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Ginder CR, Suero-Abreu GA, Ghumman SS, Bergmark BA, Arnaout O, Giugliano RP. Emergent Coronary Thrombectomy for Acute Myocardial Infarction Immediately Following Craniotomy with Tumor Resection. Cardiol Ther 2024; 13:443-452. [PMID: 38536649 PMCID: PMC11093953 DOI: 10.1007/s40119-024-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/17/2024] [Indexed: 05/15/2024] Open
Abstract
The management of perioperative acute myocardial infarction (AMI) following oncologic neurosurgery requires balancing competing risks of myocardial ischemia and postoperative bleeding. There are limited human data to establish the safest timing of antiplatelet or anticoagulation therapy following neurosurgical procedures. For patients with malignancy experiencing AMI in the acute postoperative period, staged percutaneous coronary intervention (PCI) with upfront coronary aspiration thrombectomy followed by delayed completion PCI may offer an opportunity for myocardial salvage while minimizing postoperative bleeding risks. CYP2C19 genotyping and platelet aggregation studies can help confirm adequate platelet inhibition once antiplatelet therapy is resumed.
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Affiliation(s)
- Curtis R Ginder
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Giselle A Suero-Abreu
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Brian A Bergmark
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale BTM, Suite 7022, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert P Giugliano
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale BTM, Suite 7022, 60 Fenwood Road, Boston, MA, 02115, USA.
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Ameri P, Bertero E, Lombardi M, Porto I, Canepa M, Nohria A, Vergallo R, Lyon AR, López-Fernández T. Ischaemic heart disease in patients with cancer. Eur Heart J 2024; 45:1209-1223. [PMID: 38323638 DOI: 10.1093/eurheartj/ehae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Edoardo Bertero
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Marco Lombardi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rocco Vergallo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Quirón Pozuelo University Hospital, Madrid, Spain
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Takeuchi T, Kosugi S, Ueda Y, Ikeoka K, Yamane H, Takayasu K, Ohashi T, Fukushima T, Horiuchi K, Iehara T, Sakamoto M, Ukai K, Minami S, Mizumori Y, Muraoka N, Nakamura M, Ozaki T, Mishima T, Abe H, Inoue K, Matsumura Y. Impact of a Cancer History on Cardiovascular Events Among Patients With Myocardial Infarction Who Received Revascularization. Circ J 2024; 88:207-214. [PMID: 37045768 DOI: 10.1253/circj.cj-22-0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND It remains controversial whether a cancer history increases the risk of cardiovascular (CV) events among patients with myocardial infarction (MI) who undergo revascularization. METHODS AND RESULTS Patients who were confirmed as type 1 acute MI (AMI) by coronary angiography were retrospectively analyzed. Patients who died in hospital or those not undergoing revascularization were excluded. Patients with a cancer history were compared with those without it. A cancer history was examined in the in-hospital cancer registry. The primary outcome was a composite of cardiac death, recurrent type 1 MI, post-discharge coronary revascularization, heart failure hospitalization, and stroke. Among 551 AMI patients, 55 had a cancer history (cancer group) and 496 did not (non-cancer group). Cox proportional hazards model revealed that the risk of composite endpoint was significantly higher in the cancer group than in the non-cancer group (adjusted hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.13-2.82). Among the cancer group, patients who were diagnosed as AMI within 6 months after the cancer diagnosis had a higher risk of the composite endpoint than those who were diagnosed as AMI 6 months or later after the cancer diagnosis (adjusted HR: 5.43; 95% CI: 1.55-19.07). CONCLUSIONS A cancer history increased the risk of CV events after discharge among AMI patients after revascularization.
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Affiliation(s)
- Taro Takeuchi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Shumpei Kosugi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasunori Ueda
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Kuniyasu Ikeoka
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Haruya Yamane
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Kohtaro Takayasu
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Takuya Ohashi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Takashi Fukushima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Kohei Horiuchi
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Takashi Iehara
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Mai Sakamoto
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Kazuho Ukai
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Shinya Minami
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yuuki Mizumori
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Naoya Muraoka
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Masayuki Nakamura
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Tatsuhisa Ozaki
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Tsuyoshi Mishima
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Haruhiko Abe
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Koichi Inoue
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
| | - Yasushi Matsumura
- Cardiovascular Division, National Hospital Organization Osaka National Hospital
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Kalkan A, Metze C, Iliadis C, Körber MI, Baldus S, Pfister R. Prognostic impact of cancer history in patients undergoing transcatheter mitral valve repair. Clin Res Cardiol 2024; 113:94-106. [PMID: 37581720 PMCID: PMC10808190 DOI: 10.1007/s00392-023-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND History of cancer is common in patients undergoing transcatheter mitral valve repair (TMVR). OBJECTIVES Aim was to examine the impact of cancer history on outcomes after TMVR. METHODS In patients of a monocentric prospective registry of TMVR history of cancer was retrospectively assessed from records. Associations with 6-week functional outcomes and clinical outcomes during a median follow-up period of 594 days were examined. RESULTS Of 661 patients (mean age 79 years; age-range 37-101 years; 56.1% men), 21.6% had a history of cancer with active disease in 4.1%. Compared with non-cancer patients, cancer patients had a similar procedural success rate (reduction of mitral regurgitation to grade 2 or lower 91.6% vs. 88%; p = 0.517) and similar relevant improvement in 6-min walking distance, NYHA class, Minnesota Living with Heart Failure Questionnaire score and Short Form 36 scores. 1-year survival (83% vs. 82%; p = 0.813) and 1-year survival free of heart failure decompensation (75% vs. 76%; p = 0.871) were comparable between cancer and non-cancer patients. Patients with an active cancer disease showed significantly higher mortality compared with patients having a history of cancer (hazard ratio 2.05 [95% CI 1.11-3.82; p = 0.023]) but similar mortality at landmark analysis of 1 year. CONCLUSION TMVR can be performed with equal efficacy in patients with and without cancer and symptomatic mitral regurgitation. Cancer patients show comparable clinical outcome and short-term functional improvement as non-cancer patients. However, longterm mortality was increased in patients with active cancer underlining the importance of patient selection within the heart-team evaluation.
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Affiliation(s)
- Alev Kalkan
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Clemens Metze
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Maria I Körber
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
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Castaldi G, Bharadwaj AS, Bagur R, Van Spall HGC, Kobo O, Mamas MA. Prevalence and outcomes of type 2 myocardial infarction in patients with cancer: A retrospective analysis from the National Inpatient Sample dataset. Int J Cardiol 2023; 389:131154. [PMID: 37442352 DOI: 10.1016/j.ijcard.2023.131154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/11/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND This study aimed to investigate the prevalence, clinical characteristics and outcomes of type 2 myocardial infarction (T2AMI) in patients with versus without cancer. METHODS All hospitalizations with a primary discharge diagnosis of T2AMI were stratified according to cancer status (secondary diagnosis of any-cancer vs cancer-free) using data from the US National Inpatient Sample (2016-2019). The primary outcome was in-hospital all-cause mortality while secondary outcomes were in-hospital major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Among 61,305 included hospitalizations with primary diagnosis of T2AMI, 3745 (6.1%) were associated with a diagnosis of cancer. Patients with T2AMI and cancer presented more frequently with acute respiratory failure (23.2% vs 18.1%), acute pulmonary embolism (3.7% v 1.3%), major bleeding (6.8% vs 4.1%) and renal failure (51.0% vs 46.8%), compared to patients without. On adjusted analysis, diagnosis of cancer was associated with lower odds of invasive coronary angiography (aOR 0.75, 95% CI 0.60 to 0.93, p = 0.009) but greater odds of mortality (aOR 1.95, 95% C.I. 1.26-2.99 p = 0.002). Among the different types of cancer, adjusted risk of all-cause mortality was higher in patients with colorectal (aOR 4.17 95% CI 1.68-10.32, p = 0.002), lung (aOR 3.63, 95% CI 1.83-7.18, p < 0.001) and haematologic (aOR 2.48, 95% CI 1.22-5.05, p = 0.001) cancer. CONCLUSIONS Patients with cancer presenting with T2AMI have lower odds of management with invasive diagnostic coronary angiography and have higher rates of in-hospital all-cause death. Further studies are warranted to improve overall care and outcomes of cancer patients and cardiovascular diseases.
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Affiliation(s)
| | | | - Rodrigo Bagur
- London Health Sciences Centre, Division of Cardiology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Research Institute of St. Joseph's, Hamilton, Canada; Population Health Research Institute, Hamilton, Canada
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.
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Yang YX, Zhang HP, Li C, Fu Y, He KZ, Liu XM, Wang HJ, Xia K, Xu L, Zhong JC, Chen ML, Wang LF. Comparisons of drug-eluting balloon versus drug-eluting stent for the treatment of cancer patients presenting with acute myocardial infarction. Eur J Med Res 2023; 28:334. [PMID: 37689799 PMCID: PMC10492280 DOI: 10.1186/s40001-023-01316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Treatment for cancer patients presenting with acute myocardial infarction (AMI) remains challenging. The objective of the study was to investigate the safety and efficiency of drug eluting balloon (DEB) versus drug eluting stent (DES) in this high-risk group. METHODS Between 1st January 2017 and 1st January 2022, cancer patients admitted to Beijing Chaoyang Hospital with AMI were retrospectively enrolled. The primary endpoint was major adverse cardiovascular event (MACE). The secondary endpoints included major bleeding events, heart failure and cardiac complications. RESULTS A total of 164 cancer patients presenting with AMI were included in the final analysis. Patients treated with DEB had a numerically lower rate of MACE than those treated with DES during a median follow-up of 21.8 months (22.9% vs. 37.1%, p = 0.23). Patients treated with DEB had a trend towards lower rate of major bleeding events than patients treated with DES (6.3% vs. 18.1%, HR 2.96, 95% CI [0.88, 9.92], p = 0.08). There were no significant differences between the two groups with regards to the rate of heart failure (4.2% vs. 9.5%, p = 0.32) and cardiac complications (0.0% vs. 2.6%, p = 0.56). CONCLUSIONS The present study demonstrated that in cancer patients with AMI, DEB had a trend towards lower rate of major bleeding events and a numerically lower rate of MACE compared with DES.
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Affiliation(s)
- Yi-Xing Yang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Huai-Peng Zhang
- Department of Cardiology, Heze Municipal Hospital, No. 2888, Caozhou Road, Mudan District, Heze, 274000, Shandong, China
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Yuan Fu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Kui-Zheng He
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Xin-Ming Liu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Hong-Jiang Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Kun Xia
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Li Xu
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Jiu-Chang Zhong
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Mu-Lei Chen
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Le-Feng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongti South Road, Chaoyang District, Beijing, 100020, China.
