Noncardiac mortality risk higher after PCI in patients with STEMI, cancer
In a contemporary registry of patients who underwent PCI for STEMI, one in 10 had a history of cancer, and those with cancer had elevated risk for noncardiac mortality but not cardiac mortality, according to new findings.
“We’ve watched cancer survivorship increase over the past 2 ½ decades, which is wonderful, but it has led to new challenges, such as handling of downstream illnesses and side effects to an extent never encountered before,” Joerg Herrmann, MD, interventional cardiologist at Mayo Clinic, said in a press release. “In particular, as cardiologists, we wanted to know if cancer and its therapies left these patients debilitated from a [CVD] standpoint.”
Herrmann and colleagues conducted a retrospective cohort study of 2,346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 2000 to October 2010. Of those, 11.1% had a history of cancer.
The researchers compared 261 patients with cancer with 1,313 patients without cancer, matched for age, sex, family history of CAD and date of STEMI.
Outcomes of interest were cardiac death, noncardiac death and hospitalization for HF. Median follow-up was 6.2 years.
In-hospital noncardiac mortality was higher in those with cancer than those without (1.9% vs. 0.4%; P = .03), but in-hospital cardiac mortality was similar between the groups (cancer, 5.8%; no cancer, 4.6%; P = .37), Herrmann and colleagues found.
Those who were diagnosed with cancer within 6 months before STEMI were at highest risk for acute mortality (HR = 7; 95% CI, 1.4-34.4), according to the researchers. Herrmann said in the press release that the reasons have not been determined.
At 5 years, cardiac mortality was similar between the groups (cancer, 4.2%; noncancer, 5.8%; HR = 1.27; 95% CI, 0.77-2.1), but hospitalization for HF was higher in those with cancer (15% vs. 10%; HR = 1.72; 95% CI, 1.18-2.5).
Noncardiac mortality at 5 years was three times higher in those with a history of cancer (30% vs. 11%; HR = 3.01; 95% CI, 2.33-3.88), and the difference was exclusively attributable to cancer-related deaths, the researchers wrote.
“This study supports the importance of cardiologists and oncologists working together to care for these patients,” Herrmann said in the release. “Clearly, our goal is that the cancer patients of today do not become the cardiac patients of the future and, if they do, that we comprehensively see them through.”
Three important messages
In a related editorial, Sadeer G. Al-Kindi, MD, and Guilherme H. Oliveira, MD, from the Onco-Cardiology Program, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, wrote that the findings convey three important messages.
“First, it confirms there is a high prevalence of cancer among patients with STEMIs,” they wrote. “Second, it illustrates that despite being sicker than patients without cancer, those with cancer who undergo [PCI] for STEMIs have similar [CV] outcomes. Lastly, it suggests that because of higher short- and long-term cancer-related mortality, bare-metal intracoronary stents may be preferable to drug-eluting stents for this population ... because of the expectant need for cancer-directed surgery. Taken together, the findings ... validate the importance of onco-cardiology as a discipline within biomedical science.” – by Erik Swain
Disclosure: The researchers, Al-Kindi and Oliveira report no relevant financial disclosures.