Nursing role in monitoring during cardiopulmonary resuscitation and in the peri-arrest period: a review

Objective

The study objective was to present a comprehensive literature review on the monitoring of patients with cardiac arrest (CA) and the nursing contribution in this crucial situation. Monitoring techniques during cardiopulmonary resuscitation and in the peri-arrest period (just before or after CA) are included.

Methods

Approaches used to access the research studies included a comprehensive search in relevant electronic databases (Medline, CINAHL, EMBASE, Cochrane Review, British Nursing Index) using relevant keywords (eg, cardiac arrest, resuscitation, monitoring, nurse, survival, outcome). Books and journals known to the authors were also used.

Results

The nurse’s role in patients with CA is extremely significant and if performed correctly adds great insight to treatment planning and correct management.

Conclusion

Early recognition of CA and invasive (methods and equipment that require endarterial or intravenous access) and noninvasive monitoring should be prompt and appropriate for early return of spontaneous circulation and improved neurologic outcome in patients.     

Right and left ventricular cardiac function in a developed world population with human immunodeficiency virus studied with radionuclide ventriculography

Background

Cardiac dysfunction has been reported in a substantial part of patients infected with the human immunodeficiency virus (HIV). However, most studies are from a time before the introduction of highly active antiretroviral treatment (HAART), which has significantly reduced HIV-associated morbidity and mortality rates. Accordingly, the prevalence of HIV-associated cardiac dysfunction may also have changed. The aim of the study was to establish the prevalence of right- and left-sided cardiac dysfunction in a Danish HIV population, most of whom were undergoing HAART, with radionuclide ventriculography.

Methods

Ninety-five consecutive patients with HIV infection were included. Mean HIV duration was 104 months, and 84% of the patients received HAART. All patients underwent radionuclide ventriculography, and plasma levels of atrial natriuetic peptide (ANP), brain natriuetic peptide (BNP), and endothelin-1 (ET-1) were measured. Thirty age- and sex-matched healthy volunteer subjects were included to establish reference values of radionuclide measurements of left and right ventricular ejection fraction and of left ventricular volume.

Results

Of 95 patients with HIV, 1 (1%) had a reduced left ventricular ejection fraction and 6 (7%) had a reduced right ventricle ejection fraction (0.35-0.42) compared with reference values from the age- and sex-matched reference population. Patients with HIV and reduced cardiac function did not differ in the duration of HIV, CD4 count, CD4 nadir, or HIV RNA load. No correlations were found between reduced cardiac function and levels of the 3 peptides measured.

Conclusions

No major dysfunction of the left ventricle is present in a developed world HIV population. However, a small but significant part of this population has modestly reduced right-sided systolic function.     

Respiratory syncytial virus (RSV) community-acquired pneumonia (CAP) in a hospitalized adult with human immunodeficiency virus (HIV) mimicking influenza A and Pneumocystis (carinii) jiroveci pneumonia (PCP)

Background

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infections in young children, the elderly, and immunocompromised hosts, but RSV is a rare cause of community-acquired pneumonia (CAP) in hospitalized adults with human immunodeficiency virus (HIV). In patients with HIV, CAP is most frequently attributable to the usual bacterial respiratory pathogens that cause CAP in immunocompetent hosts, eg, Streptococcuspneumoniae or Hemophilus influenzae. Adults with HIV are also predisposed to intracellular CAP pathogens, ie, Mycoplasmatuberculosis, Salmonella spp., Pneumocystis (carinii) jiroveci (PCP), cytomegalovirus, and Legionella spp. This year, co-circulating in the community during influenza season were strains of human seasonal influenza A (H3N2) and swine influenza A (H1N1). During the influenza season, in adults hospitalized with HIV, the diagnostic possibilities should include influenza-like illnesses, eg, human parainfluenza virus types 3 and 4, human metapneumovirus, and pertussis.

