Clinical Report: Acute Myocardial Injury and Infarction in US HIV Patients in Emergency Care

Overview

In a retrospective study of 79 people with HIV (PWH) presenting with elevated troponin in US emergency departments, acute myocardial injury (AMI) and type 2 myocardial infarction (T2MI) were more common than type 1 myocardial infarction (T1MI). Infection was the predominant trigger for AMI and T2MI, and both AMI and T2MI were associated with similar risks of major adverse cardiovascular events (MACE). Notably, AMI was infrequently documented with cardiovascular diagnosis codes in electronic health records.

Background

People with HIV have approximately double the risk of atherosclerotic cardiovascular disease, including myocardial infarction, compared to those without HIV. Myocardial infarction in PWH can be classified as type 1 (T1MI), caused by atherothrombosis, or type 2 (T2MI), caused by oxygen supply-demand mismatch without atherothrombosis. Acute myocardial injury (AMI), characterized by elevated troponin without ischemic symptoms, is also observed but less well understood in this population. Understanding the clinical presentations, provider responses, and outcomes of these myocardial injury types is critical to improving cardiovascular care for PWH.

Data Highlights

Key Findings

• Among 79 PWH with elevated troponin, 29.1% had AMI, 64.6% had T2MI, and 6.3% had T1MI.
• Infection was the most common precipitating factor for both AMI and T2MI presentations.
• AMI cases were rarely coded with myocardial infarction ICD codes (0%), and 91% had no cardiovascular disease–related diagnosis code.
• T2MI cases were more frequently coded with MI or other CVD ICD codes, but 53% still lacked any CVD-related diagnosis code.
• There was no significant difference in risk of major adverse cardiovascular events (MACE) following AMI versus T2MI presentations (adjusted hazard ratio 1.14; 95% CI 0.48–2.71).

Clinical Implications

Clinicians should be aware that PWH presenting with elevated troponin often have AMI or T2MI triggered by infections, and these presentations carry comparable risks for adverse cardiovascular outcomes. Improved recognition and accurate documentation of AMI in electronic health records are essential to guide preventive strategies and optimize post-event care. Enhanced provider awareness may facilitate targeted interventions to reduce subsequent cardiovascular events in this vulnerable population.

Conclusion

In US PWH seeking emergency care, AMI and T2MI predominate over T1MI and are associated with similar risks of adverse cardiovascular outcomes. Under-documentation of AMI highlights the need for improved clinical recognition to support preventive cardiovascular care.

References

1. Author/Source/Year -- Understanding the Range of Acute Myocardial Injury to Infarction in Individuals with HIV Seeking Emergency Services in the United States