Emergency Medicine Unit - Department of Clinical, Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Cancer. 2021 Jun 15;127(12):2122-2129. doi: 10.1002/cncr.33470. Epub 2021 Feb 25.
The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, as is the performance of the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA DS -VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores.
This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all-cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types.
Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow-up of 2.0 years, cancer increased all-cause mortality (hazard ratio [HR], 2.00; 95% confidence interval [CI], 1.99-2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26-1.28) and ICH (HR, 1.07; 95% CI, 1.05-1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS-BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA DS -VASc score's predictivity was slightly lower in AF patients with cancer.
Cancer increased all-cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk.
在临床实践中，患有心房颤动 (AF) 和癌症的患者数量正在迅速增加。癌症对该患者人群临床结局的影响尚不清楚，HAS-BLED（高血压、异常肾功能/肝功能、卒中、出血史或倾向、不稳定的 INR、老年人、药物/酒精）和 CHA2DS2-VASc（充血性心力衰竭、高血压、年龄≥75 岁、糖尿病、卒中或短暂性脑缺血发作、血管疾病、年龄 65 岁至 74 岁、性别）评分的表现也不清楚。
这是一项观察性、回顾性队列研究，纳入了 2435541 例因 AF 住院的成年人。作者根据癌症的存在和癌症类型调查了全因和心血管死亡率、缺血性卒中和大出血以及颅内出血 (ICH) 的发生率 (IR)。
总体而言，399344 例（16.4%）患有癌症，最常见的癌症为转移性癌症、前列腺癌、结直肠癌、肺癌、乳腺癌和膀胱癌。在平均 2.0 年的随访期间，癌症增加了全因死亡率（风险比 [HR]，2.00；95%置信区间 [CI]，1.99-2.01）。与非癌症患者（2.4%/年）相比，胰腺癌（2.8%/年）、子宫癌（2.6%/年）和乳腺癌（2.6%/年）的缺血性卒发生率较高，而肝癌/肺癌（1.9%/年）和白血病/骨髓瘤（2.0%/年）的发生率较低。癌症增加了大出血（HR，1.27；95% CI，1.26-1.28）和 ICH（HR，1.07；95% CI，1.05-1.10）的风险。白血病、肝癌、骨髓瘤和转移性癌症的大出血/ICH 发生率最高。随着 HAS-BLED 评分的增加，大出血和 ICH 发生率逐渐增加，该评分对所有癌症类型的 C 指数均>0.70，具有较好的预测性。在患有癌症的 AF 患者中，CHA2DS2-VASc 评分的预测能力略低。
癌症增加了 AF 患者的全因死亡率、大出血和 ICH 风险。癌症与缺血性卒中之间的关联在不同癌症类型之间存在差异，在某些类型中，出血风险似乎超过了血栓栓塞风险。