Case Report

We present an adult with HIV, hospitalized for an influenza-like illness during influenza season. The differential diagnosis of CAP in this patient included influenza A and PCP.

Conclusion

We report on an adult patient with HIV with CAP that mimicked influenza and PCP, and was attributable to RSV.     

Conservative treatment of staphylococcal prosthetic joint infections in elderly patients

Background

We report the outcome of debridement and prosthesis retention plus long-term levofloxacin/rifampicin treatment of prosthetic joint infections.

Methods

Staphylococcal prosthesis joint infections were defined by positive culture of joint aspirate, intraoperative debridement specimens, or sinus tract discharge in the presence of clinical criteria. Patients received long-term oral levofloxacin 500 mg and rifampicin 600 mg once per day. Sixty patients (age 74.6 ± 8.4 years) were included.

Results

Coagulase-negative staphylococci were significantly more frequently isolated in the knee (78.6%; P = .00001). Of the Staphylococcus aureus isolates, 33.3% were methicillin-resistant. Time from arthroplasty to symptoms onset was higher (P = .03) in coagulase-negative staphylococci infections. Global failure was 35% (higher for the knee) and ranged from 16.6% to 69.2% (P = .0045) in patients with symptoms duration of less than 1 month to more than 6 months. A shorter duration of symptoms (P = .001) and time to diagnosis (P = .01) were found in cured patients versus patients showing failure. Among those with S. aureus infections, a higher failure rate was found with methicillin-resistance.

Conclusions

Efficacy was higher in patients with shorter duration of symptoms, earlier diagnosis, hip infections, and methicillin susceptibility.     

Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999

Background

Although cardiac devices have been found to reduce symptoms and mortality rates in appropriate patient populations, the implications of certain important risks, such as infection, are incompletely understood. The purpose of this study was to use a large population-based database to define the population that is at risk for cardiac device infections, determine the prevalence of device infections, and study changes in the rates of cardiac device implantation and infection in the past decade.

Methods

Patients with cardiac device implantations and infections were identified with claims files from the Health Care Finance Administration for Medicare beneficiaries from January 1, 1990, through December 31, 1999. Rates of implantation of cardiac devices were determined. Time trend analyses were performed to determine the significance of the observed change in rates.

Results

Cardiac device implantation rates increased from 3.26 implantations per 1000 beneficiaries in 1990 to 4.64 implantations per 1000 beneficiaries in 1999, which represents an increase of 42% in 10 years (P for trend <.001). Cardiac device infections showed a larger increase, from 0.94 device infections per 1000 beneficiaries in 1990 to 2.11 device infections per 1000 beneficiaries in 1999, which represents an increase of 124% during the study period (P for trend <.001).

Conclusions

During the previous decade, there was a significant increase in both cardiac device implantations and infections in elderly patients, although the increase in the rates of device infections was substantially higher. Additional studies are needed to better understand the relationship and timing between cardiac device implantation and infection.     

Use of complementary and alternative medical therapies in patients with cardiovascular disease

Background

Complementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD).

Methods

Interviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD.

Results

The current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent’s usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement.

Conclusion

The use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.     

The use of interferon alpha in Behçet disease: review of the literature

Objectives

To evaluate the efficacy and safety of interferon (IFN) alpha for the treatment of Behçet’s disease (BD) and discuss its possible mechanisms of action.

Methods

Reports published until July 2002 in all languages were identified by the PubMed Database and the BD conference proceedings and abstract booklets. The indexing terms used were “Behçet” and “interferon.”

Results

Thirty-two original reports and 4 selected abstracts were included in the analysis. Systemic IFN-α was administered to 338 patients. One hundred eighty-two patients with acute ocular disease were treated with IFN-α. Two hundred sixty-four patients received IFN-α2a, and 74 received IFN-α2b. Eighty-six percent of the patients with mucocutaneous symptoms, 96% with arthritis, and 94% with uveitis exhibited a partial or complete response. Higher IFN doses were more effective than low-dose regimens and led to up to 56% long-term remissions after discontinuation of IFN-α were reported. IFN-α2a apparently was superior to IFN-α2b, with more complete remissions, but this probably was the result of a bias caused by the larger number of patients treated with IFN-α2a. Side effects were dose-dependent and similar to those noted in patients with hepatitis C.

