Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences

Outcomes of Surgery for Patients With Coexisting Heart and Lung Disease: A Retrospective Study

INTRODUCTION

The optimal surgical approach and the associated adverse outcomes in patients with lung cancer and heart disease remain unknown. This study was designed to explore the potential influence of simultaneous or staged surgery on the perioperative and oncological outcomes of these patients.

MATERIALS AND METHODS

This retrospective study analyzed 158 patients who underwent cardiac and thoracic surgery between January 2016 and December 2021. The patients were divided into two groups according to the timing of surgery: simultaneous and staged. Perioperative and oncologic outcomes between the two groups were compared using 1:1 propensity score matching analysis and Kaplan-Meier analysis.

RESULTS

In the 50 patients (72% male, mean age 60.9 ± 11.7 y) of the simultaneous surgery group, 10 (20%) developed tumor metastasis or recurrence and 6 (12%) died from tumor metastasis. In the staged surgery group, with 108 patients (75% male, mean age 66.1 ± 8.4 y), 18 (16.7%) developed tumor metastasis or recurrence, and 8 (7.4%) died. There was no significant difference in overall survival or progression-free survival between the groups. Compared with the staged surgery group, the simultaneous surgery group had a higher incidence of pulmonary infection (3.7% versus 18.0%; P = 0.002), longer operative time (173.9 ± 104.4 versus 295.6 ± 77.1 min; P < 0.001), increased intraoperative blood loss (89.2 ± 53.1 versus 386.0 ± 207.0 mL; P < 0.001), and a prolonged hospital stay (7.0 ± 3.1 versus 16.5 ± 6.1 d; P < 0.001).

CONCLUSIONS

For patients with concurrent lung cancer and heart disease, staged surgery holds certain advantages when it comes to postoperative complications. Further researches are still needed to verify these findings.

Comparison of Modified Frailty Index, Clinical Frailty Scale, ECOG Score, and ASA PS Score in Predicting Postoperative Outcomes in Cancer Surgery: A Prospective Study

Multiple pre-operative risk assessment scores are available for risk stratification of cancer patients undergoing surgery. This is the first study comparing commonly used preoperative risk assessment tools of Eastern Cooperative Oncology Group Performance Scale (ECOG) and American Society of Anaesthesiologists Physical Status Scale (ASA PS) with frailty scores of Modified Frailty Index (MFI) and Clinical Frailty Scale (CFS). This is a prospective observational study of adult cancer patients undergoing oncosurgery in a tertiary cancer center over one year. Pre-operative risk stratification was done using CFS, MFI, ASA PS, and ECOG scales. All patients were followed up postoperatively for 30 days, and complications were documented. Univariate and multivariate analyses were performed. p value of ≤0.05 was considered significant. Of the 4107 patients studied, 12.6% had prolonged hospitalization, 6.1% had morbidity, 0.9% had readmission, and mortality was 0.6%. ASA PS, ECOG, and CFS were significantly associated with prolonged hospitalization, morbidity, and mortality. MFI was significantly associated with prolonged hospitalization and morbidity. No score could predict readmission. On multivariate analysis, morbidity and readmission were significantly associated with neoadjuvant therapy (p=0.001), mortality with emergency surgery (p=0.001), and prolonged hospitalization with stage III and IV cancer (p=0.001). In adult patients undergoing oncosurgery, ASA PS, ECOG, and CFS are predictors of prolonged hospitalization, morbidity, and mortality. MFI is predictive of prolonged hospitalization and morbidity. None of the studied pre-operative risk scores predict readmission. Newer predictive tools with cancer-specific factors are required for better risk stratification of cancer patients undergoing surgery.

Peripheral Arterial Disease is Associated With Higher Rates of Hospital Encounters and Mortality in Cancer Patients: A Retrospective Study Conducted at a Tertiary Cancer Center

Cancer and peripheral arterial disease (PAD) have overlapping risk factors and common genetic predispositions. The concomitant effects of PAD and cancer on patients have not been well studied. The objective of this retrospective study is to evaluate outcomes of cancer patients with PAD. A query was made into Memorial Sloan Kettering Cancer Center's database to assess outcome of patients with and without the diagnosis of PAD (using ICD 9 and 10 codes). Inclusion criteria were patients diagnosed with lung, colon, prostate, bladder, or breast cancer between January 1, 2013 and December 12, 2018. A total of 77,014 patients were included in this cohort. 1,426 patients (1.8%, 95% CI 1.8-1.9) carried a diagnosis of PAD. PAD diagnosis was most prevalent in bladder cancer (4.7%, 95% CI 4.1-5.2) and lung cancer patients (4.6%, 95% CI 4.2-4.9). In regression models adjusted for cancer diagnosis, age at cancer diagnosis, stage, diabetes, hyperlipidemia, hypertension, coronary artery disease, cerebrovascular disease, smoking, and BMI > 30, patients with PAD had significantly higher odds of UCC admissions (OR 1.50, 95%CI 1.32-1.70, P < 0.001), inpatient admissions (OR 1.32, 95%CI 1.16-1.50, P < 0.001), and ICU admissions (OR 1.64, 95%CI 1.31-2.03, P < 0.001). After adjusting for all these same factors, patients with PAD had a 13% higher risk of dying relative to patients without PAD (HR 1.13, 95% CI 1.04-1.22, P = 0.003). Cancer patients with PAD had higher risks of ICU stays, UCC visits, inpatient admissions, and mortality compared to cancer patients without PAD even when adjusting for CAD, stroke, other comorbidities, cancer diagnosis, and cancer stage.

Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies-A Real-World Analysis

BACKGROUND

The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood.

OBJECTIVE

The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE).

