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ACUTE CORONARY SYNDROME IN RETROVIRAL POSITIVE PATIENTS CHALLENGES AND DILEMMAS WITH SPECIAL EMPHASIS ON CORONARY REVASCULARIZATION
1277 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology ACUTE CORONARY SYNDROME IN RETROVIRAL POSITIVE PATIENTS CHALLENGES AND DILEMMAS WITH SPECIAL EMPHASIS ON CORONARY REVASCULARIZATION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Timely Topics in Acute Coronary Syndromes Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-160 Authors: Natraj Setty, Nagaraja Moorthy, T. R. Raghu, Srinivas B. C., Srinivas K. H., I. Beeresh, Rangaraj Ramalingam, Jayashree Kharge, Manjunath C. N., Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India Background: Therapy of HIV with Highly Active Anti-Retroviral Therapy is getting better,life span of this selected subgroup of patients has significantly increased and this has brought forth a new challenge.The prevalence of cardiovascular diseases is increasing in these patients.The aim of our study was to study the clinical profile of HIV infected patients presenting with acute coronary syndrome and their in-hospital outcome and therapeutic challenges with respect to revascularization.
Methods: We studied consecutive 60 patients infected with HIV and presenting with acute coronary syndrome to our acute coronary care unit between 2013 to September 2016.The baseline clinical characteristics,fibrinolytic therapy,angiographic findings,results of PCI and inhospital outcome were studied.
Results: The mean age of patients was 40 years which is lower than HIV uninfected patients.Most patients presented with Acute Anterior Wall ST Elevation Myocardial Infarction (n=45, 75%).59 patients(98%)received thrombolytic therapy with streptokinase.Thombolysis was successful in 47 (78.33%)and failed in 13 (21.67%)patients.Two patients underwent rescue angioplasty and primary PCI was done in 2 patients.Coronary Angiography was done in all the patients revealing significant residual stenosis in 26 patients.Three vessel coronary artery diseases was seen in only 2 patients(3.33%),Two vessel coronary artery disease was seen in 16 patients(26.67%).42 patients(70%) had significant LAD lesion.All patients with significant residual lesions(n=26)underwent PCI with Drug Eluting Stents.1 patient died due to cardiogenic shock.All 59 patients were followed up for one year and one patient had recurrence of angina at 6 months due to ISR for which repeat revascularization was done.All patients are receiving adjuvant HAART. Conclusions: HIV infected patients hospitalized for an ACS is relatively younger.The presentation and outcome of ACS in this population are similar to rest of uninfected patients.Anterior wall MI is the most common presentation hence LAD is the most common culprit vessel. HIV status and HAART therapy didn’t interfere with revascularization approach or clinical outcome.
Interventional Cardiology ACUTE CORONARY SYNDROME IN RETROVIRAL POSITIVE PATIENTS CHALLENGES AND DILEMMAS WITH SPECIAL EMPHASIS ON CORONARY REVASCULARIZATION Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m. Session Title: Timely Topics in Acute Coronary Syndromes Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-160 Authors: Natraj Setty, Nagaraja Moorthy, T. R. Raghu, Srinivas B. C., Srinivas K. H., I. Beeresh, Rangaraj Ramalingam, Jayashree Kharge, Manjunath C. N., Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India Background: Therapy of HIV with Highly Active Anti-Retroviral Therapy is getting better,life span of this selected subgroup of patients has significantly increased and this has brought forth a new challenge.The prevalence of cardiovascular diseases is increasing in these patients.The aim of our study was to study the clinical profile of HIV infected patients presenting with acute coronary syndrome and their in-hospital outcome and therapeutic challenges with respect to revascularization.
Methods: We studied consecutive 60 patients infected with HIV and presenting with acute coronary syndrome to our acute coronary care unit between 2013 to September 2016.The baseline clinical characteristics,fibrinolytic therapy,angiographic findings,results of PCI and inhospital outcome were studied.
Results: The mean age of patients was 40 years which is lower than HIV uninfected patients.Most patients presented with Acute Anterior Wall ST Elevation Myocardial Infarction (n=45, 75%).59 patients(98%)received thrombolytic therapy with streptokinase.Thombolysis was successful in 47 (78.33%)and failed in 13 (21.67%)patients.Two patients underwent rescue angioplasty and primary PCI was done in 2 patients.Coronary Angiography was done in all the patients revealing significant residual stenosis in 26 patients.Three vessel coronary artery diseases was seen in only 2 patients(3.33%),Two vessel coronary artery disease was seen in 16 patients(26.67%).42 patients(70%) had significant LAD lesion.All patients with significant residual lesions(n=26)underwent PCI with Drug Eluting Stents.1 patient died due to cardiogenic shock.All 59 patients were followed up for one year and one patient had recurrence of angina at 6 months due to ISR for which repeat revascularization was done.All patients are receiving adjuvant HAART. Conclusions: HIV infected patients hospitalized for an ACS is relatively younger.The presentation and outcome of ACS in this population are similar to rest of uninfected patients.Anterior wall MI is the most common presentation hence LAD is the most common culprit vessel. HIV status and HAART therapy didn’t interfere with revascularization approach or clinical outcome.