Background: It is known that HIV-infected patients have an elevated risk of acute coronary syndromes, especially STEMI. The relationship between HCV infection and cardiovascular disease (CVD) risk is less well established. Data are scant, however, as to how HIV or HCV influence outcomes post-STEMI, particularly in vulnerable U.S. urban settings.
Methods: We evaluated the relationship of HIV and HCV with outcomes among 1208 patients presenting to Montefiore Health System between 2008 and 2014 with acute STEMI. Clinical, laboratory, treatment, and rehospitalization data were obtained from medical records and administrative data, and mortality from the NDI.
Results: There were 1152 uninfected (HIV-/HCV-), 22 HIV monoinfected (HIV+), 26 HCV monoinfected (HCV+) and 8 coinfected (HIV+/HCV+) patients. Compared to HIV-/HCV-, HIV+ were younger (50 vs 60 yrs), had lower BMI (26 vs 28 kg/m2), WBC (9300 vs 10800/μL) and HbA1c (5.5 vs 6.1%), with more smokers (68 vs 37%) and cocaine users (18 vs 5%), and higher biochemical indices of liver fibrosis (APRI and FIB-4). HCV+ had lower LVEF (39 vs 51%), more smokers (62 vs 37%), heavy alcohol users (31 vs 9%), Killip Class 4 (19 vs 8%) and kidney disease (46 vs 23%), and liver disease indices, and lower statin Rx at discharge (76 vs 97%). (All p<0.05). HIV+/HCV+ had more adverse characteristics, but comparisons were limited by small sample size. Over median f/u of 4.3 yrs, HIV+ had higher adjusted HRs for death and any readx or CVD readx that were marginally non-significant. HCV+ was associated with significantly higher adjusted HR’s for death, death or any readx, and death or HF readx (Table).
Conclusions: In this low-income community, HCV+ STEMI patients had significantly increased risks of adverse outcomes, which were marginally non-significant for HIV+. These findings highlight the adverse impact of HCV in the context of STEMI, indicating the importance of novel direct antiviral agents for reducing the morbidity of this infection in this setting.