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Background:  Acute coronary syndromes and coronary artery disease are an emerging complication in HIV-infected patients under highly active antiretroviral treatment. Prognosis of coronary revascularization (coronary angioplasty and coronary artery bypass graft) remains unknown in this population.

Methods:  Using a 2 case-control study design‑FRISCA-1 for percutaneous coronary intervention and FRISCA-2 for coronary artery bypass graft‑we compared baseline characteristics and outcome:  major adverse cardiac event, defined as cardiac death, non-fatal myocardial infarction, or target lesion ± vessel revascularization in 44 HIV-infected patients (HIV⁺) and 44 controls (HIV^-) matched for age and gender who underwent percutaneous coronary intervention (FRISCA-1, 2001-2003) and 19 HIV⁺ and 38 HIV^- who underwent coronary artery bypass graft (FRISCA-2, 1997-2003).

Results:  Cardiovascular risk factors (smoking, hypercholesterolemia [total cholesterol >220 mg/dL], increased LDLc [>160 mg/dL], diabetes mellitus, hypertension) and clinical characteristics at the time of coronary revascularization were not significantly different in the HIV⁺ and HIV^- groups. Hypertriglyceridemia [>175 mg/dL] and low HDL [<40 mg/dL] were more frequent in HIV⁺ than in HIV^- (81% vs 42% and 91% and 37%, p <0.001, respectively) whether obesity and family history of premature coronary artery disease were more frequent in HIV^- than in HIV⁺ (0% vs 16% and 7% and 30%, p <0.01, respectively). Angiographic characteristics (number of vessel disease, TIMI flow, left ventricular ejection fraction) were identical in the 2 groups. Indication for coronary revascularization were different in the 2 groups with a higher rate late diagnosed myocardial infarction (myocardial infarction <1 month but >24 hours) for HIV⁺ in FRISCA-1 and 2 and less frequent acute myocardial infarction (<24 hours) for HIV⁺ in FRISCA-1 compared with HIV^-. Procedural success rate was achieved in 98% and in-hospital course was uneventful in the 2 groups in FIRSCA-1 and 2. Clinical outcomes are depicted in the table.

Conclusions:  Coronary revascularization using whether percutaneous coronary intervention or coronary artery bypass graft is feasible and safe in HIV-infected patients. Mid-term follow-up demonstrated no difference in major adverse cardiac event between HIV⁺ and HIV^- patients at 1 year in FRISCA-1 and a higher rate of major adverse cardiac event at 29 months in FRISCA-2. Large prospective studies on coronary revascularization in HIV-infected patients are warranted.

Clinical Outcomes in FRISCA-1 and 2

CABG: coronary artery bypass graft, MACE: Major Adverse Cardiac Event, MI: myocardial infarction, PCI: percutaneous coronary intervention, TLR: target lesion revascularization, TVR: target vessel revascularization

Keywords: Cardiovascular disease; Coronary artery disease; Coronary artery bypass graft