Clinical presentation and treatment of acute coronary syndrome as well as 1-year survival of patients hospitalized due to cancer

Abstract

The diagnosis of acute coronary syndrome (ACS) in patients with cancer constitutes a therapeutic challenge. We aimed to assess the clinical presentation and management of ACS as well as 1-year survival in patients hospitalized for cancer. This retrospective study included patients hospitalized between 2012 and 2018 in a nonacademic center. The inclusion criteria were diagnosis of active cancer and ACS recognized using standard criteria. Patients were assessed with respect to invasive or conservative ACS strategy. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiovascular mortality during 1-year follow-up. We screened 25,165 patients, of whom 36 (0.14%) had ACS (mean [SD] age, 71.9 [9.8] years). The most common presentation was non–ST-segment elevation myocardial infarction (61% of patients). Coronary angiography was performed in 47% of patients, while 53% were treated conservatively. Overall, the primary endpoint occurred in 67% of patients and secondary endpoint in 28% during follow-up. The predictors of better outcome in a univariate analysis were invasive strategy, lack of metastases, aspirin use, and no cardiogenic shock. Invasive treatment and aspirin use remained significant predictors of better survival when adjusted for the presence of metastases (hazard ratio [HR] 0.37, confidence interval [CI] 0.15–0.92 and HR 0.39, CI 0.16–0.94, respectively) and ineligibility for cancer treatment (HR 0.37, CI 0.15–0.93 and HR 0.30, CI 0.12–0.73, respectively). The incidence of ACS in cancer patients is low but 1-year mortality rates are high. Guideline-recommended management was frequently underused. Our results suggest that invasive approach and aspirin use are associated with better survival regardless of cancer stage and eligibility for cancer treatment.

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

“…When only ACS occurring during hospitalization for active cancer is considered, its incidence is lower. A retrospective analysis on 25,165 medical records of patients hospitalized to a Polish oncological center for cancer treatment reported an occurrence of ACS in 0.14% of patients [ 22 ]. Another retrospective analysis by Park et al [ 23 ], who screened 5300 patients with active hematologic malignancies, identified 73 cases (1.4%) of ACS (unstable angina in 8%, NSTEMI in 78% and STEMI in 14% of cases) during hospitalization for cancer.…”

“…Another retrospective analysis by Park et al [ 23 ], who screened 5300 patients with active hematologic malignancies, identified 73 cases (1.4%) of ACS (unstable angina in 8%, NSTEMI in 78% and STEMI in 14% of cases) during hospitalization for cancer. Although the incidence of ACS in patients hospitalized in oncological units with active cancer seems to be low, this represents a very high-risk group, characterized by in-hospital mortality rates of about 25% [ 22 , 23 ].…”

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

“…However, recent studies [28,30,31] advocate that PCI + optimal medical therapy (OMT), especially acetylsalicylic acid use if not contraindicated, is associated with a better survival rate regardless of the cancer stage and/or eligibility for cancer treatment.…”

“…Assessment of coronary stenosis with FFR is necessary before proceeding to PCI, as well as confirmation of excellent stent apposition after PCI with intravascular ultrasound (IVUS) or optical coherence tomography (OCT) [33]. OCT is recommended after stent placement to ensure optimal expansion, and an absence of complications may allow early DAPT interruption [25][26][27][28][29][30][31][32][33][34].…”

Features of Acute Coronary Syndrome in Combination with Oncological Diseases in Elderly and Senile Patients

“…В доступной литературе имеются единичные работы с описанием клинических особенностей течения ОКС в зависимости от наличия или отсутствия ОЗ, в том числе у лиц пожилого и старческого возраста, что еще раз подтверждает актуальность изучения данной проблемы [1,8,9].…”