Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA
Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA
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DOI：
10.1093/eurheartj/ehz851
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发表时间：
2020-06-14
影响因子：
39.3
通讯作者：
Mamas, Mamas A.
中科院分区：
文献类型：
--
作者：
Bharadwaj, Aditya;Potts, Jessica;Mamas, Mamas A.
本研究的目的是评估急性心肌梗死（AMI）患者的时间趋势、治疗和临床结局，方法和结果数据来自2004年至2014年美国国家住院患者样本（NIS）中6 563 255例AMI患者数据库进行了分析。共有5 966 955人没有癌症，186 604人患有癌症，409 697人有癌症的历史诊断。前列腺癌、乳腺癌、结肠癌和肺癌是最常见的四种癌症。癌症患者年龄较大，合并症较多。有创治疗的差异，43.9%的非癌症患者接受经皮冠状动脉介入治疗（PCI），而只有21.0%的肺癌患者接受PCI。肺癌与最高的住院死亡率[比值比（OR）2.71，95%可信区间（CI）2.62-2.80]、主要不良心脑血管并发症（OR 2.38，95% CI 2.31-2.45）和卒中（OR 1.91，95% CI 1.80-2.02），而结肠癌与最高出血风险相关（OR 2.82，95% CI 2.68-2.98）。无论癌症的类型，转移的存在与不良的住院预后，和历史的癌症没有不利影响生存（OR 0.90，95%CI 0.89-0.91）。结论伴随癌症的诊断与AMI的保守的医疗管理策略，和不良的临床预后，相比，无癌症的患者。根据癌症类型和转移状态，AMI背景下的生存率和临床结局显著不同。这一高危人群的管理具有挑战性，需要采取多学科和以患者为中心的方法来改善其结局。
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.