Multi Vessel PCI in HIV Positive Patient - Dr HS Natraj Setty
Left main coronary artery stenosis is the most challenging lesion in patients with acute coronary syndromes associated with retroviral positive patients. Since the amount of myocardium at risk is very high, the patient is often in cardiogenic shock, and the risk of death is high and even more so in the left dominant coronary system. Left main stenosis is a Class I indication for CABG -ACC/AHA guidelines and has been a relative contraindication to PCI.
Antiretroviral therapy (HAART) has improved the longevity of patient’s suffering from Immunodeficiency viral infection. However the disease and HAART, on the other hand, increased the risk of myocardial infarction (MI) due to common MI risk factors and HIV-specific factors. Despite these elevated MI rates, optimal methods to predict a risk of MI in HIV-infected persons remain unclear. Cardiovascular disease, including atherosclerosis and atherosclerosis-associated complications, is an increasing cause of morbidity and mortality in human immunodeficiency virus (HIV) patients in the post-antiretroviral therapy era.
Acute myocardial infarction due to occlusion of the left main coronary artery (LMCA) and its side branches rare clinical entity. It carries a very high morbidity and mortality rate due to the involvement of a large myocardial area. Patients with HIV are usually refused for revascularization therapy, hence being managed conservatively. Risk of coronary artery disease is high in HIV infected patients and is observed to occur at much earlier when compared to general population. The presence of other traditional cardiovascular risk factors in this population is less and the disease appears to be more diffuse and severe compared to general population.
With this background, Dr H S NATRAJ SETTY is presenting a case on Multi Vessel PCI in HIV Positive Patient
- Case highlights the challenges in decision making and management of patients infected with HIV presenting with ACS.
- In view of high surgical risk and severe LV dysfunction and HIV infection he was considered for multivessel PCI.
- In day to day practice HIV infected patients are usually refused for CABG.
- In patients with suitable coronary anatomy and high surgical risk multivessel PCI maybe considered as a safe and effective alternative to CABG.
In acute coronary syndromes though previous studies reported a high rate of major adverse cardiac events (MACE) and target vessel revascularization (TVR) in HIV+ patients our case had the favorable outcome.
The author Dr H S NATRAJ SETTY is an Assistant Professor of Cardiology at Sri Jayadeva Institute of Cardiovascular sciences & research and is presenting on Multi vessel percutaneous coronary intervention in retroviral positive patient challenging case at IndiaLive 2018