Background: Whereas statins are well-known to contribute to atheromatic plaque stability and regression of atherosclerosis burden, possible interactions with anti-retroviral therapy have led to sub-prescription in this cohort. However, exactly how statins affect the angiographic phenotype, coronary lesion characteristics and clinical outcomes in HIV patients undergoing PCI has not yet been investigated.
Aim: To assess and describe the angiographic features and burden of Coronary Artery Disease (CAD) between HIV patients pre-treated with statins as compared to statin naïve patients undergoing Percutaneous Coronary Intervention (PCI).
Methods: This is a retrospective, single-center study comparing pre-treated with statin to statin-naïve HIV patients who underwent PCI between 2003-2011. Quantitative coronary angiography (QCA) was performed for all treated lesions at baseline and following PCI in both groups. 1- Year clinical outcomes post-PCI were also analyzed and compared.
Results: Statin pre-treated patients (n=47, 51%) had more frequently hyperlipidemia (95% vs. 50%, p<0.001), had higher weight (86 kg vs. 77kg, p=0.04), were more likely to have known coronary disease (17% vs. 4%, p=0.04) and presented more frequently with acute coronary syndrome (57.4% vs. 37%, p=0.04) as compared to those without pretreatment. Both groups had similar grade of stenosis and extent of CAD as measured by presence of multi-vessel disease as well as SYNTAX score; however statin pre-treated patients were more likely to have moderate/heavy calcified lesions and treated with drug eluting stents as compared to statin naïve patients. Residual syntax score post-PCI was significantly higher in the statin pre-treated group (4.65 +/- 7.4 vs. 1.9 +/- 3.8, p= 0.03). Major adverse cardiac event (MACE) rates at 1 year were significantly lower in the statin pre-treatment group.
Conclusion: While statin pre-treatment HIV patients were more likely to present with ACS and had worse cardiovascular risk profile, detailed coronary angiographic analysis reveals no significant differences in CAD burden and lesion characteristics. Statin use is associated with more favorable clinical outcomes at 1 year post-PCI suggesting the beneficial effects of statins in atherosclerosis progression in HIV patients.