Impact of cancer on short-term in-hospital mortality after primary acute myocardial infarction

Ischaemic and bleeding risk after ST-elevation myocardial infarction in patients with active cancer: a nationwide study

Aims

Treatment of patients with cancer presenting with ST-elevation myocardial infarction (STEMI) is complex given the increased risk of both thrombotic and major bleeding complications.

Methods and results

A nationally linked cohort of STEMI patients between January 2005 and March 2019 was obtained from the UK Myocardial Infarction National Audit Project and the UK National Hospital Episode Statistics Admitted Patient Care registries. The primary outcomes were major bleeding and re-infarction at 1 year following admission with STEMI. Major bleeding was defined as bleeding events that require hospital admission. Re-infarction was defined as acute MI according to the fourth Universal Definition of Myocardial Infarction. A total of 322 776 STEMI-indexed admissions were identified between January 2005 and March 2019. Of those, 7050 (2.2%) patients were diagnosed with active cancer. Cancer patients were older with more cardiovascular comorbidities. Cancer patients received invasive coronary angiography (62.2% vs. 72.7%, P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%, P < 0.001) less often compared with patients without cancer and were less likely to be prescribed dual antiplatelet therapy (85% vs. 95.4%, P < 0.001). The incidence of major bleeding (6.5% vs. 3.5%, P < 0.001) and re-infarction (cancer 5.7%, no cancer 5.1%, P = 0.01) was higher in cancer patients at 1 year. After adjustment for differences in baseline covariates, a similar risk of re-infarction (sub-hazard ratios (SHR) 1.10, 95% CI 0.94-1.27) and a 50% increased risk of major bleeding (SHR 1.49, 95% CI 1.30-1.71) were observed in cancer patients.

Conclusion

Compared with non-cancer patients, cancer patients have a higher risk of major bleeding but not of re-infarction. Mitigating bleeding risk in STEMI patients with cancer is of paramount importance to improve outcomes.

A meta-analysis on the impact of concurrent or pre-existing cancer diagnosis on acute myocardial infarction outcomes

BACKGROUND

There is still a significant gap in understanding the impact of concomitant or previous cancer diagnoses on clinical outcomes of acute myocardial infarction (AMI).

OBJECTIVE

To provide updated evidence on the effect of concomitant or previous cancer diagnoses on mortality and risk of complications, specifically major bleeding, myocardial reinfarction, and stroke, of patients with AMI.

METHODS

A literature search was conducted across PubMed, EMBASE, and Scopus databases. English-language cohort studies published in peer-reviewed journals were included. Pooled effect estimates were calculated using random-effects models and reported as odds ratio (OR) or hazards ratio (HR) with 95% confidence intervals (CI). The certainty of the evidence was assessed using the standard GRADE approach.

RESULTS

A total of 22 studies were included. AMI patients with previous or concurrent cancer had increased risk of in-hospital mortality (OR 1.44, 95% CI: 1.20, 1.73), in-hospital mortality related to cardiovascular complications (OR 2.06, 95% CI: 1.17, 3.65), mortality at 30-days follow up (OR 1.47, 95% CI: 1.24, 1.74) and mortality at 1 year follow up (HR 2.67, 95% CI: 1.73, 4.11), compared to patients without cancer. The risk of major bleeding (OR 1.74, 95% CI: 1.40, 2.16), reinfarction (OR 1.20, 95% CI: 1.05, 1.37), and stroke (OR 1.16, 95% CI: 0.99, 1.37) was also higher in patients with previous or concurrent cancer. The certainty of evidence was rated as "low" for all outcomes, except for the risk of major bleeding, which was rated as "very low."

CONCLUSION

Based on the low to very low certainty of evidence, we conclude that the presence of previous cancer diagnosis or concurrent cancer may increase the risk of adverse outcomes in patients with AMI. Early interventions, such as close monitoring of cardiac function, lifestyle modifications, and targeted pharmacological therapies, might help mitigate the risk of AMI and improve overall clinical outcomes. However, further methodologically rigorous studies are needed to validate the findings of this review.

Impact of breast cancer on in-hospital mortality and health care utilization in female heart failure patients: a retrospective cohort study

Background

Heart failure (HF) and breast cancer are major health concerns with overlapping risk factors. This study investigated the impact of breast cancer on in-hospital mortality, length of stay, and health care charges in patients with HF.

Methods

A retrospective cohort study was conducted using data from the National Inpatient Sample, focusing on female patients diagnosed with both breast cancer and HF. A control group of patients with HF without breast cancer was also analyzed. Main outcomes included in-hospital mortality, length of stay, and health care charges. Statistical analysis involved logistic and linear regression models.

