Acute Coronary Syndrome Management in Cancer Patients

Al‐Hawwas, Malek; Tsitlakidou, Despina; Gupta, Neha; Iliescu, Cezar; Çilingiroğlu, Mehmet; Marmagkiolis, Konstantinos

doi:10.1007/s11912-018-0724-8

Cited by 30 publications

(23 citation statements)

References 33 publications

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“…This finding was consistent across a wide range of age and mortality risk groups. While PCI may be offered less to cancer patients due to concerns of safety and efficacy, previous literature indicates that PCI is safe and beneficial in such population (11)(12)(13)(14), and our real-world analysis shows PCI is safe to perform in gynecological cancer patients as well. The results presented here should promote the inclusion of patients with gynecological cancer undergoing cancer treatment and with acceptable medium-and long-term survival (least 6 months and preferably 1 year expected >50% survival) in future cardiovascular trials and encourage physicians to more frequently utilize PCI in this patient population.…”

Section: Discussionmentioning

confidence: 65%

“…Historically this understanding has not been reflected in clinical practice, partly due to the exclusion of patients with cancer from cardiovascular clinical trials and vice versa (8)(9)(10). While there is now limited data exploring the overall prognostic impact of cancer on PCI outcomes (11)(12)(13)(14), there is no data regarding PCI outcomes in gynecological cancer patients. Reported incidence of gynecologic malignancies in the U.S. is approximately 94,000 cases per year (15), with the most common malignancy being uterine cancer (26.82 cases per 100,000) and the least common vaginal cancer (0.66 per 100,000).…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Thomason

Monlezun

Javaid

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDespite the growing number of patients with both coronary artery disease and gynecological cancer, there are no nationally representative studies of mortality and cost effectiveness for percutaneous coronary interventions (PCI) and this cancer type.MethodsBackward propagation neural network machine learning supported and propensity score adjusted multivariable regression was conducted for the above outcomes in this case-control study of the 2016 National Inpatient Sample (NIS), the United States' largest all-payer hospitalized dataset. Regression models were fully adjusted for age, race, income, geographic region, cancer metastases, mortality risk, and the likelihood of undergoing PCI (and also with length of stay [LOS] for cost). Analyses were also adjusted for the complex survey design to produce nationally representative estimates. Centers for Disease Control and Prevention (CDC)-based cost effectiveness ratio (CER) analysis was performed.ResultsOf the 30,195,722 hospitalized patients meeting criteria, 1.27% had gynecological cancer of whom 0.02% underwent PCI including 0.04% with metastases. In propensity score adjusted regression among all patients, the interaction of PCI and gynecological cancer (vs. not having PCI) significantly reduced mortality (OR 0.53, 95%CI 0.36–0.77; p = 0.001) while increasing LOS (Beta 1.16 days, 95%CI 0.57–1.75; p < 0.001) and total cost (Beta $31,035.46, 95%CI 26758.86–35312.06; p < 0.001). Among gynecological cancer patients, mortality was significantly reduced by PCI (OR 0.58, 95%CI 0.39–0.85; p = 0.006) and being in East North Central, West North Central, South Atlantic, and Mountain regions (all p < 0.03) compared to New England. PCI reduced mortality but not significantly for metastatic patients (OR 0.74, 95%CI 0.32–1.71; p = 0.481). Eighteen extra gynecological cancer patients' lives were saved with PCI for a net national cost of $3.18 billion and a CER of $176.50 million per averted death.ConclusionThis large propensity score analysis suggests that PCI may cost inefficiently reduce mortality for gynecological cancer patients, amid income and geographic disparities in outcomes.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Thomason

Monlezun

Javaid

et al. 2022

Front. Cardiovasc. Med.

