Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, UK.
Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Eur Heart J Acute Cardiovasc Care. 2021 Oct 27;10(8):829-839. doi: 10.1093/ehjacc/zuaa032.
Primary percutaneous coronary intervention (pPCI) is the gold standard, guideline-recommended revascularization strategy in patients presenting with ST-elevation myocardial infarction (STEMI). However, there are limited data on its use and effectiveness among patients with active cancer presenting with STEMI.
All STEMI hospitalizations between 2004 and 2015 from the National Inpatient Sample were retrospectively analysed, stratified by cancer type. Propensity score matching was performed to estimate the average treatment effect of pPCI in each cancer on in-hospital adverse events, including major adverse cardiovascular and cerebrovascular events (MACCE) and its individual components, and compare treatment effect between cancer and non-cancer patients. Out of 1 870 815 patients with STEMI, 38 932 (2.1%) had a current cancer diagnosis [haematological: 11 251 (28.9% of all cancers); breast: 4675 (12.0%); lung: 9538 (24.5%); colon: 3749 (9.6%); prostate: 9719 (25.0%)]. Patients with cancer received pPCI less commonly than those without cancer (from 54.2% for lung cancer to 70.6% for haematological vs. 82.3% in no cancer). Performance of pPCI was strongly associated with lower adjusted probabilities of MACCE and all-cause mortality in the cancer groups compared with the no cancer group. There was no significant difference in estimated average pPCI treatment effect between the cancer groups and non-cancer group.
Primary percutaneous coronary intervention is underutilized in STEMI patients with current cancer despite its significantly lower associated rates of in-hospital all-cause mortality and MACCE that is comparable to patients without cancer. Further work is required to assess the long-term benefit and safety of pPCI in this high-risk group.
经皮冠状动脉介入治疗（pPCI）是 ST 段抬高型心肌梗死（STEMI）患者的金标准，也是指南推荐的血运重建策略。然而，在患有 STEMI 并伴有活动性癌症的患者中，关于其使用和疗效的数据有限。
回顾性分析了 2004 年至 2015 年期间国家住院患者样本中所有 STEMI 住院患者，按癌症类型进行分层。采用倾向评分匹配来估计 pPCI 在每种癌症中的平均治疗效果，以评估住院期间的不良心血管和脑血管事件（MACCE）及其各个组成部分，以及比较癌症患者和非癌症患者之间的治疗效果。在 1870815 例 STEMI 患者中，有 38932 例（2.1%）有当前癌症诊断[血液系统：11251 例（所有癌症的 28.9%）；乳腺癌：4675 例（12.0%）；肺癌：9538 例（24.5%）；结肠癌：3749 例（9.6%）；前列腺癌：9719 例（25.0%）]。与非癌症患者相比，癌症患者接受 pPCI 的比例较低（从肺癌的 54.2%到血液系统的 70.6%，再到非癌症患者的 82.3%）。与非癌症组相比，癌症组的 pPCI 术后 MACCE 和全因死亡率调整后概率明显较低。癌症组和非癌症组之间估计的平均 pPCI 治疗效果没有显著差异。
尽管与非癌症患者相比，STEMI 合并当前癌症患者的住院全因死亡率和 MACCE 发生率明显较低，但 pPCI 的应用仍不足。需要进一步研究来评估该高危人群中 pPCI 的长期获益和安全性。
