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abstract
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BACKGROUND
Although cancer treatment considerably affects cardiovascular
health, little is known about how cancer patients are treated for an
acute myocardial infarction. We aimed to investigate whether acute
myocardial infarction patients with a history of cancer received the
same guideline recommended treatment as those acute myocardial
infarction patients without and whether they differ with respect to
inhospital outcome.
METHODS
All patients with ST-segment elevation myocardial infarction and
non-ST-segment elevation myocardial infarction, enrolled between
2002 and mid-2015 in the acute myocardial infarction in Switzerland
(AMIS Plus) registry with comorbidity data based on the Charlson
comorbidity index were analysed. Patients were classified as having
cancer if one of the cancer diseases of the Charlson comorbidity
index was indicated. Immediate treatment strategies and inhospital
outcomes were compared between groups using propensity score
matching.
RESULTS
Of 35,249 patients, 1981 (5.6%) had a history of cancer. After
propensity score matching for age, gender, Killip class >2,
ST-segment elevation myocardial infarction and renal disease (1981
patients per group), significant differences were no longer found
for a history of acute myocardial infarction, hypertension,
diabetes, heart failure and cerebrovascular disease between cancer
and non-cancer patients. However, cancer patients underwent
percutaneous coronary intervention less frequently (odds ratio (OR)
0.76; 95% confidence interval (CI) 0.67-0.88) and received P2Y12
blockers (OR 0.82; 95% CI 0.71-0.94) and statins (OR 0.87; 95% CI
0.76-0.99) less frequently. Inhospital mortality was significantly
higher in cancer patients (10.7% vs. 7.6%, OR 1.45; 95% CI
1.17-1.81). However, the main cause of death was cardiac in both
groups ( P=0.06).
CONCLUSION
Acute myocardial infarction patients with a history of cancer were
less likely to receive guideline recommended treatment and had worse
inhospital outcomes than non-cancer patients.
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