Coronary artery bypass graft is safe in HIV-positive patients but shows higher risk of longer term events
Graham McKerrow, HIV i-Base
Coronary artery bypass graft (CABG) is a feasible and safe procedure in HIV-positive patients, conclude Boccara and colleagues at the French Italian Study on Coronary artery disease in AIDS patients (FRISCA-2). There was no difference in immediate postoperative outcomes between HIV-positive and HIV-negative patients. However. long-term follow-up showed higher rates of major adverse cardiac events (MACE) was significantly higher in HIV-positive patients due to an increased rate of repeat revascularisation procedure (reCABG and percutaneous coronary intervention [PCI]).
From 1997 to 2003 inclusive, researchers compared 22 HIV-positive and 42 HIV-negative control patients matched for age and gender who underwent CABG. They compared baseline characteristics, immediate results and clinical outcome (MACE: death from any cause, myocardial infarction, re-intervention and/or PCI) at 34 months.
Cardiovascular risk factors were nearly identical in both groups with a higher rate of hypercholesterolaemia (96% versus 74%, p=0.045) and hypertriglyceridaemia (82% versus 45%, p=0.005) in HIV-positive patients. Obesity was more frequent in the control group (33% versus 0%, p=0.001).
In the HIV-positive group, mean CD4 count was lower post-operation compared to beforehand (427 +/- 162 vs 503 +/-200 cells/mm3) but this was without clinical significance in the follow-up. Coronary multivessel disease (> 2 vessel disease) was present in nearly all patients (96% HIV-positive and 93% HIV-negative). Left Ventricular Ejection Fraction and mean number of grafts were also similar in the 2 groups (55%+/-10 versus 50%+/-14, respectively.
After one month, the rate of post-operative death, MI, stroke, mediastinitis, and re-intervention was identical in both groups. However, at 34 +/-20 months follow-up, rate of occurrence of first MACE was higher in HIV-positive group. The only predictor of MACE at follow-up was HIV infection itself with a hazard ratio of 6.3 (95%CI 2.2-17.9, p=0.001).
Boccara F, Cohen A, Odi G et al. Coronary artery bypass graft in HIV-infected patients. A multicentre case control study. 6th Lipodystrophy Workshop (6th IWADRLH), Washington. Abstract 115. Antiviral Therapy 2004; 9:L65.