HCV infection heightens long-term mortality risk in patients with AMI
Hepatitis C virus (HCV) infection negatively affects the 12-year mortality in patients following acute myocardial infarction (AMI), as reported in a study from Taiwan. This association is particularly pronounced among males and individuals with hypertension, with cirrhosis further increasing the long-term mortality rates.
“Therefore, physicians should be aware of the impact of HCV infection in patients with AMI when choosing treatment strategies,” according to the authors who presented their study at the Asian Pacific Society of Cardiology (APSC) Congress 2018.
Using data from the Taiwan National Health Insurance Research Database (NHIRD), the authors evaluated the mortality rate of 4,659 HCV-infected AMI patients (4,552 with cirrhosis) not receiving interferon therapy who had been admitted for a first AMI between 2000 and 2012 in comparison with that of 4,552 matched controls.
Results revealed significantly higher 12-year mortality rates in patients with HCV infection and cirrhosis vs those with HCV infection but without cirrhosis (p<0.0001) or controls (p<0.0001). Long-term mortality rates were also significantly different between patients with HCV infection but without cirrhosis and matched controls, in favour of the latter (p<0.0001). [APSC 2018, abstract P101]
In Cox proportional hazards regression models, HCV infection increased the risk of mortality by 2.23 times (95 percent CI, 1.82–2.73) in patients with cirrhosis and by 1.09 times (1.04–1.15) in those without the complication.
Furthermore, HCV had an unfavourable impact on long-term outcomes in subgroup patients who were male (hazard ratio [HR], 1.15; p=0.0001), younger (<65 years; HR, 1.26; p<0.0001), hypertensive (HR, 1.14; p<0.0001), had dyslipidaemia (HR, 1.17; p=0.0029) and underwent percutaneous coronary intervention (HR, 1.17; p=0.002).
“The results of the present study are consistent with those of previous studies that linked HCV seropositivity with carotid or coronary atherosclerosis,” the authors said. [Clin Med Insights Cardiol 2014;8(Suppl 3):1-5; Heart 2004;90:565-566]
In comparison, the present work included data from NHIRD, evaluated only those patients with first AMI, and comprised a comparable proportion of elderly patients between the HCV group (65.42 percent) and the control group (66.21 percent). “Considering these factors, our study accurately analysed the influence of HCV infection on patient outcomes after AMI,” they pointed out.
Nevertheless, the authors acknowledged several limitations. First, the study was retrospective in design. Second, ICD-9-CM codes for diagnosis of HCV infection were made by positive anti-HCV serology test in NHIRD databases. Third, data on family history, actual cause of death, body weight, height, smoking history, lipid and viral load, glucose levels, and the burden of atherosclerosis were lacking.