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Thotamgari SR, Sheth AR, Patel HP, Sandhyavenu H, Patel B, Grewal US, Bhuiyan MAN, Dani SS, Dominic P. Safety of catheter ablation for atrial fibrillation in patients with cancer: a nationwide cohort study. Postgrad Med 2023; 135:562-568. [PMID: 37224412 DOI: 10.1080/00325481.2023.2218188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer, especially breast, gastrointestinal, respiratory, urinary tract, and hematological malignancies. Catheter ablation (CA) is a well-established, safe treatment option in healthy patients; however, literature regarding safety of CA for AF in patients with cancer is limited and confined to single centers. OBJECTIVE We aimed to assess the outcomes and peri-procedural safety of CA for AF in patients with certain types of cancer. METHODS The NIS database was queried between 2016 and 2019 to identify primary hospitalizations with AF and CA. Hospitalizations with secondary diagnosis of atrial flutter and other arrhythmias were excluded. Propensity score matching was used to balance the covariates between cancer and non-cancer groups. Logistic regression was used to analyze the association. RESULTS During this period, 47,765 CA procedures were identified, out of which 750 (1.6%) hospitalizations had a diagnosis of cancer. After propensity matching, hospitalizations with cancer diagnosis had higher in-hospital mortality (OR 3.0, 95% CI 1.5-6.2, p = 0.001), lower home discharge rates (OR 0.7, 95% CI 0.6-0.9, p < 0.001) as well as other complications such as major bleeding (OR 1.8, 95% CI 1.3-2.7, p = 0.001) and pulmonary embolism (OR 6.1, 95% CI 2.1-17.8, p < 0.001) but not associated with any major cardiac complications (OR 1.2, 95% CI 0.7-1.8, p = 0.53). CONCLUSION Patients with cancer who underwent CA for AF had significantly higher odds of in-hospital mortality, major bleeding, and pulmonary embolism. Further larger prospective observational studies are needed to validate these findings.
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Affiliation(s)
- Sahith Reddy Thotamgari
- Department of Internal Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA, USA
| | - Aakash R Sheth
- Division of Cardiology, University of Pittsburgh Medical Center, Harrisburg, PA, USA
| | - Harsh P Patel
- Division of Cardiology, Southern Illinois University, Springfield, IL, USA
| | - Harigopal Sandhyavenu
- Department of Internal Medicine, Louis. A. Weiss Memorial Hospital, Chicago, IL, USA
| | - Bhavin Patel
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Udhayvir S Grewal
- Department of Hematology/Oncology, University of Iowa, Iowa City, IA, USA
| | | | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Paari Dominic
- Center of Excellence for Cardiovascular Diseases & Sciences, Louisiana State University Health Sciences Center-Shreveport, LA, USA
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Tang M, Wang Y, Cao X, Day JD, Liu H, Sun C, Li G. In-hospital and one-year outcomes in cancer patients receiving percutaneous coronary intervention for acute myocardial infarction: A real-world study. Front Cardiovasc Med 2023; 9:1005473. [PMID: 36824290 DOI: 10.3389/fcvm.2021.77861510.3389/fcvm.2021.778615] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/17/2022] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Cancer and ischemic heart disease are the leading causes of mortality. The optimal management for patients with concomitant acute myocardial infarction (AMI) and cancer remains challenging. OBJECTIVE To evaluate in-hospital and 1-year adverse outcomes in cancer patients receiving percutaneous coronary intervention (PCI) to treat AMI. METHODS This was a single-center, retrospective cohort study, patients with cancer admitted to The First Affiliated Hospital of Xi'an Jiaotong University for AMI and discharged between January 2015 and June 2020 were analyzed. The outcomes were all-cause mortality at 1-year follow up and incidence of in-hospital adverse events, including arrhythmias, heart failure, major bleeding, stroke, and all-cause death. RESULTS A total of 119 patients were included, of these, 68 (57.1%) received PCI (PCI group) and 51 (42.9%) did not (non-PCI group). Patients in the PCI group had a lower incidence of in-hospital arrhythmias (22.1 vs. 39.2%; p = 0.042), major bleeding (2.9 vs. 15.7%; p = 0.013), and all-cause mortality (1.5 vs. 11.8%; p = 0.018) than those in non-PCI group. On 1-year follow-up, the PCI group had a lower all-cause mortality than the non-PCI group (log-rank test = 14.65; p < 0.001). Multivariable Cox regression showed that PCI is an independent protective factor (adjusted HR = 0.503 [0.243-0.947], p = 0.045) for cancer patients who have concomitant AMI. CONCLUSION Cancer patients receiving PCI for AMI had a lower risk of in-hospital adverse events and mortality as well as 1-year all-cause mortality compared to those who refused PCI. Our study therefore supports the use of PCI to improve prognosis of this selected group of patients.
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Affiliation(s)
- Manyun Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yidan Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiangqi Cao
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - John D Day
- Department of Cardiology, St. Mark's Hospital, Salt Lake City, UT, United States
| | - Hui Liu
- BioBank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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9
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Tang M, Wang Y, Cao X, Day JD, Liu H, Sun C, Li G. In-hospital and one-year outcomes in cancer patients receiving percutaneous coronary intervention for acute myocardial infarction: A real-world study. Front Cardiovasc Med 2023; 9:1005473. [PMID: 36824290 PMCID: PMC9941959 DOI: 10.3389/fcvm.2022.1005473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/17/2022] [Indexed: 02/09/2023] Open
Abstract
Background Cancer and ischemic heart disease are the leading causes of mortality. The optimal management for patients with concomitant acute myocardial infarction (AMI) and cancer remains challenging. Objective To evaluate in-hospital and 1-year adverse outcomes in cancer patients receiving percutaneous coronary intervention (PCI) to treat AMI. Methods This was a single-center, retrospective cohort study, patients with cancer admitted to The First Affiliated Hospital of Xi'an Jiaotong University for AMI and discharged between January 2015 and June 2020 were analyzed. The outcomes were all-cause mortality at 1-year follow up and incidence of in-hospital adverse events, including arrhythmias, heart failure, major bleeding, stroke, and all-cause death. Results A total of 119 patients were included, of these, 68 (57.1%) received PCI (PCI group) and 51 (42.9%) did not (non-PCI group). Patients in the PCI group had a lower incidence of in-hospital arrhythmias (22.1 vs. 39.2%; p = 0.042), major bleeding (2.9 vs. 15.7%; p = 0.013), and all-cause mortality (1.5 vs. 11.8%; p = 0.018) than those in non-PCI group. On 1-year follow-up, the PCI group had a lower all-cause mortality than the non-PCI group (log-rank test = 14.65; p < 0.001). Multivariable Cox regression showed that PCI is an independent protective factor (adjusted HR = 0.503 [0.243-0.947], p = 0.045) for cancer patients who have concomitant AMI. Conclusion Cancer patients receiving PCI for AMI had a lower risk of in-hospital adverse events and mortality as well as 1-year all-cause mortality compared to those who refused PCI. Our study therefore supports the use of PCI to improve prognosis of this selected group of patients.
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Affiliation(s)
- Manyun Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yidan Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiangqi Cao
- Stroke Centre and Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - John D. Day
- Department of Cardiology, St. Mark’s Hospital, Salt Lake City, UT, United States
| | - Hui Liu
- BioBank, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Chaofeng Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Chaofeng Sun,
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Guoliang Li,
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Boyer J, Deharo P, Angoulvant D, Ivanes F, Ferrara J, Vaillier A, Cautela J, Herbert J, Saint Etienne C, Cuisset T, Thuny F, Fauchier L. Cardiovascular outcomes in patients with cancer during a 5-year follow-up: Results from a French administrative database. Arch Cardiovasc Dis 2023; 116:88-97. [PMID: 36641244 DOI: 10.1016/j.acvd.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Limited data are available regarding the optimal management and prognosis of patients with cancer who develop an acute myocardial infarction. AIM The objective of this study was to analyse the characteristics and outcomes of patients according to cancer and myocardial infarction occurrence. METHODS Based on the French administrative hospital discharge database, the study collected information for all consecutive patients seen in French hospitals in 2013, excluding those with a history of myocardial infarction. The population was divided into two groups according to their history of cancer. We studied the following outcomes: all-cause and cardiovascular mortality; acute myocardial infarction; and ischaemic stroke. Data were collected after a 5-year follow-up. RESULTS Between 2013 and 2019, 3,381,472 patients were seen in French hospitals; among them, 3,323,757 had no history of myocardial infarction. Patients with a history of cancer (n=497,593) had higher incidences of all-cause mortality (17.82%/year vs 3.79%/year), cardiovascular mortality (1.61%/year vs 1.17%/year), myocardial infarction (0.82%/year vs 0.61%/year) and ischaemic stroke (0.91%/year vs 0.62%/year) compared with patients without cancer (n=2,826,164). After performing an adjusted competing-risk analysis, the cumulative incidence of acute myocardial infarction, cardiovascular death and ischaemic stroke incidence was found to be lower in patients with a history of cancer, whereas death of non-cardiac origin was more prevalent in patients with a history of cancer. CONCLUSIONS In this observational study, we have shown that patients with cancer have a higher incidence of all-cause mortality, cardiovascular mortality and myocardial infarction. However, multivariable analysis showed a lower cumulative incidence of these events.
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Affiliation(s)
- Jérémy Boyer
- Département de cardiologie, CHU Timone, 13005 Marseille, France
| | - Pierre Deharo
- Département de cardiologie, CHU Timone, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRA, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13385 Marseille, France.
| | - Denis Angoulvant
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; EA4245 Transplantation immunité inflammation, université de Tours, 37032 Tours, France
| | - Fabrice Ivanes
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; EA4245 Transplantation immunité inflammation, université de Tours, 37032 Tours, France
| | - Jerome Ferrara
- Département de cardiologie, CHU Timone, 13005 Marseille, France
| | | | - Jennifer Cautela
- Faculté de médecine, Aix-Marseille université, 13385 Marseille, France; Département de cardiologie, CHU Nord, 13015 Marseille, France
| | - Julien Herbert
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France; Service d'information médicale, d'épidémiologie et d'économie de la santé, centre hospitalier universitaire et Faculté de médecine, EA7505, université de Tours, 37044 Tours, France
| | - Christophe Saint Etienne
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France
| | - Thomas Cuisset
- Département de cardiologie, CHU Timone, 13005 Marseille, France; C2VN, Aix-Marseille université, Inserm, INRA, 13005 Marseille, France; Faculté de médecine, Aix-Marseille université, 13385 Marseille, France
| | - Franck Thuny
- Faculté de médecine, Aix-Marseille université, 13385 Marseille, France; Département de cardiologie, CHU Nord, 13015 Marseille, France
| | - Laurent Fauchier
- Service de cardiologie, centre hospitalier universitaire trousseau et Faculté de médecine, université de Tours, 37032 Tours, France
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11
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Donisan T, Madanat L, Balanescu DV, Mertens A, Dixon S. Drug-Eluting Stent Restenosis: Modern Approach to a Classic Challenge. Curr Cardiol Rev 2023; 19:e030123212355. [PMID: 36597603 PMCID: PMC10280993 DOI: 10.2174/1573403x19666230103154638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
In-stent restenosis (ISR) is a recognized complication following percutaneous coronary intervention in which the luminal diameter is narrowed through neointimal hyperplasia and vessel remodeling. Although rates of ISR have decreased in most recent years owing to newer generation drug-eluting stents, thinner struts, and better intravascular imaging modalities, ISR remains a prevalent dilemma that proves to be challenging to manage. Several factors have been proposed to contribute to ISR formation, including mechanical stent characteristics, technical factors during the coronary intervention, and biological aspects of drug-eluting stents. Presentation of ISR can range from asymptomatic to late myocardial infarction and could be difficult to differentiate from acute thrombus formation. No definite guidelines are present on the management of ISR. In this review, we will discuss the mechanisms underlying ISR and provide insight into patient-related and procedural risk factors contributing to ISR, in addition to highlighting common treatment approaches utilized in the management of ISR.
