Background: Studies have shown that drug eluting stents outperform bare metal stents in the need for revascularization in myocardial infarction patients. We sought to identify the current practice in HIV positive patients presenting with ST elevation myocardial infarction.
Methods: We used the 2012 National Inpatient Sample database, the largest publically available inpatient database in the United States, to identify adults ≥ 18 years old, with the ICD-9 CM code principal diagnosis of ST elevation myocardial infarction (STEMI). The sample was then divided into two groups based on HIV status using the appropriate ICD-9 CM codes. Demographics , co morbidities, clinical and hospital characteristics were collected and compared between the two groups. The primary outcome was the proportion of patients undergoing percutanous coronary interventions (PCI), and being treated with drug eluting stents (DES) or bare metal stents (BMS).Secondary outcomes were length of hospital stay, total charges and inpatient mortality. Multiple logistic regression models were performed to adjust for patient demographics, hospital characteristics, and co morbidities.
Results: Of 142,865 patients with STEMI admitted in 2012, 615 (0.4%) patients were HIV positive. As compared to HIV negative patients, HIV positive patients were significantly younger (mean age 52.8±0.8 vs. 63.9±0.1, P <0.0001), and fewer were female (15% vs. 33%, P =0.0001). Patients with HIV were also less likely to have hypertension (54% vs. 64%, P =0.02), diabetes (12% vs. 25% p=0.0005), or atrial fibrillation (5% vs. 13%, P=0.0006). However, they were more likely to have depression (9.7% vs. 5.7%, P=0.05), drug abuse (21% vs. 2.5%, P<0.0001), and alcohol abuse (7.3% vs. 3.4%, P=0.02). Despite similar PCI rates following STEMI in both groups (74% vs. 79%, P =0.27), HIV positive patient were less likely to receive drug eluting stents (Adjusted OR 0.54, 95% CI 0.37-0.77, P=0.001), and were more likely to receive bare metal stents (Adjusted OR 1.55, 95% CI 1.06-2.27, P=0.02).There was no significant differences between the groups in terms of hospital length of stay (Adjusted additional mean length of stay -0.125, 95%CI -0.705 to 0.455, P=0.67), total hospital charges (Adjusted additional mean total charges -2012, 95% CI -13510 to 9484, P=0.73) , or in hospital mortality (Adjusted OR 0.92, 95% CI 0.36-2.37, P=0.87).
Conclusions: Although patients with HIV were as likely to undergo PCI when presenting to our nation’s hospitals with STEMI, they were more likely to be treated with bare metal stents as compared to the superior drug eluting stents. No guidelines or obvious clinical rationale can entirely explain this observed finding. Further investigations are needed to better understand the causes of such practice in an effort to optimize health care delivery.