Conclusions

Although the comparability of the studies is hampered because of different study designs, IFN-α is effective for the treatment of BD. It was beneficial even in resistant posterior uveitis, in which long-term remissions with preservation of visual acuity was achieved. In contrast, mostly partial remissions were reported for mucocutaneous symptoms.     

Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure

Background

Mood is an independent predictor of mortality and quality of life (QoL) for people with heart failure. However, the underlying belief systems involved in mood are unknown.

Objective

We sought to identify psychological and clinical variables predicting mood and QoL for people diagnosed with heart failure (HF).

Methods

One hundred and forty-six HF patients were assessed with standardized measures, to determine their beliefs about HF, coping styles, mood, and QoL.

Results

Patients with more negative beliefs about the consequences of HF and with less perceived control over symptoms showed maladaptive coping styles such as denial and behavioral disengagement, and more severe levels of depression and anxiety. Depression also independently predicted QoL outcomes.

Conclusions

Anxious and depressed patients have more negative beliefs about HF, leading to negative coping behaviors and poor QoL. Our evidence suggests that changing negative beliefs may improve the psychological well-being and QoL of patients, irrespective of disease severity.     

Cross-sectional epidemiology of hepatitis C virus detection and treatment in HIV-infected patients

Background

Sustained virologic response to peginterferon plus ribavirin reduces liver-related complications and mortality in patients co-infected with HIV and hepatitis C virus. Therefore, the presence of any barriers to start hepatitis C virus therapy should be identified and eliminated in order to recruit all eligible patients.

Methods

Cross-sectional study. In a HIV referral clinic we assessed the proportion of patients eligible for hepatitis C virus evaluation and treatment according to consensus guidelines.

Results

We identified 134 patients with hepatitis C virus and HIV co-infection. Twenty-one patients were excluded from the analysis due to never attending the HIV clinic (n = 12) or having hepatitis C virus RNA not detectable (n = 9). In the remaining 113 patients, only 61% had identification of hepatitis C virus genotype and quantification of hepatitis C viral load. Thirty-six patients started peginterferon plus ribavirin, and 16 (44%) achieved sustained virologic response. Seventy-seven patients did not receive treatment for hepatitis C virus due to the presence of medical contraindications (n = 22), provider barriers (n = 15), or patient barriers (n = 40). Multivariate analysis identified lower education degree (odds ratio: 4.53; 95% confidence intervals: 1.36-15.16, p = 0.014) and patient civil status single, separated or widower (odds ratio: 4.81; 95% confidence intervals: 1.54-14.99, p = 0.007) as the independent determinants associated to not initiating therapy for hepatitis C virus infection in patients with barriers.

Conclusion

A minor proportion of HIV-infected patients received appropriate assessment and treatment for hepatitis C virus infection. Social disadvantages require multidisciplinary models of health care to improve hepatitis C virus treatment initiation and success.     

Thyroid and gastric autoimmune diseases

Objectives

Autoimmune thyroid disease (AITD) is frequently accompanied by other organ-specific diseases. We investigated the frequency of the association AITD-Biermer's disease (BD) in patients with AITD by investigating the prevalence of intrinsic factor antibodies (IF-Ab).

Design and Methods

Sera from 113 patients with AITD (hypo- or hyperthyroidism) were screened for the presence of type I IF-Ab with a competitive automated immunoassay based. Matched sera from 113 patients with dysthyroidism (not AITD) were tested.

Results

Four IF-Ab positive patients suffered from AITD. BD was known for two of them and strongly suspected in the two others. All patients with no AITD tested IF-Ab negative. B12 levels were often low whatever the etiology.

