Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA

Abstract

Aims The aim of this study is to evaluate temporal trends, treatment, and clinical outcomes of patients who present with an acute myocardial infarction (AMI) and have a current or historical diagnosis of cancer, according to cancer type and presence of metastases. Methods and results Data from 6 563 255 patients presenting with an AMI between 2004 and 2014 from the US National Inpatient Sample (NIS) database were analysed. A total of 5 966 955 had no cancer, 186 604 had current cancer, and 409 697 had a historical diagnosis of cancer. Prostate, breast, colon, and lung cancer were the four most common types of cancer. Patients with cancer were older with more comorbidities. Differences in invasive treatment were noted, 43.9% received percutaneous coronary intervention (PCI) in patients without cancer, whilst only 21.0% of patients with lung cancer received PCI. Lung cancer was associated with the highest in-hospital mortality [odds ratio (OR) 2.71, 95% confidence interval (CI) 2.62–2.80], major adverse cardiovascular and cerebrovascular complications (OR 2.38, 95% CI 2.31–2.45), and stroke (OR 1.91, 95% CI 1.80–2.02), while colon cancer was associated with highest risk of bleeding (OR 2.82, 95% CI 2.68–2.98). Irrespective of the type of cancer, presence of metastasis was associated with worse in-hospital outcomes, and historical cancer did not adversely impact on survival (OR 0.90, 95% CI 0.89–0.91). Conclusion A concomitant cancer diagnosis is associated with a conservative medical management strategy for AMI, and worse clinical outcomes, compared to patients without cancer. Survival and clinical outcomes in the context of AMI vary significantly according to the type of cancer and metastasis status. The management of this high-risk group is challenging and requires a multidisciplinary and patient-centred approach to improve their outcomes.

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

“…Cancer disease has been reported to be present in up to 17% of patients with ACS [ 3 , 4 , 7 , 8 ]. Very recent data from 6.5 million patients presenting with an acute myocardial infarction (AMI) between 2004 and 2014, included in the US National Inpatient Sample (NIS) database, showed a prevalence of 9% of patients with cancer [ 3 ].…”

“…A very recent analysis on a large AMI population revealed that patients with current cancer have a 50% increased risk of major in-hospital adverse cardiac events than those without cancer [ 4 ]. Conversely, AMI patients with historical cancer were at no increased risk of adverse outcomes.…”

“…Moreover, lung cancer was associated with the highest in-hospital mortality (odds ratio (OR) 2.7) and major adverse cardiovascular and cerebrovascular complications (OR 2.4), while colon cancer was associated with the highest risk of bleeding (OR 2.8). Irrespective of the type of cancer, the presence of metastases was associated with worse in-hospital outcomes [ 4 ].…”

“…Moreover, some cancers, as well as some of their therapies, should be themselves considered true cardiovascular risk factors. For these reasons, the occurrence of acute coronary syndrome (ACS) in cancer patients is not uncommon [ 3 , 4 ]. Notably, ACS may develop before or after establishing a diagnosis of cancer; sometimes, the diagnosis is made during hospitalization for ACS and, conversely, in some cases, ACS may occur during hospitalization for active cancer [ 5 ].…”

Coronary Artery Disease in Patients With Cancer: It’s Always the Small Pieces That Make the Bigger Picture

“…3 Patients with newly diagnosed cancer are at 2-to 3-fold greater risk of incident myocardial infarction or ischemic stroke compared with patients without cancer, 4 and those treated with radiotherapy have an absolute risk increase of 76.4 cases of coronary heart disease and 125.5 cases of cardiac death per 100,000 person-years. 5 It is therefore not surprising that physicians are increasingly encountering patients with cancer who have manifestations of coronary artery disease (CAD), either emergently in those presenting with acute coronary syndromes 6 or electively when myocardial revascularization in patients with severe CAD allows for subsequent safe surgical treatment of their cancer.…”