RESULTS

Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001.

CONCLUSION

Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.

Effect of cumulative radiation exposure from Coronary catheterization on lung cancer mortality

BACKGROUND

Coronary catheterization (CC) procedure inevitably exposes patients with cardiovascular disease (CVD) to radiation, while cumulative radiation exposure may lead to higher risk of cancer.

METHODS

This multi-center, retrospective study was based on the CC procedure in Cardiorenal ImprovemeNt II cohort (CIN-II, NCT05050877) among five regional central tertiary teaching hospitals in China between 2007 and 2020. Patients without known cancer were stratified according to the times they received CC procedure. Baseline information from their last CC procedure was analyzed. Cox regression and Fine-Gray competing risk models were used to assess the relationship between cumulative radiation exposure from CC procedures and cancer-specific, all-cause and cardiovascular mortality.

RESULTS

Of 136,495 hospitalized survivors without cancer at baseline (mean age: 62.3 ± 11.1 years, 30.9% female), 116,992 patients (85.7%) underwent CC procedure once, 15,184 patients (11.1%) on twice, and 4,319 patients (3.2%) underwent CC procedure more than three times. During the median follow-up of 4.7 years (IQR: 2.5 to 7.4), totally 18,656 patients (13.7%) died after discharge, of which 617 (0.5%) died of lung cancer. Compared with the patients who underwent CC procedure once, the risk of lung cancer mortality increased significantly with the increase of the number of CC procedure (CC 2 times vs. 1 time: HR 1.42, 95% CI 1.13 to 1.78, P < 0.001; CC ≥ 3 times vs. 1 time: HR 1.64, 95%CI 1.13 to 2.39, P < 0.05). Similar results were observed in all-cause mortality and cardiovascular mortality, but not in other cancer-specific mortality.

CONCLUSIONS

Our data suggest that substantial proportion of CVD patients are exposed to multiple high levels of low-dose ionizing radiation from CC procedure, which is associated with an increased risk of cancer mortality in this population.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05050877; URL: http://www.

CLINICALTRIALS

gov ; 21/09/2021.

Inequity in care delivery in cardio-oncology: dissecting disparities in underrepresented populations

It is well known that patients with cancer have a significantly higher cardiovascular mortality risk than the general population. Cardio-oncology has emerged to focus on these issues including risk reduction, detection, monitoring, and treatment of cardiovascular disease or complications in patients with cancer. The rapid advances in early detection and drug development in oncology, along with socioeconomic differences, racial inequities, lack of support, and barriers to accessing quality medical care, have created disparities in various marginalized populations. In this review, we will discuss the factors contributing to disparities in cardio-oncologic care in distinct populations, including Hispanic/Latinx, Black, Asian and Pacific Islander, indigenous populations, sex and gender minorities, and immigrants. Some factors that contribute to differences in outcomes in cardio-oncology include the prevalence of cancer screening rates, genetic cardiac/oncologic risk factors, cultural stressors, tobacco exposure rates, and physical inactivity. We will also discuss the barriers to cardio-oncologic care in these communities from the racial and socioeconomic context. Appropriate and timely cardiovascular and cancer care in minority groups is a critical component in addressing these disparities, and there need to be urgent efforts to address this widening gap.

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels

Background

Societal aging – as a global demographic phenomenon – shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early.

Methods

The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60–74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death.

Results

Mean study group age was 66.5 ± 4.1 years (\documentclass[12pt]{minimal} \usepackage{wasysym} \usepackage[substack]{amsmath} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage[mathscr]{eucal} \usepackage{mathrsfs} \DeclareFontFamily{T1}{linotext}{} \DeclareFontShape{T1}{linotext}{m}{n} {linotext }{} \DeclareSymbolFont{linotext}{T1}{linotext}{m}{n} \DeclareSymbolFontAlphabet{\mathLINOTEXT}{linotext} \begin{document} $$\overline {\rm{X}} {\rm{ \pm SD}}$$ \end{document}) and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 μg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53−8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77−0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02−1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests.

Conclusion

Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

Signature pattern of gene expression and signaling pathway in premature diabetic patients uncover their correlation to early age coronary heart disease

BACKGROUND

Coronary Heart Disease (CHD) is the leading cause of death in industrialized countries. There is currently no direct relation between CHD and type 2 diabetes mellitus (T2D), one of the major modifiable risk factors for CHD. This study was carried out for genes expression profiling of T2D associated genes to identify related biological processes/es and modulated signaling pathway/s of male subjects with CHD.

METHOD

the subjects were divided into four groups based on their disease, including control, type 2 diabetes mellitus (T2D), CHD, and CHD + T2D groups. The RNA was extracted from their blood, and RT2 Profiler™ PCR Array was utilized to determine gene profiling between groups. Finally, the PCR Array results were validated by using Q-RT-PCR in a more extensive and independent population.

RESULT

PCR Array results revealed that the T2D and T2D + CHD groups shared 11 genes significantly up-regulated in both groups. Further analysis showed that the mRNA levels of AKT2, IL12B, IL6, IRS1, IRS2, MAPK14, and NFKB1 increased. Consequently, the mRNA levels of AQP2, FOXP3, G6PD, and PIK3R1 declined in the T2D + CHD group compared to the T2D group. Furthermore, in silico analysis indicated 36 Gene Ontology terms and 59 signaling pathways were significantly enriched in both groups, which may be a culprit in susceptibility of diabetic patients to CHD development.

CONCLUSION

Finally, the results revealed six genes as a hub gene in altering various biological processes and signaling pathways. The expression trend of these identified genes might be used as potential markers and diagnostic tools for the early identification of the vulnerability of T2D patients to develop premature CHD.