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Affiliation(s)
- Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Luai Madanat
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Dinu V. Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Amy Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, MI, 48073, USA
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12
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Ahmed T, Pacha HM, Addoumieh A, Koutroumpakis E, Song J, Charitakis K, Boudoulas KD, Cilingiroglu M, Marmagkiolis K, Grines C, Iliescu CA. Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents. Front Cardiovasc Med 2022; 9:901431. [DOI: 10.3389/fcvm.2022.901431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundManagement of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).MethodsWe identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan–Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.ResultsWe included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4–38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups (p = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS (p = 0.03). The use of DES was more common in patients with NSTEMI (p = 0.03). The median survival was 46 months (95% CI, 34–66). There was no significant difference in the number of revascularizations between the BMS and DES groups (p = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis (p = 0.26). In addition, independent predictors for worse survival included age > 65 years, BMI ≤ 25 g/m2, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.ConclusionsIn our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.
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13
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Percutaneous Coronary Angioplasty in Patients with Cancer: Clinical Challenges and Management Strategies. J Pers Med 2022; 12:jpm12091372. [PMID: 36143156 PMCID: PMC9502938 DOI: 10.3390/jpm12091372] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
The number of cancer survivors in the United States is projected to increase by 31% by 2030. With advances in early screening, diagnosis and therapeutic strategies, a steadily increasing number of patients are surviving cancer. Coronary artery disease (CAD) is now one of the leading causes of death amongst cancer survivors, with the latter group of patients having a higher risk of CAD compared to the general population. Our review covers a range of specific challenges faced by doctors when considering percutaneous coronary interventions (PCI) in cancer patients; clinical outcomes in cancer patients undergoing PCI, as well as some important technical considerations to be made when making decisions regarding the management strategy in this special population of patients.
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14
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Wan Kim J, Monlezun D, Kun Park J, Chauhan S, Balanescu D, Koutroumpakis E, Palaskas N, Kim P, Hassan S, Botz G, Crommett J, Reddy D, Cilingiroglu M, Marmagkiolis K, Iliescu C. Post-Cardiac Arrest PCI is Underutilized Among Cancer Patients: Machine Learning Augmented Nationally Representative Case-Control Study of 30 Million Hospitalizations. Resuscitation 2022; 179:43-49. [PMID: 35933056 DOI: 10.1016/j.resuscitation.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer patients are less likely to undergo percutaneous coronary intervention (PCI) after cardiac arrest, although they demonstrate improved mortality benefit from the procedure. We produced the largest nationally representative analysis of mortality of cardiac arrest and PCI for patients with cancer versus non-cancer. METHODS Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States' largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models of mortality and PCI weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI RESULTS: Of the 30,195,722 hospitalized adult patients, 15.43% had cancer, and 0.79% of the whole sample presented with cardiac arrest (of whom 20.57% underwent PCI). In fully adjusted regression analysis among patients with cardiac arrest, PCI significantly reduced mortality (OR 0.15, 95%CI 0.13-0.19; p<0.001) among patients with cancer greater than those without it (OR 0.21, 95%CI 0.20-0.23; p<0.001). CONCLUSIONS This nationally representative study suggests that post-cardiac arrest PCI is underutilized among patients with cancer despite its significant mortality reduction for such patients (independent of clinical acuity).
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Affiliation(s)
- Jin Wan Kim
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Dominique Monlezun
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jong Kun Park
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Siddharth Chauhan
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dinu Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Saamir Hassan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Botz
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Crommett
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dereddi Reddy
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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15
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Balakrishna AM, Ismayl M, Srinivasamurthy R, Gowda RM, Aboeata A. Early Outcomes of Percutaneous Coronary Intervention in Patients with Cancer: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2022; 47:101305. [DOI: 10.1016/j.cpcardiol.2022.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
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16
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Matetic A, Mohamed MO, Roberts DJ, Rana JS, Alraies MC, Patel B, Sauer AJ, Diaz-Arocutipa C, Sattar Y, Van Spall HGC, Mamas MA. Real-world management and outcomes of 7 million patients with acute coronary syndrome according to clinical research trial enrolment status: a propensity matched analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:409-419. [PMID: 34940843 DOI: 10.1093/ehjqcco/qcab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/16/2021] [Indexed: 01/01/2023]
Abstract
AIMS We aimed to determine whether clinical outcomes and invasive care of acute coronary syndrome (ACS) patients participating in trials differed from those of non-participants, particularly including those who were trial eligible. METHODS AND RESULTS We included all hospitalizations with a principal diagnosis of ACS in the US National Inpatient Sample between January 2004 and September 2015, stratified by trial enrolment and eligibility using the International Classification of Diseases, ninth revision. We conducted propensity score matching to investigate the following outcomes: all-cause mortality; major bleeding; stroke; composite of mortality, stroke, and cardiac complications [major adverse cardiovascular and cerebrovascular events (MACCEs)]; coronary angiography (CA); and percutaneous coronary intervention (PCI). A total of 7 091 179 weighted ACS hospitalizations were analysed, including 19 684 (0.3%) trial participants and 7 071 495 non-participants (3 485 514 of whom were trial eligible). Trial participants were more likely to receive CA [Δ% 28.73%, 95% confidence interval (CI) 27.22-30.24, P < 0.001] and PCI (Δ% 27.13%, 95% CI 24.86-29.41, P < 0.001), with decreased mortality (Δ% -3.51%, 95% CI -4.72 to -2.31, P < 0.001), MACCEs (Δ% -3.04%, 95% CI -4.55 to -1.53, P < 0.001), and bleeding (Δ% -0.89%, 95% CI -1.59 to -0.19, P = 0.013) compared with non-participants. After accounting for eligibility, trial participants were more likely to undergo CA (Δ% 22.78%, 95% CI 21.58-23.99, P < 0.001) and PCI (Δ% 23.95%, 95% CI 21.77-26.13, P < 0.001), and had no difference in mortality (Δ% -0.21%, 95% CI -0.65 to 0.24, P = 0.362). CONCLUSION Among ACS patients, trial enrolment was associated with significantly greater invasive care and lower mortality than among matched non-participants. Trial participants were more likely to be invasively managed even when compared with eligible non-participants, even though there was no difference in mortality.
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Affiliation(s)
- Andrija Matetic
- Department of Cardiology, University Hospital of Split, Split, Croatia.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
| | - Derek J Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jamal S Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland, CA, USA
| | - M Chadi Alraies
- Division of Interventional Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Andrew J Sauer
- Department of Cardiovascular Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | | | - Yasar Sattar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, UK
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Tomdio AN, Bottinor W, Jovin IS. The challenges of percutaneous coronary intervention and dual antiplatelet therapy in cancer patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:107-108. [DOI: 10.1016/j.carrev.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
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Doolub G, Kobo O, Mohamed MO, Ullah W, Chadi Alraies M, Velagapudi P, Matula JS, Roguin A, Bagur R, Mamas MA. Outcomes of Percutaneous Coronary Intervention in Patients With Acquired Immunosuppression. Am J Cardiol 2022; 171:40-48. [PMID: 35303973 DOI: 10.1016/j.amjcard.2022.01.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 12/12/2022]
Abstract
There are limited data on the clinical outcomes of percutaneous coronary intervention (PCI) in patients with acquired immunosuppression who are frequently underrepresented in clinical trials. All PCI procedures between October 2015 and December 2018 in the Nationwide Inpatient Sample were retrospectively analyzed, stratified by immunosuppression status. Multivariable logistic regression models were performed to examine (1) the association between immunosuppression status and in-hospital outcomes, expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CIs) and (2) predictors of mortality among patients with severe acquired immunosuppression. In this contemporary analysis of nearly 1.5 million PCI procedures, approximately 4% of patients who underwent PCI had acquired immunosuppression. Of these, chronic steroid use accounted for approximately half of the cohort who underwent PCI who had acquired immunosuppression, with the remainder divided between hematologic cancer, solid organ active malignancy, and metastatic cancer, with the latter group having the highest rates of composite of in-hospital mortality or stroke (9.3%) (mortality 7.5% and acute ischemic stroke 2.4%). In conclusion, immunosuppression was independently associated with increased adjusted odds of adverse clinical outcomes, specifically mortality or stroke (aOR 1.11, 95% CI 1.06 to 1.15, p <0.001) and in-hospital mortality (aOR 1.21, 95% CI 1.13 to 1.29, p <0.001), with outcomes dependent on the cause of immunosuppression.
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Soh RYH, Sia CH, Djohan AH, Lau RH, Ho PY, Neo JWH, Ho JSY, Sim HW, Yeo TC, Tan HC, Chan MYY, Loh JPY. Clinical Characteristics and Long-Term Outcomes of Patients With Differing Haemoglobin Levels Undergoing Semi-Urgent and Elective Percutaneous Coronary Intervention in an Asian Population. Front Cardiovasc Med 2022; 9:687555. [PMID: 35369342 PMCID: PMC8971291 DOI: 10.3389/fcvm.2022.687555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to investigate the impact of anaemia on long-term clinical outcomes in patients who underwent semi-urgent and elective percutaneous coronary intervention (PCI) in an Asian population. Although the effects of anaemia on outcomes in Asian patients are well studied for acute coronary syndrome, its impact on Asian patients undergoing semi-urgent and elective PCI is unclear. Methods This was a retrospective cohort study of patients who underwent semi-urgent and elective PCI from January 1, 2014, to December 31, 2015, at a tertiary academic centre. A total of 1,685 patients were included. They were stratified into three groups: normal (≥12 g/dL), intermediate (10–11.9 g/dL), and low (<10 g/dL) haemoglobin levels. Demographics, risk factors, and end-points including the 5-point major adverse cardiac and cerebrovascular events (MACCE) (all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation), cardiovascular death, and bleeding events were analysed. Results Patients in intermediate and low haemoglobin level groups were older with more comorbidities. Compared to the normal haemoglobin level group, low haemoglobin level group patients were associated with an increased risk of composite endpoints of all-cause death, subsequent stroke, myocardial infarction, congestive cardiac failure, and target lesion revascularisation [adjusted hazard ratio (aHR) 1.89, 95% confidence interval (CI):1.22, 2.92; p = 0.004]. This was driven by the increased risk of target lesions revascularisation observed in the low haemoglobin level group compared to the normal haemoglobin level group (aHR 17.74, 95% CI: 1.74, 180.80; p = 0.015). The patients in the low haemoglobin level group were also associated with a higher risk of bleeding events compared to the normal haemoglobin level group (aHR 7.18, 95% CI: 1.13, 45.40; p = 0.036). Conclusion In our Asian cohort, patients with anaemia undergoing PCI were associated with a higher comorbid burden. Despite adjustments for comorbidities, these patients had higher mortality and worse cardiovascular outcomes following contemporary PCI.
