Previously diagnosed cancer and mortality after ST‐segment elevation acute myocardial infarction treated with primary angioplasty

Abstract

Objective We investigated if a previous cancer diagnosis influences the outcome of patients with STEMI treated with primary coronary intervention (PCI). Background ST‐segment myocardial infarction (STEMI) and a history of cancer can coexist because both have a high incidence and prevalence. Methods Prospective cohort observational study, The primary end‐point was total mortality. Results We included 917 patients, 53 of them (5.8%) were cancer survivors. During follow‐up (median, 643 days [interquartile range, 258 to 1,015 days]), 100 patients died, 88 (10.2%) patients without a cancer diagnosis and 12 (22.6%) patients with a previous cancer diagnosis, which was significantly different (log‐rank test = 8.4, p = .004). Cancer patients were older (73.4 (11.5) vs. 65.2 (13.8) years, p < .001), with a lower prevalence of previous stroke (1.1% vs. 2.2%, p = .002). Their hemoglobin concentration was also lower (13.4 (2.1) vs. 14.4 (1.7) g/L, p = .001). A trend towards a lower use of coronary stents in cancer survivors was noted (p = .061). Cancer was associated with a high probability of death (HR = 2.37, 95% confidence interval [CI] 1.30–4.34, p = .005). When confounding variables were included, this association was no longer significant (HR = 1.63, 95% CI 0.84–3.18, p = .150). Conclusions Patients with a previous cancer diagnosis who had an acute STEMI treated by primary PCI did not seem to have a worse prognosis. The difference in the crude mortality rate can be explained by the baseline differences between both groups. Previous cancer diagnosis should not be included in the clinical decision process when a patient is having an acute STEMI.

Impact of a Cancer History on Cardiovascular Events Among Patients With Myocardial Infarction Who Received Revascularization

“…The mean follow-up period in the present study was around 2 years; however, the number of patients in whom follow-up did not reach 5 years was 245 (44.5%) and the remaining 306 (55.5%) patients achieved 5 years follow-up. Followup was longer than in some of the previous studies, 5,9,11, 16 which enabled us to evaluate the effect of a history of cancer on long-term CV events.…”

“…Some concluded that a history of cancer was associated with a higher risk of CV events, 5-11 while others showed a similar risk between patients with and without a history of cancer. [12][13][14][15][16] This inconsistency among results may be explained in part by the definition of a history of cancer and the limited types of CV events. In some of the previous studies, a history of cancer was defined by questionnaire 14 or self-reporting by the patients, 15 which may have resulted in failure to identify some patients with a history of cancer and thus affecting the results of the study.…”

“…ing, 6,7,9-11 but other studies concluded that the risk of CV events was similar between patients with and without a history of cancer. 12- 16 In Asia, especially, because of the lack of registries in cardio-oncology and difficulties in integrating MI data with cancer registry, none of the previous studies have evaluated the effect of a history of cancer CV events among AMI patients with detailed information on both MI and cancer. 6, 14 Addressing this knowledge gap is important in the field of cardio-oncology because the number of patients with a history of cancer who undergo revascularization for AMI is increasing as a result of the advancements in cancer therapy in the past quarter of the century.…”

In-hospital and one-year outcomes in cancer patients receiving percutaneous coronary intervention for acute myocardial infarction: A real-world study

“…Another study also found that all-cause mortality rates were higher in patients with cancer after PCI in general ( 13 ). However, a single-center study reported that there was no survival advantage in patients with STEMI who were treated with PCI compared with the patients who did not have a previous cancer diagnosis ( 14 ). These previous studies focus on the effect of history of cancer on the prognosis of patients with AMI.…”

STEMI in the cancer patient: Do not withhold primary PCI!

“…In this current issue of CCI , Iglesias‐Garriz et al reported outcomes in patients with a prior diagnosis of cancer who sustained a STEMI . The timing from cancer diagnosis or treatment to occurrence of STEMI was unknown, but the authors stated that patients with active therapy for cancer were excluded.…”