Introduction: The rate of acute myocardial infarction (AMI) in patients with Human Immunodeficiency Virus (HIV) is higher than in the general population without the disease. Studies have reported gender bias in the management of patients with AMI in the general population. This observational study is designed to evaluate if gender differences exist in the management of HIV patients admitted for a diagnosis of AMI.
Methods: Using the National Inpatient Sample (NIS) database, we identified patients with a primary diagnosis of myocardial infarction and a secondary diagnosis of HIV. We described baseline characteristics and outcomes using International Classification of Diseases (ICD-CM), clinical classification software (CCS) and NIS documentation. We performed logistic regression analysis of gender with revascularization as the primary outcome. Our primary outcomes of interest were Revascularization and Mortality.
Results: From 2010 to 2014, of about 2,977,387 patients with a primary diagnosis of AMI, 10,907 (0.4%) had HIV. After exclusions, exclusions, 10,810 patients were included in the final analysis. The mean age was 54.1±9.3 and 18.9% (n=2,043) were female. Females were younger (53.1±9.7 vs. 44.3±9.1, p<.01) and more likely to be black (57.2% vs 36%, p<.01). They were also more likely to have hypertension, diabetes obesity and anemia (all p<.05). They were however less likely to have a history of CAD or prior PCI. Revascularization was performed less frequently in women (45.4% vs 62.7%, p<.01). This was driven primarily per the lower incidence of PCI (39.6% vs 55.9%) In a multivariate model, females were less likely to undergo revascularization (OR 0.59, 95% CI .45-.78; p<.01) a finding driven solely by PCI (OR .64, 95% CI .49-83; p<.01). All-cause mortality was slightly higher in females, although not statistically significant (3.2% vs 3.5%, p=.75), while the median length of stay was longer in females (4 vs 3 days, p<.01).
Conclusions: Acute myocardial infarction was more common in males with HIV. Females with HIV were more likely to be younger and black. Females with HIV had a significantly lower odds of revascularization by PCI.