Spectrum From Acute Myocardial Injury to Infarction Among People With Human Immunodeficiency Virus Seeking Emergency Care in the United States: Presentations, Provider Responses, and Clinical Outcomes.

BACKGROUND: In the United States (US), people with human immunodeficiency virus (PWH) have an increased risk of myocardial infarction, including type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI). Presentations and clinical trajectories of PWH experiencing acute myocardial injury (AMI) have not been well characterized. METHODS: Leveraging electronic health records (EHRs) from a US academic medical center, we identified PWH presenting to the emergency department from 2015 to 2019 with a troponin T ≥99th percentile. Presentations were adjudicated as AMI, T2MI, or T1MI. Clinical presentations, provider-level responses, and ensuing clinical outcomes (post-index event) were compared. Among PWH with AMI or T2MI, observed incidence of ensuing major adverse cardiovascular event (MACE) was evaluated using the cumulative incidence function by Aalen estimator. Adjusted cause-specific Cox proportional hazards models were used to assess the association between presentation type and ensuing MACE. RESULTS: Among 79 cases analyzed, presentations of AMI and T2MI were more common than T1MI (29.1% and 64.6% vs 6.3%, respectively). Infection represented the most common event trigger for AMI and T2MI. Among PWH presenting with AMI versus T2MI, there was no difference in risk of ensuing MACE (adjusted hazard ratio, 1.14 [95% confidence interval, .48-2.71]). The proportion of cases of AMI versus T2MI not categorized with any cardiovascular disease-related diagnosis code differed significantly (91% vs 53%, P = .001). CONCLUSIONS: Among US PWH presenting for emergency care, AMI was infrequently coded in the EHR. AMI and T2MI were associated with comparable rates of ensuing MACE. Enhanced recognition/documentation of AMI among PWH will facilitate development of preventive care approaches.

Duke Scholars

Author Brian M. Mugo Medicine, General Internal Medicine