Conclusion

The prevalence of IF-AbI is higher (3.5%) in patients with AITD. Prospective studies should investigate whether correcting thyroid dysfunction improves vitamin B12 levels, and establish whether routine screening for gastric autoimmunity is clinically useful or purely academic.     

Mid-term survival of patients undergoing major cardiac surgery

Introduction and objectives

Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain).

Methods

From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality.

Results

In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥70 years showed a lower survival rate than those aged <70 (log rank test, P <.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥70 years, a history of severe ventricular dysfunction (ejection fraction <30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality.

Conclusions

Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors.Full English text available from: www.revespcardiol.org     

Gender and age differences in symptom distress and functional disability one year after heart transplant surgery

Objective

Symptoms and functional status are major concerns for heart transplant (HT) recipients. The study objective was to examine gender and age differences in symptom distress and functional disability 1 year after HT surgery.

Methods

The sample (N = 237) consisted of 44 female and 193 male patients who were divided into younger (n = 66) and older (n = 171) groups with the breakpoint at age 50 years. Data from chart review and 2 questionnaires (Heart Transplant Symptom Checklist and Sickness Impact Profile) were analyzed with chi-square test, t tests, analysis of variance, and multivariate analysis of variance.

Results

Women reported worse symptom distress (overall, plus cardiovascular, gastrointestinal, dermatologic symptoms) and more functional disability (overall, plus disability in ambulation, mobility, self-care, home management). Older patients reported more disability in ambulation and work. Gender by age interactions showed that older men reported worse genitourinary symptoms and younger women reported worse dermatologic symptoms.

Conclusion

There were more gender than age differences in symptoms and disability.     

Enquête sur le poids de la rhinite allergique en France

Background

This paper presents the results from France of a prospective, cross-sectional, international survey conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis on health-related quality of life.

Methods

Data about the presence, severity and impact of symptoms were recorded by 504 patients and matched with data from their physicians. Health-related quality of life was assessed using the Mini Rhinoconjunctivitis Quality of Life Questionnaire.

Results

According to the physicians’ assessments, a large proportion (71%) of patients had moderate or severe disease, persistent disease (48.3%), and comorbidities such as asthma (32.3%) and anxiety (19%). Persistent disease was present in 55.3% of patients with perennial allergic rhinitis and 44.9% with seasonal allergic rhinitis. Physicians tended to underestimate the incidence of some symptoms reported by the patients, most notably cough, headache, and itchy eyes. Health-related quality of life was negatively correlated with disease severity and number of symptom-free days. Allergic rhinitis had a significantly greater impact on patients with more persistent disease compared with those with intermittent disease (2.0 ± 1.3 versus 1.8 ± 1.2; p < 0.05); nevertheless, 73.9% of patients with intermittent disease reported some impairment of their daily life.

Conclusions

Allergic rhinitis remains a significant health problem in France due to the high prevalence of moderate or severe, persistent disease in patients presenting during routine care as well as to the impact of the disease on health-related quality of life. Patients and physicians differed significantly in their perception of disease severity and in the reporting of some symptoms, including ocular symptoms and cough.     

Limited prognostic value of noninvasive assessment of reperfusion by continuous vectorcardiography in an unselected cohort of patients with acute ST-elevation myocardial infarction treated with thrombolysis

Aims

We studied the prognostic value of different reperfusion criteria of short-term continuous vectorcardiography (VCG) in an unselected cohort of 400 patients with ST-elevation myocardial infarction, treated at 4 coronary care units in Stockholm, Sweden, between 1999 and 2002. The main outcome measure was 1-year mortality.

