Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA

Aditya Bharadwaj, Jessica Potts, Mohamed O Mohamed, Purvi Parwani, Pooja Swamy, Juan C Lopez-Mattei, Muhammad Rashid, Chun Shing Kwok, David L Fischman, Vassilios S Vassiliou, Philip Freeman, Erin D Michos, Mamas A Mamas

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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.

Original languageEnglish
JournalEuropean Heart Journal
ISSN0195-668X
DOIs
Publication statusE-pub ahead of print - 4 Dec 2019

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Myocardial Infarction
Neoplasms
Odds Ratio
Confidence Intervals
Lung Neoplasms
Percutaneous Coronary Intervention
Neoplasm Metastasis
Colonic Neoplasms
Survival
Risk Management
Hospital Mortality
Comorbidity
Inpatients
Prostatic Neoplasms
Stroke
Databases
Breast Neoplasms
Hemorrhage

Cite this

Bharadwaj, Aditya ; Potts, Jessica ; Mohamed, Mohamed O ; Parwani, Purvi ; Swamy, Pooja ; Lopez-Mattei, Juan C ; Rashid, Muhammad ; Kwok, Chun Shing ; Fischman, David L ; Vassiliou, Vassilios S ; Freeman, Philip ; Michos, Erin D ; Mamas, Mamas A. / Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA. In: European Heart Journal. 2019.
@article{ed27c5efda0a4cb0b48cad81fb612014,
title = "Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA",
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.",
author = "Aditya Bharadwaj and Jessica Potts and Mohamed, {Mohamed O} and Purvi Parwani and Pooja Swamy and Lopez-Mattei, {Juan C} and Muhammad Rashid and Kwok, {Chun Shing} and Fischman, {David L} and Vassiliou, {Vassilios S} and Philip Freeman and Michos, {Erin D} and Mamas, {Mamas A}",
year = "2019",
month = "12",
day = "4",
doi = "10.1093/eurheartj/ehz851",
language = "English",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",

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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 2019, 'Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA', European Heart Journal. https://doi.org/10.1093/eurheartj/ehz851

Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA. / Bharadwaj, Aditya; Potts, Jessica; Mohamed, Mohamed O; Parwani, Purvi; Swamy, Pooja; Lopez-Mattei, Juan C; Rashid, Muhammad; Kwok, Chun Shing; Fischman, David L; Vassiliou, Vassilios S; Freeman, Philip; Michos, Erin D; Mamas, Mamas A.

In: European Heart Journal, 04.12.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA

AU - Bharadwaj, Aditya

AU - Potts, Jessica

AU - Mohamed, Mohamed O

AU - Parwani, Purvi

AU - Swamy, Pooja

AU - Lopez-Mattei, Juan C

AU - Rashid, Muhammad

AU - Kwok, Chun Shing

AU - Fischman, David L

AU - Vassiliou, Vassilios S

AU - Freeman, Philip

AU - Michos, Erin D

AU - Mamas, Mamas A

PY - 2019/12/4

Y1 - 2019/12/4

N2 - 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.

AB - 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.

U2 - 10.1093/eurheartj/ehz851

DO - 10.1093/eurheartj/ehz851

M3 - Journal article

C2 - 31800032

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

ER -