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Affiliation(s)
- Rodney Yu-Hang Soh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
- *Correspondence: Ching-Hui Sia,
| | | | - Rui-Huai Lau
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Pei-Ying Ho
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jonathan Wen-Hui Neo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Jamie Sin-Ying Ho
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Hui-Wen Sim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
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20
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Ng AKY, Ng PY, Ip A, Lam LT, Ling IWH, Wong ASL, Yap DYH, Siu CW. Impact of contrast-induced acute kidney injury on long-term major adverse cardiovascular events and kidney function after percutaneous coronary intervention: insights from a territory-wide cohort study in Hong Kong. Clin Kidney J 2022; 15:338-346. [PMID: 35145648 PMCID: PMC8824785 DOI: 10.1093/ckj/sfab212] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The impact of contrast-induced acute kidney injury (CI-AKI) on long-term major adverse cardiovascular events (MACE) remains controversial. METHOD This was a retrospective cohort study from 14 hospitals under the Hospital Authority of Hong Kong between 2004 and 2017. Severe CI-AKI was defined as an increase in serum creatinine of >50% from the baseline value, an absolute increase of >1 mg/dL (88 μmol/L) or requiring dialysis after percutaneous coronary intervention (PCI). Mild CI-AKI was defined as an increase in serum creatinine of >25% from the baseline value or an absolute increase of >0.5 mg/dL (44 μmol/L) after PCI but not fulfilling the criteria for severe CI-AKI. The primary endpoint was MACE, defined as a composite outcome of all-cause mortality, non-fatal myocardial infarction after hospital discharge, stroke or any unplanned coronary revascularization, in a time-to-first-event analysis up to 5 years after PCI. The secondary endpoints were individual components of MACE and cardiovascular mortality. RESULTS A total of 34 576 patients were analysed. After adjustment for cardiovascular risk factors, procedural characteristics and medication use, the risk of MACE at 5 years was significantly higher with mild CI-AKI {hazard ratio [HR], 1.18 [95% confidence interval (CI) 1.12-1.26); P < 0.001} and severe CI-AKI [HR 1.92 (95% CI 1.78-2.07); P < 0.001]. Severe CI-AKI was associated with higher adjusted risks of each secondary end point and the risks monotonically accrued over time. CONCLUSIONS Among patients undergoing a first-ever PCI, CI-AKI of any severity was associated with a higher adjusted risk of MACE at 5 years. Severe CI-AKI has a stronger association with MACE and its individual components, with an excess of early and late events.
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Affiliation(s)
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong SAR, China
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - April Ip
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Lap-tin Lam
- Cardiac Medical Unit, Grantham Hospital, Hong Kong SAR, China
| | | | | | - Desmond Yat-Hin Yap
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
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21
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Osman M, Benjamin MM, Balla S, Kheiri B, Bianco C, Sengupta PP, Daggubati R, Malla M, Liu SV, Mamas M, Patel B. Index Admission and Thirty-Day Readmission Outcomes of Patients With Cancer Presenting With STEMI. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 35:121-128. [PMID: 33888417 PMCID: PMC8521583 DOI: 10.1016/j.carrev.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND National-level data of cancer patients' readmissions after ST-segment elevation myocardial infarction (STEMI) are lacking. OBJECTIVES The primary aim of this study was to compare the rates and causes of 30-day readmissions in patients with and without cancer. METHODS Among patients admitted with STEMI in the United States National Readmission Database (NRD) from October 2015-December 2017, we identified patients with the diagnosis of active breast, colorectal, lung, or prostate cancer. The primary endpoint was the 30-day unplanned readmission rate. Secondary endpoints included in-hospital outcomes during the index admission and causes of readmissions. A propensity score model was used to compare the outcomes of patients with and without cancer. RESULTS A total of 385,522 patients were included in the analysis: 5956 with cancer and 379,566 without cancer. After propensity score matching, 23,880 patients were compared (Cancer = 5949, No Cancer = 17,931). Patients with cancer had higher 30-day readmission rates (19% vs. 14%, p < 0.01). The most common causes for readmission among patients with cancer were cardiac (31%), infectious (21%), oncologic (17%), respiratory (4%), stroke (4%), and renal (3%). During the first readmission, patients with cancer had higher adjusted rates of in-hospital mortality (15% vs. 7%; p < 0.01) and bleeding complications (31% vs. 21%; p < 0.01), compared to the non-cancer group. In addition, cancer (OR 1.5, 95% CI 1.2-1.6, p < 0.01) was an independent predictor for 30-day readmission. CONCLUSIONS About one in five cancer patients presenting with STEMI will be readmitted within 30 days. Cardiac causes predominated the reason for 30-day readmissions in patients with cancer.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Mina M. Benjamin
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Partho P. Sengupta
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Midhun Malla
- Division of Oncology, West Virginia University, School of Medicine, Morgantown, WV, USA
| | - Stephen V. Liu
- Division of Oncology, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, United Kingdom,Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA,Corresponding author at: WVU Heart & Vascular Institute, West Virginia University, One Medical Center Drive, Box 8003, Morgantown, WV 26506., USA.
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22
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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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Impact of Active and Historical Cancer on Short- and Long-Term Outcomes in Patients With Acute Myocardial Infarction. Am J Cardiol 2021; 159:59-64. [PMID: 34497007 DOI: 10.1016/j.amjcard.2021.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
Patients with cancer have an increased risk of cardiovascular events including myocardial infarction (MI) and vice versa, and are at high risks of ischemic and bleeding events after MI. However, short- and long-term clinical outcomes in patients with acute MI based on cancer status are not fully understood. This bi-center registry included 903 patients with acute MI undergoing primary percutaneous coronary intervention in a contemporary setting. Patients were divided into active cancer, a history of cancer, and no cancer according to the status of malignancy. Major adverse cardiovascular events (MACE), a composite of all-cause death, recurrent MI, and stroke, and major bleedings were evaluated. Of 903 patients, 49 (5.4%) and 65 (7.2%) had active cancer and a history of cancer, and 87 (9.6%) patients died during the hospitalization. In-hospital MACE was not significantly different among the 3 groups (16.3% vs 10.8% vs 10.9%, p = 0.48), whereas the rate of major bleeding events during the index hospitalization was significantly higher in patients with active cancer than their counterpart (20.4% vs 6.2% vs 5.8%, p = 0.002). After discharge, patients with active cancer had an increased risk of MACE and major bleedings compared with those with a history of cancer and no cancer during the mean follow-up period of 853 days. In conclusions, active cancer rather than a history of cancer and no cancer had significant impact on in-hospital bleeding events, and MACE and major bleedings after discharge in patients with acute MI undergoing primary percutaneous coronary intervention.
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Prevalence, clinical characteristics, and impact of active cancer in patients with acute myocardial infarction: data from an all-comer registry. J Cardiol 2021; 78:193-200. [PMID: 34167885 DOI: 10.1016/j.jjcc.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although a history of cancer is a poor prognostic factor in patients with acute myocardial infarction (AMI), the clinical importance of coexisting active cancer remains unclear. METHODS In this single-center retrospective study, we reviewed an AMI registry and assessed the prevalence and predictors of active cancer, 1-year incidence of cardiac death or major bleeding events (defined as a Bleeding Academy Research Consortium type 3 or 5), and the impact of coexisting active cancer on clinical outcomes. Active cancer was defined as either an already-diagnosed or undiagnosed occult cancer. RESULTS Between January 2012 and December 2017, 1140 AMI patients (median age, 69 years; male, 76.0%) were enrolled. Active and historical cancers were diagnosed in 63 patients (5.5%) and 50 patients (4.4%), respectively. The most common location was the urinary tract (n=21). In the Kaplan-Meier analysis, the active cancer group had a higher incidence of 1-year cardiac death (17.5% vs. 5.3%, p < 0.001) and major bleeding events (19.0% vs. 5.6%, p < 0.001) than the non-cancer group. In the multivariate Cox proportional hazards regression models, active cancer was an independent predictor of both cardiac death and major bleeding at 1 year. Specifically, gastrointestinal tract and advanced-stage cancers had the poorest outcomes. Compared to the non-cancer group, the 1-year major bleeding rate was higher for all cancer types and stages. In contrast, early-stage cancers had a weaker impact on the 1-year cardiac mortality compared to advanced-stage cancers. Similarly, cardiac death during 1-year also occurred less frequently in occult cancers than in already-known cancers. CONCLUSIONS In patients with AMI, coexisting active cancer was rare, but it significantly impacted cardiac death and major bleeding events.
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Leedy D, Tiwana JK, Mamas M, Hira R, Cheng R. Coronary revascularisation outcomes in patients with cancer. Heart 2021; 108:507-516. [PMID: 34415850 DOI: 10.1136/heartjnl-2020-318531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/04/2022] Open
Abstract
Cancer and coronary artery disease (CAD) overlap in traditional risk factors as well as molecular mechanisms underpinning the development of these two disease states. Patients with cancer are at increased risk of developing CAD, representing a high-risk population that are increasingly undergoing coronary revascularisation. Over 1 in 10 patients with CAD that require revascularisation with either percutaneous coronary intervention or coronary artery bypass grafting have either a history of cancer or active cancer. These patients are typically older, have more comorbidities and have more extensive CAD compared with patients without cancer. Haematological abnormalities with competing risks of thrombosis and bleeding pose further unique challenges during and after revascularisation. Management of patients with concurrent cancer and CAD requiring revascularisation is challenging as these patients carry a higher risk of morbidity and mortality compared with those without cancer, often driven by the underlying cancer and associated comorbidities. However, due to variability by different types and stages of cancer, revascularisation outcomes are specific to cancer characteristics such as the timing of onset, cancer subtype and site, stage, presence of metastases, and cancer-related therapies received. Recent studies have provided insights into defining revascularisation outcomes, procedural considerations and best practices in managing patients with cancer. Nevertheless, many gaps remain that require further studies to inform clinical best practices in this population.
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Affiliation(s)
- Douglas Leedy
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Jasleen K Tiwana
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Ravi Hira
- Division of Cardiology, Pulse Heart Institute, Tacoma, Washington, USA
| | - Richard Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Abstract
PURPOSE OF REVIEW Coronary artery disease (CAD) is a common comorbidity in patients with cancer. We review shared risk factors between the two diseases and cancer treatments that increase the risk of CAD. We also discuss outcomes and management considerations of patients with cancer who develop CAD. RECENT FINDINGS Several traditional and novel risk factors promote the development of both CAD and cancer. Several cancer treatments further increase the risk of CAD. The presence of cancer is associated with a higher burden of comorbidities and thrombocytopenia, which predisposes patients to higher bleeding risks. Patients with cancer who develop acute coronary syndromes are less likely to receive timely revascularization or appropriate medical therapy, despite evidence showing that receipt of these interventions is associated with substantial benefit. Accordingly, a cancer diagnosis is associated with worse outcomes in patients with CAD. The risk-benefit balance of revascularization is becoming more favorable due to the improving prognosis of many cancers and safer revascularization strategies, including shorter requirements for dual antiplatelet therapy after revascularization. SUMMARY Several factors increase the complexity of managing CAD in patients with cancer. A multidisciplinary approach is recommended to guide treatment decisions in this high-risk and growing patient group.
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27
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Monlezun DJ, Lawless S, Palaskas N, Peerbhai S, Charitakis K, Marmagkiolis K, Lopez-Mattei J, Mamas M, Iliescu C. Machine Learning-Augmented Propensity Score Analysis of Percutaneous Coronary Intervention in Over 30 Million Cancer and Non-cancer Patients. Front Cardiovasc Med 2021; 8:620857. [PMID: 33889598 PMCID: PMC8055825 DOI: 10.3389/fcvm.2021.620857] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/15/2021] [Indexed: 12/17/2022] Open
Abstract
Background: It is unknown to what extent the clinical benefits of PCI outweigh the risks and costs in patients with vs. without cancer and within each cancer type. We performed the first known nationally representative propensity score analysis of PCI mortality and cost among all eligible adult inpatients by cancer and its types. Methods: This multicenter case-control study used machine learning–augmented propensity score–adjusted multivariable regression to assess the above outcomes and disparities using the 2016 nationally representative National Inpatient Sample. Results: Of the 30,195,722 hospitalized patients, 15.43% had a malignancy, 3.84% underwent an inpatient PCI (of whom 11.07% had cancer and 0.07% had metastases), and 2.19% died inpatient. In fully adjusted analyses, PCI vs. medical management significantly reduced mortality for patients overall (among all adult inpatients regardless of cancer status) and specifically for cancer patients (OR 0.82, 95% CI 0.75–0.89; p < 0.001), mainly driven by active vs. prior malignancy, head and neck and hematological malignancies. PCI also significantly reduced cancer patients' total hospitalization costs (beta USD$ −8,668.94, 95% CI −9,553.59 to −7,784.28; p < 0.001) independent of length of stay. There were no significant income or disparities among PCI subjects. Conclusions: Our study suggests among all eligible adult inpatients, PCI does not increase mortality or cost for cancer patients, while there may be particular benefit by cancer type. The presence or history of cancer should not preclude these patients from indicated cardiovascular care.
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Affiliation(s)
- Dominique J Monlezun
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Sean Lawless
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shareez Peerbhai
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | - Konstantinos Charitakis
- Division of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United States
| | | | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Department of Cardiology, Royal Stroke Hospital Stoke on Trent, Stoke-on-Trent, United Kingdom
| | - Cezar Iliescu
- Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
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28
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Takeuchi T, Hikoso S, Hattori S, Kitamura T, Nakatani D, Mizuno H, Okada K, Dohi T, Kojima T, Kida H, Sunaga A, Oeun B, Sato T, Sakata Y, Sato H, Hori M, Komuro I, Sobue T, Sakata Y. The Effect of a Cancer History on Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention. Int Heart J 2021; 62:238-245. [PMID: 33731519 DOI: 10.1536/ihj.20-452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effect of a history of cancer on the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) is poorly understood.From the Osaka Acute Coronary Insufficiency Study (OACIS) registry in Osaka, Japan, we enrolled the case data of a total of 3499 patients with AMI treated with PCI between 1998 and 2014, of whom 462 had a cancer history (cancer group, 13.2%) and 3037 did not (non-cancer group, 86.8%). All of the cases were followed for up to five years from discharge.The Kaplan-Meier curve and multivariate analysis using Cox proportional hazards models revealed that all-cause mortality was significantly higher in the cancer group than in the non-cancer group (adjusted hazard ratio [HR], 2.43; P < 0.001). Deaths from cardiac, cancer, and other causes were treated as competing events, and competing analysis using the cumulative incidence function (CIF) and Fine-Gray model revealed that mortality due to cancer was higher in the cancer group than in the non-cancer group, whereas cardiac mortality was similar between the two groups. The incidences of cardiovascular events, including stroke, recurrent infarction, and heart failure requiring readmission, were also similar between the two groups, although the Kaplan-Meier analysis and univariate Cox proportional hazards model revealed that the incidence of stroke was higher in the cancer group than in the non-cancer group.A history of cancer increased all-cause and cancer mortality among patients with AMI treated with PCI, although it was not associated with cardiovascular events.
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Affiliation(s)
- Taro Takeuchi
- Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Satoshi Hattori
- Division of Biomedical Statistics, Department of Integrated Medicine, Graduate School of Medicine, Osaka University
| | - Tetsuhisa Kitamura
- Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroshi Sato
- School of Human Welfare Studies Health Care Center and Clinic, Kwansei Gakuin University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
| | - Tomotaka Sobue
- Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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Temporal trends in short and long-term outcomes after percutaneous coronary interventions among cancer patients. Heart Vessels 2021; 36:1283-1289. [PMID: 33646432 DOI: 10.1007/s00380-021-01817-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
While mortality of acute coronary syndrome (ACS) is known to have steadily decline over the last decades, data are lacking regarding the complex sub-population of patients with both coronary artery disease and cancer. A large single-center percutaneous coronary intervention (PCI) registry was used to retrieve patients who had a known diagnosis of malignancy during PCI. Patients were divided into two groups according to the period in which PCI was performed (period 1: 2006-2011, period 2: 2012-2017). Cox regression hazard models were implemented to compare primary endpoint, defined as the composite outcomes of major adverse cardiac events (MACE) (which include cardiovascular death, myocardial infarction or target vessel revascularization) and secondary endpoint of all-cause mortality, between the two time periods. A total of 3286 patients were included, 1819 (55%) had undergone PCI in period 1, and 1467 (45%) in period 2. Both short- and long-term MACE and overall mortality were significantly lower in patients who underwent PCI at the latter period (2.3% vs. 4.3%, p < 0.001 and 1.1% vs. 3.2%, p < 0.001 after 30 days and 24% vs. 30%, p < 0.001 and 12% vs. 22%, p < 0.001 after 2 years, respectively). However, in a multivariate analysis, going through PCI in the latter period was still associated with lower rates of overall mortality (HR 0.708, 95% confidence interval [CI] 0.53-0.93, p = 0.014) but there was no significant difference in MACE (HR 0.83, 95% CI 0.75-1.42, p = 0.16). Patients with cancer undergoing PCI during our most contemporary period had an improved overall survival, but no significant differences were observed in the composite cardiovascular endpoints, compared to an earlier PCI period. The management of coronary patients with cancer disease remains challenging.
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30
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Milazzo V, Cosentino N, Campodonico J, Lucci C, Cardinale D, Cipolla CM, Marenzi G. Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. J Clin Med 2020; 9:E3642. [PMID: 33198355 PMCID: PMC7696544 DOI: 10.3390/jcm9113642] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023] Open
Abstract
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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Affiliation(s)
- Valentina Milazzo
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Jeness Campodonico
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Claudia Lucci
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Carlo M. Cipolla
- Cardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Giancarlo Marenzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.M.); (N.C.); (J.C.); (C.L.)
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Guha A, Dey AK, Kalra A, Gumina R, Lustberg M, Lavie CJ, Sabik JF, Addison D. Coronary Artery Bypass Grafting in Cancer Patients: Prevalence and Outcomes in the United States. Mayo Clin Proc 2020; 95:1865-1876. [PMID: 32861331 PMCID: PMC7860624 DOI: 10.1016/j.mayocp.2020.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/04/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To characterize the contemporary efficacy and utilization patterns of coronary artery bypass grafting (CABG) in specific cancer types. METHODS We leveraged the data from the National Inpatient Sample and plotted trends of utilization and outcomes of isolated CABG (with no other additional surgeries during the same hospitalization) procedures from January 1, 2003, through September 1, 2015. Propensity score matching was used to assess for potential differences in outcomes by type of cancer status among contemporary (2012-2015) patients. RESULTS Overall, the utilization of CABG decreased over time (250,677 in 2003 vs 134,534 in 2015, P<.001). However, the proportion of those with comorbid cancer increased (7.0% vs 12.6%, P<.001). Over time, in-hospital mortality associated with CABG use in cancer remained unchanged (.9% vs 1.0%, P=.72); yet, cancer patients saw an increase in associated major bleeding (4.5% vs 15.3%, P<.001) and rate of stroke (.9% vs 1.5%, P<.001) over time. In-hospital cost-of-care associated with CABG-use in cancer also increased over time ($29,963 vs $33,636, P<.001). When stratified by cancer types, in-hospital mortality was not higher in breast, lung, prostate, colon cancer, or lymphoma versus non-cancer CABG patients (all P>.05). However, there was a significantly higher prevalence of major bleeding but not stroke in patients with breast and prostate cancer only compared with non-cancer CABG patients (P<.01). Discharge dispositions were not found to be different between cancer sub-groups and non-cancer patients (P>.05), except for breast cancer patients who had lower home care, but higher skilled care disposition (P<.001). CONCLUSION Among those undergoing CABG, the prevalence of comorbid cancer has steadily increased. Outside of major bleeding, these patients appear to share similar outcomes to those without cancer indicating that CABG utilization should be not be declined in cancer patients when otherwise indicated. Further research into the factors underlying the decision to pursue CABG in specific cancer sub-groups is needed.
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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH; Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Amit K Dey
- Division of Cardiology, National Heart, Lung and Blood Institute, Bethesda, MD
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Richard Gumina
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH
| | - Maryam Lustberg
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH; Division of Medical Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Carl J Lavie
- Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| | - Joseph F Sabik
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH.
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Bharadwaj A, Potts J, Mohamed MO, Parwani P, Swamy P, Lopez-Mattei JC, Rashid M, Kwok CS, Fischman DL, Vassiliou VS, Freeman P, Michos ED, Mamas MA. Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA. Eur Heart J 2020; 41:2183-2193. [DOI: 10.1093/eurheartj/ehz851] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
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.
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Affiliation(s)
- Aditya Bharadwaj
- Division of Cardiology, Department of Medicine, Loma Linda University , 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Jessica Potts
- Keele Cardiovascular Research Group, Keele University , Stoke-on-Trent, ST5 5BG, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Keele University , Stoke-on-Trent, ST5 5BG, UK
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University , 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Pooja Swamy
- Division of Cardiology, Department of Medicine, Loma Linda University , 11234 Anderson St, Loma Linda, CA 92354, USA
| | - Juan C Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center , 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University , Stoke-on-Trent, ST5 5BG, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University , Stoke-on-Trent, ST5 5BG, UK
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital , 111 S 11th St, Philadelphia, PA 19107, USA
| | - Vassilios S Vassiliou
- Department of Cardiology, Norwich Medical School, University of East Anglia, Bob Champion Research and Education , Norwich NR4 7TJ, UK
| | - Philip Freeman
- Cardiology Department, Aalborg University Hospital , Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Erin D Michos
- Department of Medicine (Cardiology), Johns Hopkins School of Medicine , 733 N Broadway, Baltimore, MD 21205, USA
- Department of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine , 733 N Broadway, Baltimore, MD 21205, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University , Stoke-on-Trent, ST5 5BG, UK
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Bisceglia I, Canale ML, Lestuzzi C, Parrini I, Russo G, Colivicchi F, Gabrielli D, Gulizia MM, Iliescu CA. Acute coronary syndromes in cancer patients. J Cardiovasc Med (Hagerstown) 2020; 21:944-952. [PMID: 32520859 DOI: 10.2459/jcm.0000000000000993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
: Cardiovascular disease and cancer are responsible for the majority of deaths in the Western world. These two entities share common risk factors and their intersection will be more and more frequent in future due to general population aging and long-term cancer control. Clinical presentation, management and outcome of acute coronary syndromes (ACS) in cancer patients could differ from noncancer ones. Cancer patients were frequently excluded from clinical trials and so the paucity of data further complicates the scenario. The management of ACS in cancer patients represents a unique setting in which the risk/benefit ratio of invasive treatment should be carefully evaluated. This review focused on the available evidence of all aspects of ACS in cancer patients providing a guide to a multidisciplinary approach.
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Affiliation(s)
- Irma Bisceglia
- Servizi Cardiologici Integrati Cardiology Department, Azienda Ospedaliera San Camillo-Forlanini, Roma
| | - Maria Laura Canale
- Division of Cardiology, Azienda USL Toscana Nord Ovest, Versilia Hospital, Lido di Camaiore
| | - Chiara Lestuzzi
- Cardiology Unit, Oncology Department, CRO National Cancer Institute, Aviano
| | - Iris Parrini
- Divisione di Cardiologia, Ospedale Mauriziano, Torino
| | - Giulia Russo
- SC Centro Cardiovascolare Ospedale Maggiore, Cardiology Department, Trieste
| | - Furio Colivicchi
- Division of Cardiology, San Filippo Neri Hospital, ASL Roma 1, Rome
| | | | | | - Cezar A Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Iglesias-Garriz I, Delgado I, Prieto-Salvador I, Garrote C, García-Palomo A, Fernández-Vazquez F. Previously diagnosed cancer and mortality after ST-segment elevation acute myocardial infarction treated with primary angioplasty. Catheter Cardiovasc Interv 2020; 95:1269-1274. [PMID: 31584247 DOI: 10.1002/ccd.28506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 01/28/2023]
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.
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Affiliation(s)
| | - Irene Delgado
- Service of Oncology, Complejo Asistencial Universitario de León, León, Spain
| | | | - Carmen Garrote
- Service of Cardiology, Complejo Asistencial Universitario de León, León, Spain
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Balanescu DV, Donisan T, Deswal A, Palaskas N, Song J, Lopez-Mattei J, Kim PY, Durand JB, Doundoua D, Marmagkiolis K, Iliescu C. Acute myocardial infarction in a high-risk cancer population: Outcomes following conservative versus invasive management. Int J Cardiol 2020; 313:1-8. [PMID: 32320781 DOI: 10.1016/j.ijcard.2020.04.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 04/16/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The benefits of invasive versus noninvasive management in oncology patients with acute myocardial infarction (AMI) are unclear. We aimed to retrospectively determine outcome differences between conservative and invasive management of AMI in cancer patients. METHODS Patients from our institution between March 2016 and December 2018 with type 1 and type 2 AMI (excluding STEMI) were classified into 2 groups: medical therapy only and invasive strategies. Analyzed outcomes were overall survival (OS), procedural complications, subsequent events, and hospice referral. Kaplan-Meier method and log-rank test were used to compare OS between subgroups. Cox proportional hazards regression analyses were conducted to find factors associated with OS. RESULTS We included 201 patients. Type 1 MI was seen in 152 patients (76%) and type 2 MI in 49 (24%). Median OS was 13 months. Most presented with symptoms other than dyspnea or chest pain (49%) and with ECG revealing changes other than ST-segment depression and T-wave inversion (62%). Patients with type 2 MI had worse OS than patients with type 1 MI (HR = 2.3, p = 0.0002). Early coronary angiography (≤72 h; HR = 0.327, p < 0.0001), late coronary angiography (>72 h; HR = 0.496, p = 0.0426), and percutaneous coronary intervention (HR = 0.481, p = 0.0116) were associated with better OS than noninvasive approaches. Single and dual agent antiplatelet therapy, beta blockers, and statins were each associated with better OS. CONCLUSIONS Cancer patients without STEMI who underwent invasive treatment for AMI had better OS compared with those treated only medically, with the highest benefit when coronary angiography was performed within 72 h of admission for AMI.
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Affiliation(s)
- Dinu Valentin Balanescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Teodora Donisan
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Y Kim
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Bernard Durand
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Doundoua
- Center of Endosurgery and Lithotripsy Clinic, Moscow, Russia
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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36
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Piróth Z. PCI in patients with cancer: What is the evidence? Int J Cardiol 2020; 304:150-151. [PMID: 31864792 DOI: 10.1016/j.ijcard.2019.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Zsolt Piróth
- Hungarian Institute of Cardiology, 29 Haller str., 1096 Budapest, Hungary.
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Yang QY, Li XF, Lin MQ, Xu JH, Yan H, Zhang ZM, Wang SY, Chen HC, Chen XN, Lin KY, Guo YS. Association between red blood cell distribution width and long-term mortality among patients undergoing percutaneous coronary intervention with previous history of cancer. Biomarkers 2020; 25:260-267. [PMID: 32141338 DOI: 10.1080/1354750x.2020.1734860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: The number of patients suffering from coronary heart disease with cancer is rising. There is scarce evidence concerning the biomarkers related to prognosis among patients undergoing percutaneous coronary intervention (PCI) with cancer. Thus, the aim of this study was to investigate the association between red blood cell distribution width (RDW) and prognosis in this population.Methods: A total of 172 patients undergoing PCI with previous history of cancer were enrolled in this retrospective study. The endpoint was long-term all-cause mortality. According to tertiles of RDW, the patients were classified into three groups: Tertile 1 (RDW <12.8%), Tertile 2 (RDW ≥12.8% and <13.5%) and Tertile 3 (RDW ≥13.5%).Results: During an average follow-up period of 33.3 months, 29 deaths occurred. Compared with Tertile 3, mortality of Tertile 1 and Tertile 2 was significantly lower in the Kaplan-Meier analysis. In multivariate Cox regression analysis, RDW remained an independent risk factor of mortality (HR: 1.938, 95% CI: 1.295-2.655, p < 0.001). The all-cause mortality in Tertile 3 was significantly higher than that in Tertile 1 (HR: 5.766; 95% CI: 1.426-23.310, p = 0.014).Conclusions: An elevated RDW level (≥13.5%) was associated with long-term all-cause mortality among patients undergoing PCI with previous history of cancer.
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Affiliation(s)
- Qing-Yong Yang
- Department of Internal Medicine, Jinshan Branch of Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China.,Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Xiu-Feng Li
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Mao-Qiang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Jia-Hao Xu
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han Yan
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Zhi-Ming Zhang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Sun-Ying Wang
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Han-Chuan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Xi-Nan Chen
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Kai-Yang Lin
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
| | - Yan-Song Guo
- Clinical Medical College of Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China.,Department of Cardiology, Fujian Provincial Hospital, Fujian Cardiovascular Institute, Fuzhou, China
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Velders MA, Hagström E, James SK. Temporal Trends in the Prevalence of Cancer and Its Impact on Outcome in Patients With First Myocardial Infarction: A Nationwide Study. J Am Heart Assoc 2020; 9:e014383. [PMID: 32067596 PMCID: PMC7070202 DOI: 10.1161/jaha.119.014383] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 12/19/2019] [Indexed: 12/24/2022]
Abstract
Background Coexistence of cancer and cardiovascular disease is increasingly frequent, but nationwide data covering cancer patients with myocardial infarction (MI) are scarce. We sought to investigate the prevalence of cancer in patients with first MI, and its impact on cardiovascular and bleeding outcome. Methods and Results Using nationwide Swedish quality registries, all patients admitted for first MI between 2001 and 2014 were identified. Data on comorbidity, cancer, and outcome were obtained from the national cancer and patient registries. Stratification was performed according to cancer during the 5 years before MI. Multivariable Cox proportional hazards analyses adjusting for cardiovascular risk factors and invasive treatment assessed the association of cancer with outcome. In total, 175 146 patients with first MI were registered, of whom 9.3% (16 237) had received care for cancer in the 5 years before admission. The cancer rate increased from 6.7% in the years 2001-2002 to 10.7% in 2013-2014, independent of sex and cancer type. The presence of a new cancer diagnosis within 5 years increased from 4.9% to 6.2%. During a median follow-up of 4.3 years, cancer was associated with all-cause mortality (hazard ratio, 1.44; 95% CI, 1.40-1.47), recurrent MI (hazard ratio, 1.08; 95% CI, 1.04-1.12), heart failure (hazard ratio, 1.10; 95% CI, 1.06-1.13), and major bleeding (hazard ratio, 1.45; 95% CI, 1.34-1.57). Risk for adverse events varied strongly according to cancer extent, timing, and type. Conclusions Cancer as a comorbid disorder is increasing and is strongly associated with mortality, severe bleeding, and adverse cardiovascular outcome after first MI.
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Affiliation(s)
| | - Emil Hagström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Uppsala Clinical Research CentreUppsala UniversityUppsalaSweden
| | - Stefan K. James
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Uppsala Clinical Research CentreUppsala UniversityUppsalaSweden
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Roule V, Verdier L, Blanchart K, Ardouin P, Lemaitre A, Bignon M, Sabatier R, Alexandre J, Beygui F. Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:38. [PMID: 32000685 PMCID: PMC6993442 DOI: 10.1186/s12872-020-01352-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI. Conclusion Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.
| | - Laurine Verdier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Joachim Alexandre
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.,CHU de Caen Normandie, Service de Pharmacologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France
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40
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Bharadwaj AS, Swamy PM, Mamas MA. Outcomes of percutaneous coronary interventions in cancer patients. Expert Rev Cardiovasc Ther 2020; 18:25-32. [PMID: 31951772 DOI: 10.1080/14779072.2020.1718493] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: There are numerous shared risk factors in the etiopathogenesis of coronary artery disease (CAD) and cancer both at epidemiologic and molecular level. Additionally, different modalities of treatment of cancer such as radiation, chemotherapy, immunotherapy, and hormonal therapies further increase the risk of CAD and acute coronary syndrome. Most large database analysis and single-center experiences have shown that cancer patients undergoing PCI are at an increased risk of in-hospital mortality, bleeding, repeat revascularization.Areas covered: In this review article the authors discuss the associations between CAD and cancer, challenges for PCI in cancer patients and outcome data.Expert opinion: Interventionists performing PCI on cancer patients should be cognizant of the heightened risk of bleeding, thrombosis, possible need for interruption of dual-antiplatelet therapy, and the increased risk of target lesion revascularization in this cohort. These risks may be partially mitigated by utilization of best practices such as the use of radial artery access, intravascular imaging for lesion assessment and stent optimization and avoidance of complex stenting strategies. Finally, it is of paramount importance to have a multidisciplinary approach consisting of the treating cardiologist, medical and/or surgical oncologist, and palliative medicine, and involve the patient and their family in making informed decisions.