Results

Of 400 study patients, 41 (10.2%) died within 1 year. One-year mortality in patients without reperfusion at 90 minutes, defined as ST resolution below 50% on VCG, was 11.6% compared with 9.0% in patients with reperfusion, (P = 0.4). Ninety-eight (24.5%) patients underwent intervention before discharge and percutaneous coronary intervention or coronary artery bypass grafting or both during the index admission. Percutaneous coronary intervention or coronary artery bypass grafting was related to improved 1-year survival (97 ± 2% vs 87 ± 2%, P = .0076). ST-vector magnitude resolution at 90 minutes was lower in patients who underwent intervention (P = .045). None of the reperfusion criteria of VCG was significantly associated with 1-year mortality.

Conclusion

Our results show that noninvasive assessment of reperfusion by continuous VCG has limited prognostic value in unselected patients treated with thrombolysis because of ST-elevation myocardial infarction when subsequent revascularizations are performed. However, VCG might be useful in selecting patients for coronary angiography with subsequent revascularization.     

Evolution and follow-up of hunger strikers: experience from an interregional hospital secured unit

Purpose

A hunger strike is a voluntary fast, performed to protest publicly against an issue deemed unfair. In the case of French prisoners, hospitalization in an interregional hospital secured units (UHSI) may be necessary.

Methods

A retrospective epidemiological study based on one UHSI medical records was performed on the period of May, 2006 to December, 2008, and focused on symptoms, outcomes and ethical problems encountered.

Results

Seven men and one woman with a mean age of 32.6 years were hospitalized in an UHSI, with nine episodes of hunger strike of a median duration of 57 days. Clinical symptoms began after two weeks of voluntary deprivation in the form of dizziness, weakness, muscle pain and headache. Laboratory tests showed hypoglycemia (< 0.4 g/L) on admission, 16.3% decrease of albumin after 40.5 days, and dehydration in case of thirst strike. The clinical tolerance was good and no patient presented Wernicke's encephalopathy. A diabetic patient developed acidocetosis during two hunger strikes. All hunger strikes were respected by medical staff, and treatment was based upon surveillance of symptoms, vitamin B and sweetened drinks administration and explanations of the clinical hazards on a daily basis.

Conclusion

The special problem encountered in the medical management of these strikers was to convince them to accept treatments in order to avoid a coercive life-saving treatment as requested by French law.     

Biomarkers for ventilator-associated pneumonia: review of the literature

Objective

Ventilator-associated pneumonia (VAP) contributes significantly to morbidity and mortality in critically ill patients, but it can be difficult to diagnose. Clinical criteria, Clinical Pulmonary Infection Score, and quantitative culture of bronchoalveolar lavage have been used to distinguish between patients who are likely positive (sensitivity) and patients who are likely negative (specificity). Despite these test methods, patients continue to be misclassified. False-positive results may lead to inappropriate antibiotic use in patients. For those misclassified as test negative, appropriate treatment may be delayed. Biomarkers have been suggested as another method to enhance the ability to predict VAP. This article analyzes the evidence for the usefulness of 3 biomarkers that have been proposed as possible biomarkers of VAP: soluble triggering receptor expressed on myeloid type 1 cells, procalcitonin, and C-reactive protein.

Methods

A Medline search was conducted for the years between 1990 and 2009 to locate articles on the subject of biomarkers for predicting VAP in critically ill adult patients.

Results

Analysis of the literature does not currently support a clinical role for these biomarkers in predicting VAP. Variations in the diagnostic methods, antimicrobial use, cutoff values, and patient populations limit comparisons among the studies.

Conclusion

Recommendations are offered to strengthen and standardize methods in future studies to clarify the utility of biomarkers for predicting VAP in specific patient populations.     

Do baseline atrial electrocardiographic and infarction patterns predict new-onset atrial fibrillation after ST-elevation myocardial infarction? Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

Background

Atrial infarction reportedly occurs in 0.7% to 52% of ST-elevation myocardial infarctions (STEMIs), up to two thirds of whom develop atrial fibrillation and flutter (AF). Prospective validation of electrocardiographic atrial infarction patterns is lacking. Hence, in STEMI patients treated with primary percutaneous coronary intervention, we examined whether baseline atrial electrocardiographic changes or atrial infarction patterns predicted new AF or mortality.

