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Leiva O, Cheng RK, Pauwaa S, Katz JN, Alvarez-Cardona J, Bernard S, Alviar C, Yang EH. Outcomes of Patients With Cancer With Myocardial Infarction-Associated Cardiogenic Shock Managed With Mechanical Circulatory Support. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101208. [PMID: 39131775 PMCID: PMC11307771 DOI: 10.1016/j.jscai.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Background Cardiogenic shock (CS) is the leading cause of death among patients with acute myocardial infarction (AMI) and is managed with temporary mechanical circulatory support (tMCS) in advanced cases. Patients with cancer are at high risk of AMI and CS. However, outcomes of patients with cancer and AMI-CS managed with tMCS have not been rigorously studied. Methods Adult patients with AMI-CS managed with tMCS from 2006 to 2018 with and without cancer were identified using the National Inpatient Sample. Propensity score matching (PSM) was performed for variables associated with cancer. Primary outcome was in-hospital death, and secondary outcomes were major bleeding and thrombotic complications. Results After PSM, 1287 patients with cancer were matched with 12,870 patients without cancer. There was an increasing temporal trend for prevalence of cancer among patients admitted with AMI-CS managed with tMCS (P trend < .001). After PSM, there was no difference in in-hospital death (odds ratio [OR], 1.00; 95% CI, 0.88-1.13) or thrombotic complications (OR, 1.10; 95% CI, 0.91-1.34) between patients with and without cancer. Patients with cancer had a higher risk of major bleeding (OR, 1.29; 95% CI, 1.15-1.46). Conclusions Among patients with AMI-CS managed with tMCS, cancer is becoming increasingly frequent and associated with increased risk of major bleeding, although there was no difference in in-hospital death. Further studies are needed to further characterize outcomes, and inclusion of patients with cancer in trials of tMCS is needed.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sunil Pauwaa
- Division of Cardiology, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Jason N. Katz
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Jose Alvarez-Cardona
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Samuel Bernard
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Carlos Alviar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California
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Hultcrantz M, Wilkes SR, Kristinsson SY, Andersson TML, Derolf ÅR, Eloranta S, Samuelsson J, Landgren O, Dickman PW, Lambert PC, Björkholm M. Risk and Cause of Death in Patients Diagnosed With Myeloproliferative Neoplasms in Sweden Between 1973 and 2005: A Population-Based Study. J Clin Oncol 2015; 33:2288-95. [PMID: 26033810 DOI: 10.1200/jco.2014.57.6652] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Myeloproliferative neoplasms (MPNs) are associated with a shortened life expectancy. We assessed causes of death in patients with MPN and matched controls using both relative risks and absolute probabilities in the presence of competing risks. PATIENTS AND METHODS From Swedish registries, we identified 9,285 patients with MPN and 35,769 matched controls. A flexible parametric model was used to estimate cause-specific hazard ratios (HRs) of death and cumulative incidence functions, each with 95% CIs. RESULTS In patients with MPN, the HRs of death from hematologic malignancies and infections were 92.8 (95% CI, 70.0 to 123.1) and 2.7 (95% CI, 2.4 to 3.1), respectively. In patients age 70 to 79 years at diagnosis (the largest patient group), the HRs of death from cardiovascular and cerebrovascular disease were 1.5 (95% CI, 1.4 to 1.7) and 1.5 (95% CI, 1.3 to 1.8), respectively; all were statistically significantly elevated compared with those of controls. In the same age group, no difference was observed in the 10-year probability of death resulting from cardiovascular disease in patients with MPN versus controls (16.8% v 15.2%) or cerebrovascular disease (5.6% v 5.2%). In patients age 50 to 59 years at diagnosis, the 10-year probability of death resulting from cardiovascular and cerebrovascular disease was elevated, 4.2% versus 2.1% and 1.9% versus 0.4%, respectively. Survival in patients with MPN increased over time, mainly because of decreased probabilities of dying as a result of hematologic malignancies, infections, and, in young patients, cardiovascular disease. CONCLUSION Patients with MPN had an overall higher mortality rate than that of matched controls, primarily because of hematologic malignancy, infections, and vascular events in younger patients. Evidently, there is still a need for effective disease-modifying agents to improve patient outcomes.
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Affiliation(s)
- Malin Hultcrantz
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Sally R Wilkes
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sigurdur Y Kristinsson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Therese M-L Andersson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Åsa R Derolf
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sandra Eloranta
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jan Samuelsson
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ola Landgren
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul W Dickman
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Paul C Lambert
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Magnus Björkholm
- Malin Hultcrantz, Sigurdur Y. Kristinsson, Åsa R. Derolf, and Magnus Björkholm, Karolinska University Hospital; Malin Hultcrantz, Sigurdur Y. Kristinsson, Therese M.-L. Andersson, Åsa R. Derolf, Sandra Eloranta, Paul W. Dickman, Paul C. Lambert, and Magnus Björkholm, Karolinska Institutet; Jan Samuelsson, South Hospital, Stockholm, Sweden; Sally R. Wilkes, University of Nottingham, Nottingham; Paul C. Lambert, University of Leicester, Leicester, United Kingdom; Sigurdur Y. Kristinsson, University of Iceland and Landspitali National University Hospital, Reykjavik, Iceland; and Ola Landgren, Memorial Sloan Kettering Cancer Center, New York, NY
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