HIV, vascular surgery and cardiovascular outcomes: a South African cohort study

SummaryRisk factors for peri‐operative cardiac morbidity are poorly described in HIV‐positive patients. This prospective observational study describes cardiovascular risk factors in a cohort of vascular surgical patients of known HIV status. We recruited 225 patients with 73 (32%) being HIV‐positive. When compared with HIV‐negative patients, the HIV‐positive patients were younger (mean (SD) 56.4 (13.3) vs 40.5 (10.4) years, respectively, p < 0.01). They had fewer Revised Cardiac Risk Index cardiovascular risk factors (median (range [IQR]) 1 (0–5 [0–2]) vs 0 (0–2 [0–0]), respectively, p < 0.001), with the exception of congestive cardiac failure (p = 0.23) and renal dysfunction (p = 0.32), and so were of a significantly lower Revised Cardiac Risk Index risk category (p < 0.01). HIV‐positive and ‐negative patients had similar outcomes in: 30‐day mortality (p = 0.78); three‐day postoperative troponin leak (p = 0.66); and a composite outcome of mortality and troponin release (p = 0.69). We conclude that although HIV‐positive patients have fewer cardiovascular risk factors, they have similar peri‐operative major adverse cardiac events to HIV‐negative patients. Research should focus on why this is the case, and if alternative clinical risk predictors can be developed for HIV patients.