Sex differences in the contemporary management of HIV patients admitted for acute myocardial infarction

Clin Cardiol. 2018 Apr;41(4):488-493. doi: 10.1002/clc.22902. Epub 2018 Apr 19.


Background: Studies have reported sex differences in the management of patients with acute myocardial infarction (AMI) in the general population. This observational study is designed to evaluate whether sex differences exist in the contemporary management of human immunodeficiency virus (HIV) patients admitted for diagnosis of AMI.

Hypothesis: There is no difference in management of HIV patients with AMI.

Methods: Using the National Inpatient Sample database, we identified patients with a primary diagnosis of AMI and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using NIS documentation. Our primary areas of interest were revascularization and mortality.

Results: Among 2 977 387 patients presenting from 2010 to 2014 with a primary diagnosis of AMI, 10907 (0.4%) had HIV (mean age, 54.1 ± 9.3 years; n = 2043 [18.9%] female). Females were younger, more likely to be black, and more likely to have hypertension, diabetes, obesity, and anemia. Although neither males nor females were more likely to undergo coronary angiography in multivariate analysis, revascularization was performed less frequently in females than in males (45.4% vs 62.7%; P < 0.01), driven primarily by lower incidence of PCI. In a multivariate model, females were less likely to undergo revascularization (OR: 0.59, 95% CI: 0.45-0.78, P < 0.01), a finding driven solely by PCI (OR: 0.64, 95% CI: 0.49-0.83, P < 0.01). All-cause mortality was similar in both groups.

Conclusions: AMI was more common in males than females with HIV. Females with HIV were more likely to be younger and black and less likely to be revascularized by PCI.

Keywords: Acute Myocardial Infarction; Human Immunodeficiency Virus; Sex Differences.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Black or African American
  • Chi-Square Distribution
  • Comorbidity
  • Coronary Angiography / trends
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / mortality
  • Coronary Artery Bypass / trends*
  • Databases, Factual
  • Female
  • HIV Infections / diagnosis
  • HIV Infections / ethnology
  • HIV Infections / mortality
  • HIV Infections / therapy*
  • Health Status Disparities
  • Healthcare Disparities / trends*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Percutaneous Coronary Intervention / adverse effects
  • Percutaneous Coronary Intervention / mortality
  • Percutaneous Coronary Intervention / trends*
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / ethnology
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Sex Factors
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult