Coronary Artery Disease
Outcome After ST Elevation Myocardial Infarction in Patients With Cancer Treated With Primary Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2013.08.019Get rights and content

The simultaneous occurrence of cancer and coronary heart disease is increasing in the Western world. Nevertheless, the influence of cancer on ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has not been investigated extensively. This multicenter registry included patients with STEMI treated with primary PCI from 2006 to 2009. Patients were stratified according to history of cancer, and primary focus lay on all-cause and cardiac mortalities during 1-year follow-up. Adjusted effect sizes were calculated using Cox proportional hazard models. In total, 208 patients had a history of cancer (diagnosed ≤6 months ago in 20.7%, 6 months to 3 years ago in 21.7%, and >3 years ago in 57.6%) and 3,215 patients had no history of cancer. Chemotherapy had been administered previously to 23% of patients with cancer. Patients with cancer were older, more frequently women, and more commonly known with previous myocardial infarction or anemia. Reperfusion rates were similar after PCI. Patients with cancer showed greater all-cause (17.4% vs 6.5% in other patients) and cardiac mortalities at 1 year (10.7% vs 5.4% in other patients) because of high early cardiac death (23.8%) in recently diagnosed patients with cancer. After adjustment, a recent cancer diagnosis predicted cardiac mortality at 7 days (hazard ratio 3.34, 95% confidence interval 1.57 to 7.08). The adverse prognosis was partly explained by anemia and occurrence of cardiogenic shock, whereas outcome was independent of cancer treatment. In conclusion, patients with cancer showed greater mortality after STEMI. A cancer diagnosis in the 6 months before primary PCI was strongly associated with early cardiac mortality.

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Methods

The current Dutch registry prospectively included patients with STEMI treated in 3 tertiary centers in the Netherlands. The design of this registry has been described previously.7 In short, all consecutive patients undergoing primary PCI for STEMI from January 2006 to December 2009 were included. Patients without return of spontaneous circulation after out-of-hospital cardiac arrest were excluded, as well as patients permanently living outside the Netherlands to allow follow-up through

Results

During the inclusion period, 208 patients (6.0%) treated for STEMI had a history of cancer (hereafter referred to as patients with cancer) and 3,215 patients (92.3%) had no known history of cancer. Cancer history was uncertain in 60 patients (1.7%). Baseline characteristics are listed in Table 1. Patients with cancer were on average older, more often women, and more frequently had hypertension compared with patients without a history of cancer. Patients with cancer were less frequently smokers

Discussion

The present multicenter study evaluated the influence of cancer on the prognosis of patients with STEMI. Most notably, a cancer diagnosis in the 6 months before primary PCI was a strong predictor of early cardiac mortality. The adverse effect of cancer on prognosis after STEMI was partly explained by a high prevalence of anemia and the occurrence of cardiogenic shock, whereas outcome was independent of cancer treatment.

In the present population, patients with cancer were on average older and

Disclosures

The Department of Cardiology of Leiden University Medical Center received unrestricted research grants from Medtronic, Biotronik, Boston Scientific, Lantheus Medical Imaging, St. Jude Medical, Edwards Lifesciences, and GE Healthcare. All other authors have reported that they have no relationships relevant to the contents of this article to disclose.

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    It should be also noted that in the US registry, only 27.1% of patients with active cancer underwent PCI, as often seen in clinical practice.8 In terms of long-term data, previous investigations have reported outcomes mostly up to 1 year following MI.6,7,21 Several previous studies including patients with cancer undergoing PCI for stable coronary artery disease and acute MI showed that the presence of cancer was associated with increased risks of both ischemic and bleeding events during a follow-up period for up to 5 years.22,23

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