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“…In general, cancer is a procoagulant state as it can activate the tissue factors and release inflammatory cytokines (i.e., TNF-α, IL-1β) which increases the risk of thrombosis and hence MI. Also, the chemotherapeutic agents used for the treatment of cancers also increase the risk of MI through different mechanisms including endothelial injury, acute arterial thrombosis, direct vasospastic effect, and plaque destabilization [ 11 , 12 ]. Likewise in hematological cancers, MI can occur due to thrombus formation through activation of the coagulation cascade, infiltration of the artery by leukemic cells, compression of the coronary arteries due to infiltration of the pericardium by leukemic cells, and leukostasis syndrome induced by hyperleukocytosis [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical In-Hospital Outcomes of Acute Myocardial Infarction in Patients With Hematological Malignancies

Khan¹,

Baqi²,

Patel³

et al. 2022

Cureus

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The purpose of our study is to determine in-hospital outcomes of acute myocardial infarction in patients with hematological malignancies and their subtypes. MethodPatient data were obtained from the nationwide inpatient sample (NIS) database between the years 2009-2014. Patients with hematological cancer subtypes and acute MI (non-ST segment elevation myocardial infarction and ST-segment elevation myocardial infarction (NSTEMI/STEMI) were identified using validated international classification of diseases (ninth revision) and clinical modification (ICD-9-CM) codes. Statistical analysis using the chi-square test was performed to determine the hospital outcomes of acute MI in patients with hematological cancers and subtypes. ResultsThe prevalence of acute myocardial infarction was 2.4% in patients with hematological neoplasms (N=3,027,800). Amongst the subtypes of blood cancers, the highest prevalence of acute MI was seen in lymphocytic leukemia (2.9%). The mortality of MI in patients with hematological malignancies was 16.8% vs 8.8% in patients with non-hematological malignancies, in-hospital costs were $25469 ± 36763 vs. $20534 ± 24767, and length of in-hospital stay was 8.3 ± 10 vs 6.3 ± 7.8 days. Amongst the hematological cancer subtypes, the highest mortality of acute MI was found in myeloid leukemia (23%) followed by multiple myeloma (MM) (17.9%), lymphocytic leukemia (15.9%), and lymphoma (14.4%). The length of stay and hospitalization cost was highest for myeloid leukemia, followed by MM, lymphocytic leukemia, and lymphoma. ConclusionThis study showed that acute MI in patients with hematological malignancies has higher in-hospital mortality, length of stay, and cost. Amongst the blood neoplasm subtypes the highest mortality, length of hospital stay, and hospitalization cost were found in myeloid leukemia.

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“…Symptoms of ACS are generally atypical in malignancy patients, and less than one-third of them experience chest pain, and less than half have dyspnea. For this reason, careful clinical evaluation of patient history, the presence of risk factors, electrocardiogram findings, cardiac biomarkers, and echocardiographic imaging may allow ACS diagnosis in neoplastic patients [ 72 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

Lucà

Parrini²,

Abrignani

et al. 2022

JCM

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Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. Nonetheless, cancer patients have generally not been evaluated in ACS trials, so that the treatment in these cases is still not fully known. We reviewed the current literature and discussed the best management for these very high-risk patients. The treatment strategy must be tailored based on the cancer type and stage, balancing thrombotic and bleeding risks. When the prognosis is longer than six months, especially if a clinical instability coexists, patients with ACS and cancer should be referred for percutaneous coronary intervention (PCI) as soon as possible. Moreover, an invasive strategy should be preferred in STEMI patients as well as in NSTEMI patients who are considered as high risk. On the contrary, in clinically stable NSTEMI patients, a conservative non-invasive strategy could be adopted, especially in cases of a poor life expectancy and/or of high risk of bleeding. Drug-Eluting-Stents (DES) should be the first choice if an invasive strategy is adopted. Conservative therapy could instead be considered in cancer patients with more stable CAD at an increased risk of major bleeding complications. However, the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended, but it should be as short as possible, whereas triple antithrombotic therapy is non-advised because it significantly increases the risk of bleeding. ACS management among cancer patients should be based on an accurate evaluation of the risk of thrombosis and bleeding. Future studies focused on choosing optimal strategies in tumor patients with ACS should be performed to treat this subset of patients better.

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Acute Coronary Syndrome Management in Cancer Patients

Cited by 30 publications

References 33 publications

Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Clinical In-Hospital Outcomes of Acute Myocardial Infarction in Patients With Hematological Malignancies

Management of Acute Coronary Syndrome in Cancer Patients: It’s High Time We Dealt with It

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