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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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HIV and acute coronary syndromes: a 10-year analysis from a single centre prospective registry
Session:
CO 02 - Isquemia/SCA
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gustavo Sá Mendes; António Tralhão; Catarina Brízido; Franscisco Fernandes Gama; JOANA LIMA; Carlos Aguiar; Jorge Santos Ferreira; Miguel Mendes
Abstract
<p><strong>Background: </strong>Human immunodeficiency virus (HIV) infection and associated anti-retroviral therapy are accepted risk factors for coronary atherosclerosis and major cardiovascular (CV) events. We sought to characterize the risk profile and outcomes of an HIV population presenting with acute coronary syndromes (ACS).</p> <p><strong>Methods: </strong>Single-centre retrospective study of 5071 consecutive patients admitted to a tertiary high-volume centre with a diagnosis of ACS between February 2006 and October 2017. HIV status was defined as known follow-up in our institution or referring hospitals’ HIV outpatient clinic. Traditional CV risk factors were collected from the institution’s prospective registry. ROC curve analysis and c-statistics were obtained to discriminate the occurrence of CV mortality and a composite of CV mortality, stroke and myocardial infarction (MACCE) according to HIV status.</p> <p><strong>Results: </strong>In the whole ACS population, 27 (0.5 %) patients had previously known and treated HIV infection. In these patients, the most frequent presentation was STEMI (n = 18) and all underwent revascularization (23 PCI, 4 CABG). In-hospital mortality was 7.4% (2 patients, 1 CV death) and in a mean follow up of 3.1 ± 2.9 years 8.0% (n = 2) died from CV causes. When compared to the non-HIV patients, HIV-patients were younger, more frequently male, had increase prevalence of hyperlipidaemia or tobacco use and presented more frequently with STEMI (Table). Lower last CD4 count [c-statistic 0.884 (CI 95% 0.726-1.00; c-statistic 0.672 (CI 95% 0.421-0.923)], lower nadir CD4 count [c-statistic 0.841 (CI 95% 0.688-0.994; c-statistic 0.715 (CI 95% 0.432-0.938)], higher last viral copy count [c-statistic 0.952 (CI 95% 0.861-1.00; c-statistic 0.673 (CI 95% 0.430-0.916)] and lower duration of HIV-infection [c-statistic 0.855 (CI 95% 0.635-1.00; c-statistic 0.791 (CI 95% 0.614.0.967)] were significantly associated with increased CV mortality and MACCE, respectively. GRACE score did not differ significantly among survivors vs. non-survivor or in those with MACCE vs. without MACCE (p = 0.689, p = 0.386).</p> <p><strong>Conclusions: </strong>The HIV population with ACS had distinctive demographic and risk profiles. In this population, less prolonged disease duration and heightened disease activity were associated with increased cardiovascular death and MACCE.</p>
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