Cancer history influences treatment of myocardial infarction


Dragana Radovanovic (AMIS Plus Data Centre, Zurich, Switzerland) and colleagues report in the European Heart Journal: Acute Cardiovascular Care that the treatment of myocardial infarction depends on a patient’s history of cancer.

In a review of more than 35,000 myocardial infarction patients, Radovanovic et al found that those with a history of cancer were less likely to receive recommended drugs and interventions, and more likely to die in hospital than those without such a hisory.

The aim of the study was to investigate whether acute myocardial infarction patients with a history of cancer received the same guideline recommended treatment and had the same in-hospital outcomes as those without cancer. The study included 35, 249 patients enrolled in the acute myocardial infarction in Switzerland (AMIS Plus) registry between 2002 and mid-2015. Of these, 1, 981 (5.6%) had a history of cancer. Propensity score matching was used to create two groups (with 1, 981 patients in each)—one with cancer history and one without—that were matched for age, gender, and cardiovascular risk factors.

The authors compared the proportions of patients in each group who received specific immediate drug therapies for acute myocardial infarction and those who underwent percutaneous coronary intervention (PCI). They also compared the rates of in-hospital complications and death between the two groups.

Cancer patients underwent PCI less frequently (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.67–0.88) and received P2Y12 blockers (OR, 0.82; 95% CI 0.71–0.94) and statins (OR, 0.87; 95% CI, 0.76–0.99) less frequently than those without a history of cancer. In-hospital mortality was significantly higher in patients with cancer than those without (10.7% versus 7.6%; OR, 1.45; 95% CI, 1.17–1.81). Furthermore, patients with a history of cancer were more likely to have complications while in hospital. They had 44% higher odds of cardiogenic shock, 47% higher chance of bleeding

Radovanovic comments: “Patients with a history of cancer were less likely to receive evidence-based treatments for myocardial infarction. They were 24% less likely to undergo PCI, 18% less likely to receive P2Y12 antagonists and 13% less likely to receive statins. They had also more complications and were 45% more likely to die while in hospital. More research is needed to find out why cancer patients receive suboptimal treatment for myocardial infarction and have poorer outcomes.”

She adds that the possible reasons for the differences observed between those with cancer history and those without “could be the type and stage of cancer, or severe comorbidities” and notes “some cancer patients may have a very limited life expectancy and refuse treatment for myocardial infarction”.