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Affiliation(s)
| | - Pooja M Swamy
- Division of Cardiology, Loma Linda University, CA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
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Ueki Y, Vögeli B, Karagiannis A, Zanchin T, Zanchin C, Rhyner D, Otsuka T, Praz F, Siontis GC, Moro C, Stortecky S, Billinger M, Valgimigli M, Pilgrim T, Windecker S, Suter T, Räber L. Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention. JACC CardioOncol 2019; 1:145-155. [PMID: 34396175 PMCID: PMC8352169 DOI: 10.1016/j.jaccao.2019.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate ischemic and bleeding outcomes of unselected cancer patients undergoing percutaneous coronary intervention (PCI). BACKGROUND The number of cancer patients undergoing PCI is increasing despite concerns regarding ischemic and bleeding risks. METHODS Between 2009 and 2017, consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Cancer-specific data including type, date of initial diagnosis, and health status at index PCI were collected. We performed propensity score matching to adjust for baseline differences between patients with and without cancer. The primary ischemic endpoint was the device-oriented composite endpoint (cardiac death, target vessel myocardial infarction, target lesion revascularization) at 1 year, and the primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) 2 to 5 at 1 year. RESULTS Among 13,647 patients, 1,368 (10.0%) had an established diagnosis of cancer. The 3 leading cancer types were prostate (n = 294), gastrointestinal tract (n = 188), and hematopoietic (n = 177). At index PCI, 179 (13.1%) patients were receiving active cancer treatment. In matched analysis, there was no significant difference in device-oriented composite endpoint (11.5% vs. 10.2%; p = 0.251), whereas cardiac death and BARC 2 to 5 bleeding occurred more frequently among patients with cancer compared with those without cancer (6.8% vs. 4.5%; p = 0.010 and 8.0% vs. 6.0%; p = 0.026, respectively). Cancer diagnosis within 1 year before PCI emerged as an independent predictor for cardiac death and BARC 2 to 5 bleeding at 1 year. CONCLUSIONS Cancer patients carry an increased risk of cardiac mortality that was not associated with stent-related ischemic events among patients undergoing PCI in routine clinical practice. Higher risk of bleeding in cancer patients undergoing PCI deserves particular attention. (CARDIOBASE Bern PCI Registry; NCT02241291).
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Key Words
- BARC, Bleeding Academic Research Consortium
- CAD, coronary artery disease
- CI, confidence interval
- DAPT, dual antiplatelet therapy
- DES, drug-eluting stent
- DOCE, device-oriented composite endpoint
- HR, hazard ratio
- IPTW, inverse probability of treatment weighting
- MI, myocardial infarction
- PCI, percutaneous coronary interventions
- PS, propensity score
- bleeding
- cancer
- coronary artery disease
- ischemia
- percutaneous coronary intervention
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Affiliation(s)
- Yasushi Ueki
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Benjamin Vögeli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Zanchin
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel Rhyner
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tatsuhiko Otsuka
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George C.M. Siontis
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christina Moro
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Billinger
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Suter
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
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In-hospital outcomes and 5-year mortality following an acute myocardial infarction in patients with a history of cancer: Results from the French registry on Acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) 2005 cohort. Arch Cardiovasc Dis 2019; 112:657-669. [PMID: 31761740 DOI: 10.1016/j.acvd.2019.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cancer and acute myocardial infarction (AMI) have important prognostic consequences. Treatment of some cancers may affect coronary artery disease, myocardial function and/or AMI management. Whether the early and long-term mortality of patients with AMI differ according to their history of cancer remains questionable. AIMS To determine in-hospital outcomes and 5-year mortality following AMI according to patient history of cancer. METHODS The FAST-MI registry is a nationwide French survey collecting data on characteristics, management and outcomes of 3670 consecutive patients admitted for AMI during October 2005. RESULTS Overall, 246/3664 patients (6.7%) admitted for an AMI (47.6% with ST-segment elevation myocardial infarction [STEMI]; 52.4% with non-STEMI [NSTEMI]) had a history of cancer. In-hospital mortality was not significantly different for patients with versus without a history of cancer, overall (adjusted odds ratio [OR]: 1.15, 95% confidence interval [CI]: 0.68-1.94; P=0.61) and in patients with STEMI (adjusted OR: 1.37, 95% CI: 0.69-2.71; P=0.37) or NSTEMI (adjusted OR: 0.97, 95% CI: 0.41-2.28; P=0.95). All-cause mortality at 5 years was higher among patients with a history of cancer (adjusted hazard ratio [HR]: 1.36, 95% CI: 1.08-1.69; P=0.008), whereas 5-year cardiovascular mortality did not differ (adjusted HR: 1.17, 95% CI: 0.89-1.53; P=0.25), regardless of whether the patients had STEMI or NSTEMI. Similar results were found in populations matched on a propensity score including baseline characteristics and early management. CONCLUSION A history of cancer, per se, does not appear to be a risk factor for increased in-hospital mortality or long-term cardiovascular mortality in patients admitted for AMI.
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Sueta D, Tabata N, Ikeda S, Saito Y, Ozaki K, Sakata K, Matsumura T, Yamamoto-Ibusuki M, Murakami Y, Jodai T, Fukushima S, Yoshida N, Kamba T, Araki E, Iwase H, Fujii K, Ihn H, Kobayashi Y, Minamino T, Yamagishi M, Maemura K, Baba H, Matsui K, Tsujita K. Differential predictive factors for cardiovascular events in patients with or without cancer history. Medicine (Baltimore) 2019; 98:e17602. [PMID: 31689764 PMCID: PMC6946347 DOI: 10.1097/md.0000000000017602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Although attention has been paid to the relationship between malignant diseases and cardiovascular diseases, few data have been reported. Moreover, there have also been few reports in which the preventive factors were examined in patients with or without malignant disease histories requiring percutaneous coronary intervention (PCI).This was a retrospective, single-center, observational study. A total of 1003 post-PCI patients were divided into a malignant group, with current or past malignant disease, and a nonmalignant group. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, stroke, revascularization, and admission due to heart failure within 5 years of PCI. Kaplan-Meier analysis showed a significantly higher probability of the primary endpoint in the malignant group (P = .002). Multivariable Cox hazard analyses showed that in patients without a history of malignant, body mass index (BMI) and the presence of dyslipidemia were independent and significant negative predictors of the primary endpoint (BMI: hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.53-0.99, P = .041; prevalence of dyslipidemia: HR 0.72, 95% CI 0.52-0.99, P = .048), and the presence of multi-vessel disease (MVD) and the prevalence of peripheral artery disease (PAD) were independent and significant positive predictors of the primary endpoint (prevalence of MVD: HR 1.68, 95% CI 1.18-2.40, P = .004; prevalence of PAD: HR 1.51, 95% CI 1.03-2.21, P = .034). In patients with histories of malignancy, no significant independent predictive factors were identified.Patients undergoing PCI with malignancy had significantly higher rates of adverse cardiovascular events but might not have the conventional prognostic factors.
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Affiliation(s)
- Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
| | - Satoshi Ikeda
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba
| | - Kazuyuki Ozaki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Takeshi Matsumura
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
- Department of Metabolic Medicine, Faculty of Life Sciences
| | | | | | - Takayuki Jodai
- Department of Respiratory Medicine, Graduate School of Medical Sciences
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences
- Division of Translational Research and Advanced Treatment Against Gastrointestinal Cancer
| | | | - Eiichi Araki
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
- Department of Metabolic Medicine, Faculty of Life Sciences
| | - Hirotaka Iwase
- Department of Breast and Endocrine Surgery, Graduate School of Medical Sciences
| | - Kazuhiko Fujii
- Department of Respiratory Medicine, Graduate School of Medical Sciences
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Hideo Baba
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences
| | - Kunihiko Matsui
- Community, Family, and General Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences
- Center for Metabolic Regulation of Healthy Aging, Kumamoto University, Kumamoto
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Quintana RA, Monlezun DJ, Davogustto G, Saenz HR, Lozano-Ruiz F, Sueta D, Tsujita K, Landes U, Denktas AE, Alam M, Paniagua D, Addison D, Jneid H. Outcomes following percutaneous coronary intervention in patients with cancer. Int J Cardiol 2019; 300:106-112. [PMID: 31611091 DOI: 10.1016/j.ijcard.2019.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Randomized clinical trials demonstrated the benefits of percutaneous coronary interventions (PCI) in diverse clinical settings. Patients with cancer were not routinely included in these studies. METHODS/RESULTS Literature search of PubMed, Cochrane, Medline, SCOPUS, EMBASE, and ClinicalTrials was conducted to identify studies that assessed one-year all-cause, cardiovascular and non-cardiovascular mortality in patients with historical or active cancer. Using the random effects model, we computed risk ratios (RRs) and standardized mean differences and their 95% confidence intervals for the dichotomous and continuous measures and outcomes, respectively. Of 171 articles evaluated in total, 5 eligible studies were included in this meta-analysis. In total, 33,175 patients receiving PCI were analyzed, of whom 3323 patients had cancer and 29,852 no cancer history. Patients in the cancer group had greater all-cause mortality [RR 2.22 (1.51-3.26; p<0.001)], including cardiovascular mortality [RR 1.34 (1.1-1.65; p=0.005)] and non-cardiovascular mortality [RR 3.42 (1.74-6.74; p≤0.001], at one-year compared to non-cancer patients. Patients in the cancer group had greater one-month all-cause mortality [RR 2.01 (1.24-3.27; p=0.005)] and greater non-cardiovascular mortality [RR 6.87 (3.10-15.21; p≤0.001)], but no difference in one-month cardiovascular mortality compared to non-cancer patients. Meta-regression analyses showed that the difference in one-year all-cause and cardiovascular mortality between both groups was not attributable to differences in baseline characteristics, index PCI characteristics, or medications prescribed at discharge. CONCLUSIONS Patients with cancer undergoing PCI have worse mid-term outcomes compared to non-cancer patients. Cancer patients should be managed by a multi-specialist team, in an effort to close the mortality gap.
