Statin use and its impact on long-term clinical outcomes in active cancer patients following acute myocardial infarction (MI) remains insufficiently elucidated. Of the 1011 consecutive acute MI patients treated invasively between 2012 and 2017, cancer was identified in 134 (13.3%) subjects. All patients were observed within a median follow-up of 69.2 (37.8–79.9) months. On discharge, statins were prescribed less frequently in MI patients with cancer as compared to the non-cancer MI population (79.9% vs. 91.4%, p < 0.001). The most common statin in both groups was atorvastatin. The long-term mortality was higher in MI patients not treated vs. those treated with statins, both in non-cancer (29.5%/year vs. 6.7%/year, p < 0.001) and cancer groups (53.9%/year vs. 24.9%/year, p < 0.05), respectively. Patient’s age (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.03–1.05, p < 0.001, per year), an active cancer (HR 2.42, 95% CI 1.89–3.11, p < 0.001), hemoglobin level (HR 1.14, 95% CI 1.09–1.20, p < 0.001, per 1 g/dL decrease), and no statin on discharge (HR 2.13, 95% CI 1.61–2.78, p < 0.001) independently increased long-term mortality. In MI patients, simultaneous diagnosis of an active cancer was associated with less frequently prescribed statins on discharge. Irrespective of cancer diagnosis, no statin use was found as an independent predictor of increased long-term mortality.
Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.
Depressive disorders are a common problem in patients with cardiovascular diseases. They are associated with increased mortality, disability, increased healthcare expenditure and reduced quality of life. Depression occurs in 1 in 5 patients with coronary artery disease, peripheral arterial disease or heart failure. It significantly complicates the optimal management of a patient with cardiovascular disease, primarily by reducing compliance with healthy lifestyle principles and therefore reducing the effectiveness of recommended therapeutic methods. The mechanisms responsible for unfavorable prognosis in patients with cardiovascular disease and depression are associated with lifestyle factors, autonomic dysfunction, neuroendocrine disorders, inflammation, immune system dysfunction, insulin resistance and increased platelet reactivity. These mechanisms significantly interact in the regulation of both cardiovascular and central nervous system functions. Therefore, it is important to perform prompt and complete diagnosis of depression in a particular patient with cardiovascular disease, and to implement optimal therapeutic management from the psychiatric and cardiological point of view. In recent years, interest in the effect of antidepressants on cardiac parameters in patients with depression has increased. The assessment of the safety and efficacy of antidepressant therapy in the treatment of cardiac patients with depression is also important due to the fact that depression in these patients is often accompanied by other significant comorbidities such as diabetes, hypertension and tobacco addiction. The aim of this study was to review the most important aspects necessary in the cooperation of a psychiatrist and cardiologist that may enable the most effective treatment of patients with depressive disorders coexisting with selected cardiovascular diseases.
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