Methods

Within the Assessment of Pexelizumab in Acute Myocardial Infarction trial, a nested case-control study was conducted. Patients with new AF were matched 1:1 with controls, and baseline atrial electrocardiographic variables were examined.

Results

Abnormal P wave morphology (Liu minor criterion for atrial infarction) was significantly associated with new AF (adjusted odds ratio, 1.68; 1.03-2.73). This was also independently associated with 90-day mortality in the overall case-control cohort (adjusted hazard rate, 1.90; 1.04-3.46) and among patient with new-onset AF (adjusted hazard rate, 2.43; 1.22-4.84).

Conclusions

Abnormal P wave morphology significantly predicted new AF and 90-day mortality in STEMI patients.     

Low-risk patients admitted with community-acquired pneumonia

Purpose

To describe the natural history of community-acquired pneumonia in the subset of a large cohort of patients at low risk for mortality who were admitted to the hospital.

Methods

Prospective observational study of all patients at low risk for mortality (risk classes I and II) who presented to 6 hospitals and 1 emergency department in Edmonton, Alberta, Canada with a diagnosis of possible community-acquired pneumonia from November 15, 2000, to November 14, 2002.

Results

A total of 586/3065 (19.1%) low-risk patients (Fine criteria) were admitted, 48.4% of whom stayed more than 5 days. Multivariate analysis revealed that patients who were admitted were more likely to be female, to have presented at Site B, which serves an inner city population, to have diminished premorbid functional status, to have comorbidities likely to be made worse by pneumonia (chronic obstructive pulmonary disease, asthma, heart disease, inflammatory bowel disease), and to suffer from substance abuse or psychiatric illness. A respiratory rate of ≥28 breaths per minute, and symptoms of shaking chills, shortness of breath, nausea or diarrhea were the remaining factors predicting admission. Nineteen percent of the patients suffered one or more complications, the most serious of which was progression of the pneumonia, resulting in respiratory failure necessitating mechanical ventilation in 2.4% and empyema in 1.4%. Four patients had lung cancer, and 1 had cancer of the vocal cords. Thirty-one percent of those who were admitted were still unable to eat or drink enough to maintain hydration by hospital day 5 or on discharge day.

Conclusions

One in 5 patients at low risk for mortality were admitted to the hospital and half stayed more than 5 days; 19% suffered 1 or more complications. Our data emphasize the need for better rules to guide the admission decision and the importance of physician judgment in this decision.     

Acute myocardial infarction in patients infected with human immunodeficiency virus

Background

Recent clinical and post-mortem reports suggests that human immunodeficiency virus (HIV) infection may participate in the process of atherosclerosis independent of other coronary risk factors. In this prospective and observational study, we investigated whether an associative link exists between HIV infection and coronary artery disease.

Methods

Of 690 patients admitted to our hospital in a 3-year period, 29 patients (28 men and 1 woman) with a mean age of 46 ± 10 years had an acute myocardial infarction (AMI) on the basis of acute prolonged chest pain, ischemic electrocardiogram abnormalities, and elevated serum markers of myocardial necrosis at presentation.

Results

ST-segment elevation MI was present in 15 patients, and non-ST-segment elevation MI was present in 14 patients. Twenty-two patients (76%) were <55 years; 17 of these patients had no or 1 coronary risk factor, and 5 patients had 2 or 3 risk factors. Five patients >55 years had 1 coronary risk factor, and 2 patients had 2 risk factors. Thirteen patients underwent a myocardial revascularization procedure, and 1 patient died during hospitalization.

Conclusions

HIV infection, as a cause of endothelial injury, may initiate the inflammatory process of early atherosclerosis and participate in the evolution of the atherothrombotic lesion responsible for AMI. This study suggests that the association of HIV infection and acute coronary syndrome may be more common than previously reported and underscores the need for further clinical studies.