information
- Praskas Chandra Mandal1
Coronary artery disease has emerged as one of the common chronic co-morbid conditions with improved survival with highly active antiretroviral therapy in patients with ‘HIV' infection. The risk of coronary artery disease is high in ‘HIV' infected patients with more long diffuse lesions and more acute presentations which got heightened with antiretroviral therapy.
The objective of this study was to evaluate procedural outcomes and long-term prognosis of ‘PCI' in ‘HIV' infected patients.
This Comparative observational study was conducted in Apollo-Gleneagles hospital, Kolkata, India. From November 2003 to June 2016. Clinical outcome analysis of ‘32' ‘HIV' infected patients and ‘32' age and sex matched control undergone ‘PC' were done. Baseline demographic data, cardiovascular risk factors, indications for ‘PCI', angiographic results and in-hospital clinical events and 5 years clinical outcomes were analyzed.
Cardiovascular risk factors were well comparable in both groups. Typical Indian dyslipidemia (low HDL and high triglyceride level) were prevalent in both groups but more in ‘HIV' infected group. Presentation with acute coronary syndromes was more prevalent in ‘HIV' infected group (22 of 32; 68.75% vs 12 of 32; 37.50% p<0.01). Procedural success rates were comparable except one death in ‘HIV' infected group due to ventricular fibrillation. The in-hospital course was uneventful in both groups including no acute stent thrombosis. Clinical restenosis was higher in ‘HIV' infected group (15.6%) than non-infected group (6.2%) (p<0.01). Very long (.30 mm) lesion type was a predictor of restenosis. CD4 cell count and type of ongoing retroviral drugs has no impact on MACE or restenosis.
‘PCI' is safe and similarly successful in HIV+ and HIV- patients with stable and unstable coronary artery disease. Relatively higher rates of MACE and TVR noted in HIV+ patients. Clinical restenosis rate is also high in HIV+ patients. Angiographic restenosis was not evaluated in this study.