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Affiliation(s)
- Raymundo A Quintana
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Dominique J Monlezun
- Division of Cardiology, Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Giovanni Davogustto
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Humberto R Saenz
- Division of Geriatrics, Department of Internal Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Israel
| | - Ali E Denktas
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA
| | - Mahboob Alam
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA
| | - David Paniagua
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA
| | - Daniel Addison
- Cardio-Oncology Program Division of Cardiology, Ohio State University Columbus, OH, USA
| | - Hani Jneid
- Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA
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Potts J, Mohamed MO, Lopez Mattei JC, Iliescu CA, Konopleva M, Rashid M, Bagur R, Mamas MA. Percutaneous coronary intervention and in-hospital outcomes in patients with leukemia: a nationwide analysis. Catheter Cardiovasc Interv 2019; 96:53-63. [PMID: 31410970 DOI: 10.1002/ccd.28432] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/20/2019] [Accepted: 07/27/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To examine the association between current leukemia diagnosis and in-hospital clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) in the United States. BACKGROUND Leukemia is the most common hematological malignancy and is associated with an increased risk of thrombotic and bleeding complications in patients undergoing PCI. There are limited data around clinical outcomes of leukemia patients undergoing PCI. METHODS We used the National Inpatient Sample to investigate the outcomes of leukemia patients undergoing PCI between 2004 and 2014. Patients were then subdivided into diagnoses of acute myeloid leukemia (AML) or chronic myeloid leukemia and acute lymphoid leukemia or chronic lymphoid leukemia (CLL). Multiple logistic regressions were used to study the association of a leukemia diagnosis with in-hospital outcomes: mortality, bleeding, vascular and cardiac complications, and stroke. RESULTS There were 6,561,445 records of patients who underwent PCI during the study time, of which 15,789 patients had a diagnosis of leukemia. The most common leukemia subtype was CLL accounting for 75% of the cohort (n = 10,800). After multivariable adjustment, a leukemia diagnosis was associated with significantly increased odds of in-hospital mortality (odds ratio [OR]: 1.41; 95% confidence interval [CI]: [1.11-1.79]) and bleeding (OR: 1.87; 95% CI: [1.56-2.09]), whereas patients with AML had a fivefold increase of in-hospital mortality (OR: 5.38; 95% CI: [2.94-9.76]). CONCLUSIONS Patients with current diagnosis of leukemia are at increased risk of procedure-related complications following PCI. A multidisciplinary approach is needed among interventional cardiologists, oncologists, and hematologists to minimize procedural complications and improve outcomes in this high-risk cohort.
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Affiliation(s)
- Jessica Potts
- Keele Cardiovascular Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Juan C Lopez Mattei
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cezar A Iliescu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Marina Konopleva
- Division of Cancer Medicine, Department of Leukemia, MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Muhammad Rashid
- Keele Cardiovascular Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Rodrigo Bagur
- Keele Cardiovascular Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Cardiology, London Health Sciences Centre, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.,Institute of Population Health, University of Manchester, Manchester, UK
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Outcomes for Cancer Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:711-715. [DOI: 10.1016/j.carrev.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/10/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022]
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Guha A, Buck B, Biersmith M, Arora S, Yildiz V, Wei L, Awan F, Woyach J, Lopez-Mattei J, Plana-Gomez JC, Oliveira GH, Fradley MG, Addison D. Contemporary impacts of a cancer diagnosis on survival following in-hospital cardiac arrest. Resuscitation 2019; 142:30-37. [PMID: 31310845 DOI: 10.1016/j.resuscitation.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023]
Abstract
AIM The objective of this study was to determine whether survival and post-arrest procedural utilization following in-hospital cardiac arrest (IHCA) differ in patients with and without comorbid cancer. METHODS We retrospectively reviewed all adult (age ≥18 years old) hospital admissions complicated by IHCA from 2003 to 2014 using the National Inpatient Sample (NIS) dataset. Utilizing propensity score matching using age, gender, race, insurance, all hospital level variables, HCUP mortality score, diabetes, hypertension and cardiopulmonary resuscitation use, rates of survival to hospital discharge and post-arrest procedural utilization were compared. RESULTS From 2003 to 2014, there were a total of 1,893,768 hospitalizations complicated by IHCA, of which 112,926 occurred in patients with history of cancer. In a propensity matched cohort from 2012 to 2014, those with cancer were less likely to survive the hospitalization (31% vs. 46%, p < 0.0001). Following an IHCA, rates of procedural utilization in patients with cancer were significantly less when compared to those without a concurrent malignancy: coronary angiography (4.0% vs. 13.0%), percutaneous coronary intervention (2.2% and 8.0%), targeted temperature management (0.8% vs. 6.0%); p < 0.0001 for all comparisons. This patient population was less likely to have acute coronary syndrome (12.6% vs. 27.0%) or congestive heart failure (24.5% vs. 38.2%); p < 0.0001 for both comparisons. Survival improved in both groups over the study period (p < 0.0001). CONCLUSIONS Patients with a history of cancer who sustain IHCA are less likely to receive post-arrest procedures and survive to hospital discharge. Given the expected rise in the rates of cancer survivorship, these findings highlight the need for broader application of potentially life-saving interventions to lower risk cancer patients who have sustained a cardiac arrest.
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Affiliation(s)
- Avirup Guha
- Division of Cardiology, Cardio-Oncology Program, The Ohio State University Medical Center, Columbus, OH, USA; Harrington Heart and Vascular Institute at UH Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin Buck
- Division of Cardiology, Cardio-Oncology Program, The Ohio State University Medical Center, Columbus, OH, USA
| | - Michael Biersmith
- Division of Cardiology, Cardio-Oncology Program, The Ohio State University Medical Center, Columbus, OH, USA
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA; Division of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vedat Yildiz
- Division of Biostatistics, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
| | - Lai Wei
- Division of Biostatistics, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
| | - Farrukh Awan
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
| | - Jennifer Woyach
- Division of Hematology, James Cancer Hospital and Solove Research Institute at The Ohio State University, Columbus, OH, USA
| | - Juan Lopez-Mattei
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Guilherme H Oliveira
- Harrington Heart and Vascular Institute at UH Cleveland Medical Center, Cleveland, OH, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiology, University of South Florida and Moffitt Cancer Center, Tampa, FL, USA
| | - Daniel Addison
- Division of Cardiology, Cardio-Oncology Program, The Ohio State University Medical Center, Columbus, OH, USA.
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Guha A, Dey AK, Armanious M, Dodd K, Bonsu J, Jneid H, Abraham W, Fradley MG, Addison D. Health care utilization and mortality associated with heart failure-related admissions among cancer patients. ESC Heart Fail 2019; 6:733-746. [PMID: 31264809 PMCID: PMC6676288 DOI: 10.1002/ehf2.12450] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/20/2019] [Accepted: 04/21/2019] [Indexed: 12/13/2022] Open
Abstract
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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Affiliation(s)
- Avirup Guha
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Amit Kumar Dey
- National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Merna Armanious
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Katherine Dodd
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Janice Bonsu
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Hani Jneid
- Division of Cardiology, Michael E. DeBakey VA Hospital, Baylor College of Medicine, Houston, TX, USA
| | - William Abraham
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA
| | - Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.,Cancer Control Program, Department of Medicine, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
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Inohara T, Endo A, Melloni C. Unmet Needs in Managing Myocardial Infarction in Patients With Malignancy. Front Cardiovasc Med 2019; 6:57. [PMID: 31157239 PMCID: PMC6533845 DOI: 10.3389/fcvm.2019.00057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/23/2019] [Indexed: 12/28/2022] Open
Abstract
Patients with cancer face a high short-term risk of arterial thromboembolism. One of the most fatal manifestations of arterial thromboembolism is myocardial infarction (MI), and patients with cancer face a 3-fold greater risk of MI than patients without cancer. The individual risk for arterial thrombotic events in patients with cancer is determined by the complex interaction of baseline cardiovascular risk factors, cancer type and stage, chemotherapeutic regimen, and other general contributing factors for thrombosis. Managing MI 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. When patients with cancer present with MI, a limited proportion are treated with guideline-recommended therapy, such as antiplatelet therapy or invasive revascularization. Despite the limited evidence, existing reports consistently suggest similar clinical benefits of guideline-recommended therapy when administered to patients with cancer presenting with MI. In this review, we briefly summarize the available evidence, clinical challenges, and future perspectives on simultaneous management of MI and cancer, with a focus on invasive strategy.
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Affiliation(s)
- Taku Inohara
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Ayaka Endo
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiology, Saiseikai Central Hospital, Tokyo, Japan
| | - Chiara Melloni
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States
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Nakatsuma K, Shiomi H, Morimoto T, Watanabe H, Nakagawa Y, Furukawa Y, Kadota K, Ando K, Ono K, Shizuta S, Kimura T. Influence of a history of cancer on long-term cardiovascular outcomes after coronary stent implantation (an Observation from Coronary Revascularization Demonstrating Outcome Study-Kyoto Registry Cohort-2). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 4:200-207. [PMID: 29897437 DOI: 10.1093/ehjqcco/qcy014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/19/2018] [Indexed: 12/14/2022]
Abstract
Aims To evaluate the influence of a history of cancer on clinical outcomes in coronary artery disease (CAD) patients who underwent percutaneous coronary intervention (PCI). Methods and results In the Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/coronary artery bypass grafting (CABG) Registry Cohort-2, there were 12 180 CAD patients who received PCI with stents. There were 1109 patients with a history of cancer (cancer group) and 11 071 patients without cancer (non-cancer group). The cumulative 5-year incidences of cardiac death and heart failure (HF) hospitalization were significantly higher in the cancer group than in the non-cancer group (12.4% vs. 7.5%, P < 0.001 and 12.1% vs. 7.6%, P < 0.001, respectively). Even after adjusting for confounders, the excess risk of the cancer group relative to non-cancer group for cardiac death and HF hospitalization remained significant [hazard ratio (HR) 1.27, 95% confidence interval (95% CI) 1.05-1.53; P = 0.02, and HR 1.39, 95% CI 1.13-1.68; P = 0.002, respectively]. Also, the cancer group had a trend toward higher adjusted risk for definite or probable stent thrombosis as compared with the non-cancer group (HR 1.49, 95% CI 0.99-2.16; P = 0.055). The cancer group had significantly higher adjusted risk for all-cause death, non-cardiac death, major bleeding, and non-CABG surgery than the non-cancer group, while the risks for myocardial infarction and stroke were neutral between the two groups. Conclusion Patients with a history of cancer at the time of PCI had increased risk for cardiac events such as cardiac death and HF hospitalization as well as non-cardiac events such as non-cardiac death, major bleeding, and non-CABG surgery.
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Affiliation(s)
- Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Gosho-cho, Nishikyo-ku, Kyoto, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Hirotoshi Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Yoshihisa Nakagawa
- Division of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan
| | - Yutaka Furukawa
- Division of Cardiology, Kobe City Medical Center General Hospital, 1-1, 2 Minatoshimaminami-cho, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazushige Kadota
- Division of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, Japan
| | - Kenji Ando
- Division of Cardiology, Kokura Memorial Hospital, 2-1, 3 Asano, Kokurakita-ku, Kitakyushu, Fukuoka, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
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