Temporal trends and outcomes of acute myocardial infarction in patients with cancer

Pothineni, Naga Venkata K.; Shah, Nishi; Rochlani, Yogita; Saad, Marwan; Kovelamudi, Swathi; Marmagkiolis, Konstantinos; Bhatti, Sabha; Çilingiroğlu, Mehmet; Aronow, Wilbert S.; Hakeem, Abdul

doi:10.21037/atm.2017.11.29

Cited by 40 publications

(33 citation statements)

References 7 publications

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“…The risks and benefits of cardiovascular interventions themselves might be incompletely understood and over-or underestimated. A summary of the available evidence based on studies specifically enrolling cancer patients with ACS is outlined in Table 2 (23,(98)(99)(100)(101)(102)(103)(104).…”

Section: Treatment Of Acs In Cancer Patientsmentioning

confidence: 99%

Arterial events in cancer patients—the case of acute coronary thrombosis

Ohad¹,

Herrmann²

2018

J. Thorac. Dis

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Patients with cancer are at high risk for both venous and arterial thrombotic complications. A variety of factors account for the greater thrombotic risk, including the underlying malignancy and numerous cancer-directed therapies. The occurrence of an acute thrombotic event in patients with cancer is associated with substantial morbidity and mortality. Acute coronary syndrome (ACS) represents a particularly important cardiovascular complication in cancer patients. With cardio-vascular risk factors becoming more prevalent in an aging cancer population that is surviving longer, questions pertaining to the appropriate management of vascular toxicity are likely to assume even greater value in the coming years. In this article, we review the current understanding of ACS in patients with cancer. The predisposition to thrombosis in a malignant host and the cancer treatments most commonly associated with vascular toxicity are reviewed. Risk prediction and management strategies are discussed, and discrepancies in the clinical evidence are highlighted.

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Section: Treatment Of Acs In Cancer Patientsmentioning

confidence: 99%

Arterial events in cancer patients—the case of acute coronary thrombosis

Ohad¹,

Herrmann²

2018

J. Thorac. Dis

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“…28 However, available data offer conflicting views on the safety of these procedures among lower-risk cancer patients. 29,30 Additionally, patients with cancer had higher 30 day readmission rates than had non-cancer patients; however, HF-related readmission rates were higher in the non-cancer cohort, when compared with cancer patients. This discrepancy is likely related to cancer-specific morbidities such as infection, anaemia, or thrombosis.…”

Section: Heart Failure Admissions In Cancermentioning

confidence: 98%

Health care utilization and mortality associated with heart failure‐related admissions among cancer patients

et al. 2019

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Aims Heart failure (HF) outcomes continue to improve with widespread use of new therapies. Concurrently, cancer survival has dramatically improved. Yet whether cancer patients share similar strategies and outcomes of inpatient HF treatment to those without HF is unknown. We sought to assess the contemporary impacts of cancer on inpatient HF outcomes over time. Methods and results The retrospective National Inpatient Sample (2003–15) and National Readmissions Database (2013–14) registries were queried for adults admitted for HF and stratified for cancer status, excluding cases of metastatic disease. Temporal trends in HF admissions, hospital charge rates, length of hospitalization, HF‐related procedure utilization, in‐hospital mortality, and hospital readmissions were analysed. Over 13 years of follow‐up, there were 12 769 077 HF admissions (mean age 73 years, 50.8% female, 30.8% non‐White), among which 1 413 287 (11%) had a co‐morbid cancer diagnosis. Cancer patients were older, were predominantly male, and tended to be smokers. Over time, HF admission rates among cancer patients increased, despite a concurrent decrease among patients without cancer (P < 0.0001). After propensity matching, in‐hospital mortality was significantly higher among cancer HF patients (5.1% vs. 2.9%, P < 0.0001). Additionally, HF‐related procedure utilization was disproportionately lower among cancer patients (0.30 vs. 0.35 procedures/HF hospitalization, P < 0.001); the presence of cancer was associated with increased costs, length of hospitalizations, and all‐cause readmissions, but fewer HF readmissions (P < 0.0001, each). Conclusions While the incidence of HF hospitalizations has increased among cancer patients, they do not appear to share the same rates of advanced HF care, readmissions trends, or reductions in in‐hospital mortality. Future studies targeting modifiable factors related to these differences are needed.

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“…A study comprising 49,515 ACS patients with cancer found that the in-hospital mortality rate of patients undergoing myocardial revascularization was significantly lower than that of patients receiving conservative medical therapy [ 65 ]. Despite this growing evidence, a less frequent use of percutaneous coronary intervention with drug-eluting stents in patients with a history of cancer admitted for ACS has been consistently reported [ 9 , 15 , 58 ]. A study performed at the MD Anderson Cancer Center (Houston, Texas) found that, among cancer patients with AMI, only 3% underwent percutaneous coronary intervention and only 6% of STEMI patients underwent primary angioplasty [ 58 ].…”

Section: Clinical Management Of Acs In Cancer Patientsmentioning

confidence: 99%

“…A study performed at the MD Anderson Cancer Center (Houston, Texas) found that, among cancer patients with AMI, only 3% underwent percutaneous coronary intervention and only 6% of STEMI patients underwent primary angioplasty [ 58 ]. Similarly, Pothineni et al [ 15 ] analyzed the United States National Inpatient Sample and found that the utilization of primary angioplasty in STEMI patients with cancer varied according to the type of cancer, ranging from 17% in patients with colon cancer to 31% in those with breast cancer. Notably, cancer patients treated with primary angioplasty were less likely to die than those who did not receive myocardial revascularization [ 15 ].…”

Section: Clinical Management Of Acs In Cancer Patientsmentioning

confidence: 99%

“…Similarly, Pothineni et al [ 15 ] analyzed the United States National Inpatient Sample and found that the utilization of primary angioplasty in STEMI patients with cancer varied according to the type of cancer, ranging from 17% in patients with colon cancer to 31% in those with breast cancer. Notably, cancer patients treated with primary angioplasty were less likely to die than those who did not receive myocardial revascularization [ 15 ]. Not only are patients with active cancer and ACS less frequently referred to the catheterization laboratory, but also those with a previous history of cancer; in the National Registry of Acute Myocardial Infarction in Switzerland (AMIS Plus), ACS patients with a history of cancer were less likely to undergo percutaneous coronary intervention than those without (68% vs. 73%) [ 9 ].…”

Section: Clinical Management Of Acs In Cancer Patientsmentioning

confidence: 99%

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

Milazzo

Cosentino

Campodonico

et al. 2020

JCM

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Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.

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Temporal trends and outcomes of acute myocardial infarction in patients with cancer

Abstract: Patients with cancer have significantly worse in-hospital mortality compared to those without cancer, partly due to a relatively lower rate of PCI utilization in cancer patients with STEMI.

Cited by 40 publications

References 7 publications

Arterial events in cancer patients—the case of acute coronary thrombosis

Arterial events in cancer patients—the case of acute coronary thrombosis

Health care utilization and mortality associated with heart failure‐related admissions among cancer patients

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

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