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 - Scorecard - MDSpire
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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
Clinical Scorecard: Understanding the Range of Acute Myocardial Injury to Infarction in Individuals with HIV Seeking Emergency Services in the United States: Clinical Presentations, Provider Interventions, and Outcomes
At a Glance
Category
Detail
Condition
Acute myocardial injury (AMI), type 1 myocardial infarction (T1MI), and type 2 myocardial infarction (T2MI) in people with HIV (PWH)
Key Mechanisms
T1MI caused by atherothrombosis; T2MI caused by myocardial oxygen supply/demand mismatch without atherothrombosis; AMI defined by troponin elevation without ischemic symptoms/signs
Target Population
People with HIV presenting to emergency departments in the United States
Care Setting
Emergency department of a large academic medical center
Key Highlights
Among PWH presenting with elevated troponin, AMI and T2MI presentations are more common than T1MI (64.6% and 29.1% vs 6.3%).
Infection is the most common trigger event for both AMI and T2MI presentations in PWH.
AMI and T2MI are associated with comparable risks of ensuing major adverse cardiovascular events (MACE) post-index event.
Guideline-Based Recommendations
Diagnosis
Use troponin T ≥99th percentile to identify myocardial injury in PWH presenting to emergency care.
Adjudicate presentations as AMI, T1MI, or T2MI based on clinical signs, symptoms, and troponin dynamics.
Management
No proscriptive cardiology society guidelines exist for treatment of AMI or T2MI in PWH post-event due to etiopathologic heterogeneity.
Enhanced recognition and documentation of AMI in PWH is necessary to facilitate preventive care development.
Monitoring & Follow-up
Monitor for ensuing major adverse cardiovascular events (MACE) including myocardial infarction, stroke, and death after index event.
Use electronic health record data and ICD coding to track cardiovascular outcomes, noting that AMI is often undercoded.
Risks
PWH have a twofold increased risk of atherosclerotic cardiovascular disease including myocardial infarction compared to people without HIV.
Both AMI and T2MI presentations confer increased risk of adverse cardiovascular outcomes.
Patient & Prescribing Data
People with HIV presenting to emergency departments with elevated troponin levels.
AMI is infrequently coded in electronic health records despite comparable risk of adverse outcomes to T2MI; improved documentation may guide preventive treatment strategies.
Clinical Best Practices
Perform detailed chart review and adjudication to accurately classify myocardial injury and infarction types in PWH.
Recognize infection as a common precipitating factor for myocardial injury in PWH.
Improve cardiovascular disease-related diagnosis coding in electronic health records to better capture AMI cases.
Implement longitudinal follow-up for PWH with myocardial injury to monitor and manage risk of major adverse cardiovascular events.
by Rebecca A Abelman, Brian M Mugo, Claudia G Durbin, Sophia Campbell, Sayon Dutta, Dustin McEvoy, Emily S Lau, Sophia Zhao, Sara L Stockman, Sarah M Chu, Markella V Zanni
