Characteristics and Outcomes of Cancer Patients Presenting with Myocardial Infarction

Osnat Itzhaki Cardiology Department, Rabin Medical Center, Israel Sackler Faculty of Medicine, Tel Aviv University, Israel David Hasdai Cardiology Department, Rabin Medical Center, Israel Sackler Faculty of Medicine, Tel Aviv University, Israel Shmuel Gottlieb Department of Cardiology, Shaare Zedek Medical Center, Israel Faculty of Medicine, Hebrew University of Jerusalem, Israel Avital Porter Cardiology Department, Rabin Medical Center, Israel Sackler Faculty of Medicine, Tel Aviv University, Israel Roy Beigel Sackler Faculty of Medicine, Tel Aviv University, Israel Department of Cardiology, Sheba Medical Center, Israel Tal Cohen Department of Statistics, Israeli Center of Cardiovascular Research, Israel Nir Shlomo Department of Statistics, Israeli Center of Cardiovascular Research, Israel Ran Kornowski Cardiology Department, Rabin Medical Center, Israel Sackler Faculty of Medicine, Tel Aviv University, Israel Zaza Iakobishvili Cardiology Department, Rabin Medical Center, Israel Sackler Faculty of Medicine, Tel Aviv University, Israel

Background: There is limited data regarding patients with prior/current malignancies and acute myocardial infarction.

Aims: To define the characteristics and outcomes of patients with a diagnosis of cancer hospitalized with acute myocardial infarction.

Methods: We studied consecutive acute myocardial infarction patients included in the ACSIS (Acute Coronary Syndrome in Israel) registry in the years 2010 and 2016 and the diagnosis of prior/current malignancy.

Results: Our cohort consisted of 2,925 non-cancer patients and 152 patients with cancer of whom 35% (53 patients) presented with active malignancies. Sixty-two patients with cancer presented with STEMI (40.8%) compared to 1,426 (48.8%) non-cancer patients (p=0.067). Compared to non-cancer patients, patients with cancer were older (64.0±12.8 versus 74.1±10.8 years), more often female patients (21% versus 25%), with a history of hypertension (64% versus 77%) and chronic kidney disease (11% versus 22%) (p≤0.001 for all comparisons) and presented more often with atypical chest pain (8% versus 15%, p=0.003). Time from symptom onset to first medical contact was significantly longer in the cancer group (831±2,155 versus 524±1,370 minutes, p=0.038). GRACE score>140 was more common in the cancer group (37.4% versus 17.2%, p<0.001). There were no significant differences between the groups regarding their invasive management, except for a less frequent usage of the femoral access (p<0.05) and bare metal stents (p=0.03) in patients with cancer. 30-day mortality and MACE were both similar between the groups (OR=1.1, p=0.75), but the risk for 1-year all-cause mortality was significantly higher in the cancer group after multivariate (HR 4.74, p=0.001) and propensity score analysis.

Conclusion: Patients with cancer and acute myocardial infarction have a more complicated clinical presentation, yet their short-term prognosis is similar to non-cancer patients. However, their one-year outcome is worse.

Osnat Itzhaki