Introduction
Patients presenting with acute myocardial infarction (AMI) represent a diverse population with varying comorbidities, including a significant subset with a history of cancer. Understanding the interplay between a Historical Diagnosis of cancer and AMI is crucial for optimizing treatment strategies and improving patient outcomes. This study delves into the temporal trends, treatment approaches, and clinical outcomes of AMI patients with a past cancer diagnosis, comparing them to those with current cancer and no cancer history. By analyzing a large patient database, this research sheds light on the specific challenges and considerations in managing this complex patient group.
Methods and Results
This comprehensive analysis utilized data from 6,563,255 patients admitted for AMI between 2004 and 2014, sourced from the US National Inpatient Sample (NIS) database. The patient cohort was categorized into three groups: those with no cancer (5,966,955), patients with current cancer (186,604), and individuals with a historical diagnosis of cancer (409,697). The study identified prostate, breast, colon, and lung cancers as the most prevalent cancer types within the cancer groups.
The analysis revealed that patients with cancer, both current and historical, tended to be older and present with a higher burden of comorbidities compared to those without cancer. Notably, there were significant differences in the application of invasive treatments. Percutaneous coronary intervention (PCI) was performed in 43.9% of AMI patients without cancer, but this rate was considerably lower in cancer patients, with only 21.0% of lung cancer patients receiving PCI.
Lung cancer emerged as a particularly high-risk factor, 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 events (OR 2.38, 95% CI 2.31-2.45), and stroke (OR 1.91, 95% CI 1.80-2.02). Conversely, colon cancer was linked to the highest risk of bleeding complications (OR 2.82, 95% CI 2.68-2.98).
Interestingly, the presence of metastasis, irrespective of cancer type, was consistently associated with poorer in-hospital outcomes. However, and importantly, a historical diagnosis of cancer did not demonstrate an adverse impact on survival in AMI patients (OR 0.90, 95% CI 0.89-0.91). This suggests that while the acute phase management of AMI in patients with a past cancer history requires careful consideration, the long-term survival may not be negatively affected by the historical cancer itself.
Conclusion
The study underscores that a concurrent cancer diagnosis is associated with a more conservative management approach for AMI and is linked to worse clinical outcomes compared to patients without cancer. Outcomes for AMI patients are significantly influenced by both the type of cancer and the presence of metastasis. Despite these challenges, the finding that a historical diagnosis of cancer does not negatively impact survival is a crucial insight.
Managing AMI in patients with a history of cancer or current cancer remains a complex clinical challenge. It necessitates a multidisciplinary, patient-centered approach to optimize treatment strategies and ultimately improve outcomes in this high-risk population. Further research is warranted to refine management guidelines and personalize treatment plans for AMI patients with both current and historical diagnoses of cancer, taking into account cancer type, metastasis status, and individual patient characteristics.