Results

The study included 17,551 unweighted cases of breast cancer, corresponding to 87,755 weighted cases. Breast cancer, particularly metastatic, was associated with increased in-hospital mortality across various types of HF. Patients with breast cancer and HF had longer hospital stays, which was more pronounced in metastatic cases. However, the impact on hospital charges was not consistent across the different HF types. Racial disparities were evident, with Native Americans showing the highest mortality risk in acute HF.

Conclusion

Breast cancer significantly increases the in-hospital mortality risk and length of hospital stay in patients with HF. These findings highlight the need for integrated cardiovascular and oncological care, especially in the presence of metastatic breast cancer. The study underscores the importance of tailored management strategies for patients with HF with concurrent breast cancer and points toward the necessity for addressing racial disparities in health care.

Impact of Cancer History on Temporal Changes in the Cardiopulmonary Exercise Test of Patients with Cardiovascular Disease

The elevated risk of cardiovascular disease (CVD) in cancer patients and survivors is likely the result of normal age-related pathologies coupled with the direct and indirect effects of cancer therapy that extend across multiple systems. The purpose of this study was to investigate the impact of cardiac rehabilitation (CR) on CVD patients with a history of cancer.In this study, patients who had participated in the outpatient CR program were enrolled and were divided into 2 groups (cancer survivor group and no-cancer group) based on their history of cancer. The cardiopulmonary exercise test (CPET) was performed at the beginning (baseline) and at the end of the CR program (follow-up). The results of CPET at baseline and those at follow-up were analyzed retrospectively.A total of 105 patients were analyzed in this study. The cancer survivor group had 25 patients, and the non-cancer group 80. At baseline, peak oxygen uptake (peak VO2) (14.7 [11.9 to 17.6] mL/kg/minute versus 11.3 [9.7 to 14.7] mL/kg/minute; P = 0.003) was significantly lower in cancer survivors. The percent changes in peak VO2 between baseline and follow-up were not significantly different between the 2 groups (7.9 % [-11.5 to 24.5] versus 9.4 % [-7.5 to 27.3] P = 0.520).The percent changes in peak VO2 of CR participants were not significantly different despite their cancer history.

Risk of mortality and other adverse outcomes from myocardial infarction in cancer survivors: a meta-analysis

BACKGROUND AND PURPOSE

Myocardial infarction (MI) is an acute cardiovascular disease that can increase prognosis risks such as arrhythmia, heart failure, shock, etc. Studies have found that even well-controlled coexistence of cancer could affect the quality of life in MI patients. However, the prognostic impact of cancer on MI patients is controversial. This meta-analysis aimed to assess the influence of cancer on the risk of future all-cause mortality, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) in MI patients.

METHODS

The Embase, PubMed, and Cochrane libraries were searched for cohort studies and case-control from inception to May 2022. The quality of the included pieces of literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analyses were performed using Stata statistical software versions 14.0 and 16.0. Sensitivity analysis assessed the robustness of the results, and funnel plots and Egger's tests evaluated the publication bias.

RESULTS

A total of 10 studies were included, covering 7,210,530 participants. Summary analyses show that compared with non-cancer patients, cancer increased the risk of long-term all-cause mortality in MI patients (HR 1.58, 95% CI 1.36-1.84, I² = 94.2%). However, no significant difference was observed in the risk of cardiovascular mortality (HR 1.18, 95% CI 0.91-1.54, I² = 52.4%) or MACCE (HR 1.26, 95% CI 0.94-1.70, I² = 99.2%). In subgroup analysis, cancer was associated with the risk of recurrent MI (HR 1.18, 95% CI 1.03-1.34, I² = 88.8%), and major bleeding (HR 2.01, 95% CI 1.60-2.52, I² = 93.1%), with no significant difference in the risk of stroke (HR 1.11, 95% CI 0.97-1.27, I² = 85.1%).

CONCLUSION

This meta-analysis shows that cancer increases the risk of all-cause mortality, recurrent MI, and major bleeding in MI patients but is not associated with the risk of cardiovascular death. Therefore, comprehensive multidisciplinary management and monitoring of potential future adverse events in MI patients with cancer are needed.

SYSTEMATIC REVIEW REGISTRATION

The meta-analysis was registered in the International Register of Prospective Systematic Reviews (NO. CRD42022332775).

Acute coronary syndrome in patients with cancer

INTRODUCTION

Improvement in cancer survival has led to an increased focus on cardiovascular disease as the other major determinant of survivorship. As a result, there has been an increasing interest in managing cardiovascular disease during and post cancer treatment.

AREAS COVERED

This article reviews the current literature on the pathogenesis, risk factors, presentation, treatment and clinical outcomes of acute coronary syndrome (ACS) in patients with cancer.

EXPERT OPINION

There is growing evidence that both medical therapy and invasive management of ACS improve outcomes in patients with cancer. Appropriate patient selection, risk stratification and tailored therapy represents the cornerstone of management in these patients.