2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Approaches to MI ascertainment

Positivepredictive value 1,2

Sensitivity 1,2

(ReferenceStandard)N (%)

False positive (FP)event

MI (probable ordefinite)

Test Criteria

Noevent

P value

%

95%CI

%

95%CI

MIdiagnosis No

549 (79)

121 (95)

166 (56)

<0.001

44

38-49

45

39-51

Yes

148 (21)

7 (5)

128 (44)

ElevatedCK-MBvalue No 196 (28)

82 (64) 46 (36)

102 (35) 192 (65)

<0.001

65

60-71

26

23-29

Yes

501 (72)

Elevated troponinvalue No 639 (92)

15 (12) 113 (88)

65 (22)

<0.001

78

73-83

57

52-62

Yes 229 (78) Anyelevated cardiacenzyme (CK-MBor troponin) No 158 (23) 0 (0) 31 (11) 58 (8)

<0.001

89

85-93

28

25-31

Yes

539 (77)

128 (100)

263 (89)

1FP recodedasNoEvent 2Estimatesassessedamong thosewho testpositiveonat leastoneof three criteria.Nopatients identifiedas negativeby the three criteriawere included in theanalysis;as suchestimatesof specificityandnegativepredictive valueareunavailable. Crane et al,Am JEpi, 2014

Slide16of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Risk factors for Type 1 MI

Covariate

Hazard Ratio [95% CI]

Covariate

Hazard Ratio [95% CI]

TraditionalCVDRiskFactors

HIV-associated RiskFactors

Age (per year)

1.06 [1.04 –1.07]

HIV transmission risk

Male

1.54 [1.00 –2.39]

Heterosexual

1.00

Race

MSM

0.89 [0.59 –1.35]

White

1.00

IDU

0.92 [0.59 –1.42]

Black

0.65 [0.45–0.92]

Other

1.08 [0.22 –1.37]

Hispanic

0.40 [0.20 –0.77]

Time-updatedHIVRNA

Other

0.56 [0.22 –1.37]

Undetectable (<400 copies/ml) 1.00

Treated hypertension

2.01 [1.42 –2.85]

≥400 copies/ml

1.35 [0.96 –1.88]

Treated dyslipidemia (statin)

1.71 [1.11 –2.63]

Time-updatedCD4

Ever smoker

1.51 [1.06 –2.14]

≥500

1.00

eGFR<60

1.91 [1.28 –2.84]

350-499

1.12 [0.75 –1.67]

Diabetesmellitus

1.63 [1.06 –2.51]

200-349

1.26 [0.84 –1.88]

100-199

1.82 [1.14 –2.92]

<100

2.00 [1.17 –3.43]

Slide17of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Causes of Type 2 MI

Anemia, 1% Rhabdomyolysis, 1%

Overdose, 2%

Procedure related, 4% GI bleed, 4% Neurologic, 2%

Hypotension, 5%

Other/unknown, 6%

Sepsis/bacteremia , 35%

Non-coronary cardiac, 8%

Respiratory failure, 9%

Cocaine or other illicit drug induced, 14%

Hypertensive urgency/emergency, 10%

Crane et al., JAMA Cardiology, 2017

Slide18of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.