Coronary Artery Bypass Graft in HIV-Infected Patients: A Multicenter Case Control Study

F.      Boccara; A.      Cohen; E.   Di   Angelantonio; C.      Meuleman; S.      Ederhy; G.      Dufaitre; G.      Odi; E.      Teiger; G.      Barbarini; G.      Barbaro

Abstract

Coronary artery disease (CAD) is an emerging complication in HIV-infected patients treated with highly active antiretroviral therapy. Immediate results and long-term outcome after coronary artery bypass graft (CABG) have not been yet evaluated in this population. Between January 1997 and December 2005, we compared baseline characteristics, immediate results and clinical outcome [Major Adverse Cardiac Events (MACE): death for cardiac cause, myocardial infarction (MI), coronary revascularization] at 41 months in 27 consecutive HIV-infected (HIV+) patients and 54 HIVuninfected (HIV-) controls matched for age and gender (mean age of the cohort, 49±8 years; 96% male) who underwent CABG. Cardiovascular risk factors were well-balanced and nearly identical in both groups. In HIV+ group, mean preoperative CD4 was 502±192/mm3 compared with 426.2±152.6/mm3 postoperatively (p=0.004) without clinical manifestations at follow-up. At 30-day, the rate of post-operative death, MI, stroke, mediastinitis, re-intervention was identical in both groups. At follow-up [median: 41-months (range: 34-60)], rate of occurrence of 1st MACE was higher in HIV+ group compared with HIV- group (11, 42% versus 13, 25%, p±0.03), mostly due to the need of repeated revascularization using percutaneous coronary intervention of the native coronary arteries but not of the grafts in the HIV+ group [9 (35%) versus 6 (11%), p±0.02]. CABG is a feasible and safe revascularization procedure in HIV+ patients with multivessel CAD. Immediate postoperative outcome was similar compared to controls. However, long-term followup was significantly different, due to an increased rate of repeated revascularization procedure in the native coronary arteries of HIV+ patients.

Keywords: Coronary artery disease, Coronary artery bypass graft, Coronary revascularization, HIV infection, Highly active antiretroviral treatment

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