HIV感染者在急性冠状动脉综合征(ACS)或经皮冠状动脉介入治疗(PCI)后的临床结果尚未得到足够详细的表征。现有数据还没有得到充分的综合。
■为了更好地表征ACS或PCI后HIV感染者与HIV阴性对照组患者的临床结局和出院后治疗。
■OvidMEDLINE,Embase,和WebofScience检索了从开始到2023年8月在ACS或PCI后感染HIV患者的所有可用纵向研究。
■纳入的研究符合以下标准:HIV感染者和HIV阴性对照组,出现ACS或接受PCI的患者包括,以及在初始事件发生后收集的纵向随访数据。
■根据系统评价和荟萃分析(PRISMA)的首选报告项目进行数据提取。使用随机效应模型荟萃分析汇集临床结果数据。
■研究了以下临床结果:全因死亡率,主要不良心血管事件,心血管死亡,复发性ACS,中风,新的心力衰竭,全病变血运重建,和全血管血运重建。随访中比较HIV感染者与对照组患者的临床结局的最大调整相对风险(RR)被视为主要结局指标。
■共15项研究,包括9499名HIV感染者(合并比例[范围],76.4%[64.3%-100%]男性;合并平均[范围]年龄,56.2[47.0-63.0]年)和1531117名对照组无HIV患者(合并比例[范围],61.7%[59.7%-100%]男性;合并平均[范围]年龄,包括67.7[42.0-69.4]岁);这两个人群主要是男性,但是感染艾滋病毒的患者年轻了大约11岁。感染艾滋病毒的患者也更有可能是目前的吸烟者(合并比例[范围],59.1%[24.0%-75.0%]吸烟者对42.8%[26.0%-64.1%]吸烟者)和从事非法药物使用(合并比例[范围],31.2%[2.0%-33.7%]的药物使用率与6.8%[0%-11.5%]的药物使用率)和更高的甘油三酯(合并平均值[范围],233[167-268]vs171[148-220]mg/dL)和较低的高密度脂蛋白胆固醇(合并平均值[范围],40[26-43]对46[29-46]mg/dL)水平。对有和没有HIV的人群进行了合并平均(范围)16.2(3.0-60.8)个月和11.9(3.0-60.8)个月的随访,分别。关于出院后的随访,HIV感染者的他汀类药物患病率较低(合并比例[范围],53.3%[45.8%-96.1%]对59.9%[58.4%-99.0%])和β受体阻滞剂(合并比例[范围],与对照组相比,处方为54.0%[51.3%-90.0%]vs60.6%[59.6%-93.6%]),但这些差异没有统计学意义.感染HIV的患者与没有感染HIV的患者相比,全因死亡率的风险显着增加(RR,1.64;95%CI,1.32-2.04),主要不良心血管事件(RR,1.11;95%CI,1.01-1.22),复发性ACS(RR,1.83;95%CI,1.12-2.97),和新的心力衰竭入院(RR,3.39;95%CI,1.73-6.62)。
这些研究结果表明,需要注意二级预防策略,以解决艾滋病毒感染者心血管疾病的不良结局。
UNASSIGNED: Clinical outcomes after acute coronary syndromes (ACS) or percutaneous coronary interventions (PCIs) in people living with HIV have not been characterized in sufficient detail, and extant data have not been synthesized adequately.
UNASSIGNED: To better characterize clinical outcomes and postdischarge treatment of patients living with HIV after ACS or PCIs compared with patients in an HIV-negative control group.
UNASSIGNED: Ovid MEDLINE, Embase, and Web of Science were searched for all available longitudinal studies of patients living with HIV after ACS or PCIs from inception until August 2023.
UNASSIGNED: Included studies met the following criteria: patients living with HIV and HIV-negative comparator group included, patients presenting with ACS or undergoing PCI included, and longitudinal follow-up data collected after the initial event.
UNASSIGNED: Data extraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Clinical outcome data were pooled using a random-effects model meta-analysis.
UNASSIGNED: The following clinical outcomes were studied: all-cause mortality, major adverse cardiovascular events, cardiovascular death, recurrent ACS, stroke, new heart failure, total lesion revascularization, and total vessel revascularization. The maximally adjusted relative risk (RR) of clinical outcomes on follow-up comparing patients living with HIV with patients in control groups was taken as the main outcome measure.
UNASSIGNED: A total of 15 studies including 9499 patients living with HIV (pooled proportion [range], 76.4% [64.3%-100%] male; pooled mean [range] age, 56.2 [47.0-63.0] years) and 1 531 117 patients without HIV in a control group (pooled proportion [range], 61.7% [59.7%-100%] male; pooled mean [range] age, 67.7 [42.0-69.4] years) were included; both populations were predominantly male, but patients living with HIV were younger by approximately 11 years. Patients living with HIV were also significantly more likely to be current smokers (pooled proportion [range], 59.1% [24.0%-75.0%] smokers vs 42.8% [26.0%-64.1%] smokers) and engage in illicit drug use (pooled proportion [range], 31.2% [2.0%-33.7%] drug use vs 6.8% [0%-11.5%] drug use) and had higher triglyceride (pooled mean [range], 233 [167-268] vs 171 [148-220] mg/dL) and lower high-density lipoprotein-cholesterol (pooled mean [range], 40 [26-43] vs 46 [29-46] mg/dL) levels. Populations with and without HIV were followed up for a pooled mean (range) of 16.2 (3.0-60.8) months and 11.9 (3.0-60.8) months, respectively. On postdischarge follow-up, patients living with HIV had lower prevalence of statin (pooled proportion [range], 53.3% [45.8%-96.1%] vs 59.9% [58.4%-99.0%]) and β-blocker (pooled proportion [range], 54.0% [51.3%-90.0%] vs 60.6% [59.6%-93.6%]) prescriptions compared with those in the control group, but these differences were not statistically significant. There was a significantly increased risk among patients living with HIV vs those without HIV for all-cause mortality (RR, 1.64; 95% CI, 1.32-2.04), major adverse cardiovascular events (RR, 1.11; 95% CI, 1.01-1.22), recurrent ACS (RR, 1.83; 95% CI, 1.12-2.97), and admissions for new heart failure (RR, 3.39; 95% CI, 1.73-6.62).
UNASSIGNED: These findings suggest the need for attention toward secondary prevention strategies to address poor outcomes of cardiovascular disease among patients living with HIV.