Analysis of outcomes of percutaneous coronary intervention in metastatic cancer patients with acute coronary syndrome over a 10-year period

Abstract

There were 49,515 patients with metastatic disease who were discharged with a diagnosis of ACS. Of these, 15,964 had STEMI and 33,551 had NSTEMI. 3981 patients (24.9%) with STEMI and 3209 patients (9.6%) with NSTEMI received percutaneous coronary intervention. Caucasian male patients under age 65 years were more likely to receive PCI in the setting of an ACS. The hospital characteristics associated with higher use of PCI included academic affiliation, large bedsize, private for-profit hospitals and Midwestern and Western regions of USA. The adjusted odds of receiving PCI in this group of patient have gradually increased by 1.14 every year in last decade (95% CI 1.11-1.16). The beneficial effect of PCI on in-hospital mortality has declined in NSTEMI such that by 2009, there was no significant difference between patients who received PCI and those who did not receive PCI. This has remained unchanged for STEMI patients.C ONCLUSIONS: In metastatic cancer patients with ACS, the rate of PCI has increased over the last decade. In the current era, metastatic cancer patients with NSTEMI may perform equally well without PCI in terms of in-hospital mortality. The decision to provide such care may be considered on an individual basis based on the extent of their medical comorbidity and tumor burden.

Perception of prognosis of cancer patients by non-oncologists

“…It is unknown whether similar pessimism is the cause of the apparent undertreatment of cancer patients in published literature. 4,6,7,15 Similar studies performed in different locations can provide the lacking data.…”

“…Current literature demonstrates that cancer patients are often undertreated. For example, a recent cohort of 49, 515 metastatic patients with acute coronary syndrome documented a percutaneous coronary intervention (PCI) for only 24.9% of ST elevation myocardial infarction (STEMI) and 9.6% for non‐STEMI . In addition, while both short term and long term prognosis of cancer patients admitted to intensive care units has considerably improved, many patients are not considered as candidates for intensive care, or admitted after a detrimental delay .…”

“…Third, our results might represent a local misconception in the perception of the prognosis of cancer patients in Israel. It is unknown whether similar pessimism is the cause of the apparent undertreatment of cancer patients in published literature . Similar studies performed in different locations can provide the lacking data.…”

“…Univariate and multivariate analyses for pessimistic perception of the prognosis of cancer patients STEMI 15. In addition, while both short term and long term prognosis of cancer patients admitted to intensive care units has considerably improved, many patients are not considered as candidates for intensive care, or admitted after a detrimental delay 4,[16][17][18].…”

Acute Coronary Syndrome in Malignancy Patients

“…Необходимость про-филактического переливания тромбоцитов во время/ после ЧКВ может возникнуть, если: 1) ТП <20*10 9 /л сочетается с высокой температурой тела, лейкоцито-зом, стремительным снижением уровня тромбоцитов и другими коагулопатиями; 2) ТП <20*10 9 /л у паци-ентов, получающих лечение по поводу опухолей мочевого пузыря, органов малого таза, колоректаль-ных опухолей, меланомы или некроза опухолей [34]. Госпитальная летальность при выполнении ЧКВ у пациентов с метастазирующими опухолями и ОКС-пST, так и ОКСбпST оказалась ниже, чем у пациентов тех же групп, которым не проводилось ЧКВ (11,2% и 26,2% для ОКСпST; 5,3% и 14,7% для ОКСбпST; р<0,001 для обоих сравнений) [37].…”