CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.
BMC Cardiovasc Disord. 2020 Jan 30;20(1):38. doi: 10.1186/s12872-020-01352-0.
Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI.
We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI.
Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI.
Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.
患有癌症并因急性冠状动脉综合征（ACS）和/或经皮冠状动脉介入治疗（PCI）入院的患者代表了一个不断增长且高风险的人群。在这些患者中，并存癌症对死亡率的影响尚不清楚。我们旨在评估 ACS 和/或 PCI 患者中并存癌症对早期和晚期、全因和心脏死亡率的影响。
我们对比较 ACS 和/或 PCI 入院患者有无癌症史的结局的研究进行了系统评价和荟萃分析。
纳入了 6 项包括 294528 例 ACS 患者和 3 项包括 39973 例 PCI 患者的研究进行荟萃分析。患有癌症的患者住院期间全因死亡率（RR 1.74 [1.22; 2.47]）、心脏死亡率（RR 2.44 [1.73; 3.44]）和出血（RR 1.64 [1.35; 1.98]）以及 ACS 研究中的 1 年全因死亡率（RR 2.62 [1.2; 5.73]）和心脏死亡率（RR 1.89 [1.25; 2.86]）的发生率更高。在因 PCI 入院的癌症患者中，长期全因死亡率（RR 1.96 [1.52; 2.53]）但心脏死亡率无更高发生率。
癌症患者在 ACS 或 PCI 后的急性期和长期都属于高危人群。然而，死亡率风险的大小应因研究间的异质性而有所缓和。在临床实践中应促进此类患者的早期和长期最佳管理。
