A Concomitant Cancer Diagnosis Is Associated With Poor Cardiovascular Outcomes Among Acute Myocardial Infarction Patients

Abstract

Background and AimsWith the increasing coexistence of cardiovascular disease and cancer in contemporary clinical practice, studies on the outcomes in acute myocardial infarction (AMI) patients with cancer has not been systematically investigated. This study sought to investigated the effect of coexisting cancer on the treatment and clinical outcomes among AMI patients.MethodsWe retrospectively integrated and analyzed cardiovascular data of 6,607 AMI patients between June 2016 and December 2019. Patients with cancer were compared with pair-matched cancer-naive patients. Cox proportional hazards models were constructed to compare the differences in outcomes.ResultsOf 6,607 patients, 2.3% (n = 150) had been diagnosed with cancer. Patients with cancer were older (70.3 ± 10.0 vs. 63.9 ± 11.5 years, P < 0.001) and had a higher burden of comorbidities. Moreover, patients with cancer tended to receive clopidogrel (52.0 vs. 40.0%, P = 0.004) rather than ticagrelor (45.6 vs. 58.2%, P = 0.003) than those without cancer. After pairwise matching, patients with cancer were less likely to undergo in-hospital percutaneous coronary intervention (61.3 vs. 70.0%, P = 0.055). And after 3-year follow-up, the cumulative incidence of cardiovascular death (14.0 vs. 8.3%; adjusted HR, 1.93; 95% CI, 1.11–3.39; P = 0.021) among patients with cancer was significantly higher than that among the matched controls, a similar pattern was observed for the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke (16.0 vs. 10.3%; adjusted HR, 1.98; 95% CI, 1.21–3.26; P = 0.007). Moreover, patients with a historical cancer diagnosis within 5 years had a higher risk of cardiovascular ischemic events.ConclusionsAMI patients with a concomitant diagnosis of cancer tended to be treated with conservative therapies and were at substantially higher risk for adverse cardiovascular outcomes.

Brief Overview of Specific Features of Cancer in Atherosclerosis Patients and Therapeutic Strategies

“…The CVD risk is considerably higher in patients suffering from cancer than in those without a neoplasm. For instance, according to a recent study involving patients who have been diagnosed with cancer within the year before the study, the risk for Acute Myocardial Infarction (AMI) is three times greater Hazard Ratio (HR) = 2.9; 95% CI, 2.8-3.1 in patients who experience a neoplastic process compared to control population (Peng et al, 2022). Furthermore, the increase in AMI risk is directly associated with cancer stage.…”

Cardiogenic shock among cancer patients

“…Moreover, mortality caused by ACS is higher in oncological patients ( 24 , 25 ) with malignancy being considered an independent predictor of increased risk of repeated revascularization and stent thrombosis ( 17 ). Patients with ACS and malignancies might also be more likely to experience CS ( 26 ), even if this additional risk is not found in all studies ( 27 ).…”