Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

J Gen Intern Med. 2020 Jan;35(1):57-62. doi: 10.1007/s11606-019-05416-6. Epub 2019 Nov 11.


Introduction: Previous studies have reported lower rates of coronary angiography and revascularization, and significantly higher mortality among patients infected with human immunodeficiency virus (HIV) presenting with acute myocardial infarction (AMI). This observational study was designed to evaluate characteristics and inpatient outcomes of patients with seropositive HIV infection presenting with AMI.

Methods: Using the National Inpatient Sample (NIS) database, we identified patients (admissions) with a primary diagnosis of myocardial infarction and a co-occurring HIV. We described baseline characteristics and outcomes. Our primary outcomes of interest were prevalence of coronary angiography, revascularization (percutaneous coronary intervention (PCI) or CABG), and mortality.

Results: From 2010 to 2014, of about 2,977,387 patients with a primary diagnosis of AMI, 10,907 (0.4%) were HIV seropositive. Patients with HIV were younger and more likely to be African American or Hispanic. Coronary angiography and revascularization were performed more frequently in the HIV population. The higher prevalence of revascularization was driven by a higher incidence of PCI. In a multivariable model, patients with HIV were no more likely to undergo revascularization than the general population. This was also the case for PCI. Unadjusted all-cause mortality was lower among patients with HIV. After controlling for confounders, this finding was not significant (OR 0.97, 95% CI 0.75-1.25, p = 0.79). The length of stay between both groups was comparable.

Conclusion: In this current analysis, we did not note any treatment bias or difference in the rate of in-hospital total mortality for HIV-seropositive patients presenting with AMI compared with the general population.

Keywords: acute myocardial infarction; human immunodeficiency virus; revascularization.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • HIV Infections* / complications
  • HIV Infections* / epidemiology
  • HIV Infections* / therapy
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Myocardial Infarction* / epidemiology
  • Myocardial Infarction* / therapy
  • Percutaneous Coronary Intervention*
  • Treatment Outcome