Cancer tied to increased risk for acute MI, bleeding readmission after PCI
The odds of readmission for acute MI or major bleeding after PCI were greater among patients with cancer compared with those with no cancer, with the likelihood varying by cancer type and presence of metastasis, researchers reported.
“Our analysis of close to 2 million patients who underwent a PCI procedure shows that patients with active cancer are at increased risk of acute MI and major bleeding complications post-discharge, with an approximate two- and threefold increase at 90 days for readmission with acute MI or major bleeding, respectively,” Chun Shing Kwok, MBBS, clinical lecturer in cardiology at Keele University in Staffordshire, U.K., and colleagues wrote. “We show that the rates of acute MI readmissions within 90 days vary among cancer types and the presence of metastasis, with the highest rates observed for active lung cancer and colon cancer who had a twofold increase compared to patients without cancer.”
For the analysis published in the European Heart Journal, researchers utilized the U.S. Nationwide Readmission Database to determine the effect of cancer on 90-day readmissions for acute MI and bleeding after PCI. Neary 2 million participants were included in this analysis (2.7% with active cancer; 6.8% with history of cancer).
Overall, the rate of 90-day readmission was 5.8% for acute MI and 0.7% for major bleeding.
For patients with no cancer, the rates of 90-day readmission were 5.6% for acute MI and 0.6% for major bleeding.
For any cancer, the rate of readmission for acute MI was 9.1% and the rate of readmission for bleeding was 1.6%.
For each cancer type included in this analysis, researchers observed the following readmission rates:
- active prostate cancer, 7% for acute MI and 1.4% for bleeding;
- active breast cancer, 7.5% for acute MI and 0.6% for bleeding;
- active colon cancer, 10.8% for acute MI and 4.2% for bleeding; and
- active lung cancer, 12.1% for acute MI and 1.5% for bleeding.
Readmission for acute MI
For any cancer type, there were increases in acute MI readmission after PCI for active nonmetastatic cancer (OR = 1.28; 95% CI, 1.2-1.37; P < .001) and active metastatic cancer (OR = 1.63; 95% CI, 1.38-1.93; P < .001) compared with no cancer.
According to the study, for prostate cancer, only patients with active metastatic cancer experienced increased odds for acute MI readmission compared with those without cancer (OR = 1.69; 95% CI, 1.2-2.4; P = .003).
Active colon cancer (OR without metastasis = 1.71; 95% CI, 1.23-2.39; P = .002; OR with metastasis = 1.84; 95% CI, 1.17-2.88; P = .008) and active lung cancer (OR without metastasis = 1.55; 95% CI, 1.28-1.88; P < .001; OR with metastasis = 1.69; 95% CI, 1.22-2.34; P = .002) were associated with greater odds for acute MI readmission compared with no cancer.
Readmission for bleeding
For the outcome of bleeding, researchers found that any active cancer with or without metastatic disease was associated with increased likelihood for readmission (OR with metastasis = 1.82; 95% CI, 1.33-2.48; P < .001; OR without metastasis = 1.63; 95% CI, 1.41-1.9; P < .001), compared with no cancer, with the highest odds of readmission observed among patients with active colon cancer without metastasis (OR = 5.44; 95% CI, 3.29-8.99; P < .001).
“Our analysis suggests that the presence of metastases is also an important determinant of future acute MI and major bleeding risk, with the presence of metastases generally increasing the risk of adverse outcomes,” the researchers wrote. “Future attempts at personalization of antiplatelet regimens in this population of cancer patients should take into consideration both ischemic and major bleeding risk according to cancer type and the presence of metastasis and take into account the risk profile of different cancer types.”