Department of Cardiology, Houston Methodist Hospital, Houston, TX, United States.
Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California.
Am J Cardiol. 2022 Mar 1;166:25-37. doi: 10.1016/j.amjcard.2021.11.015. Epub 2021 Dec 20.
There are limited data on readmission with ischemic and major bleeding events in patients with acute myocardial infarction (AMI) with active cancer. The purpose of our study was to evaluate in-hospital characteristics and 30-day readmission rates for recurrent AMI and major bleeding by cancer type in patients with AMI and active cancer. From 2016 through 2018, patients in the Nationwide Readmission Database admitted with AMI and underlying active colon, lung, breast, prostate, and hematological cancers were included. Thirty-day readmission for recurrent AMI and major bleeding were reported. Of 1,524,677 index hospitalizations for AMI, 35,790 patients (2.2%) had cancer (0.9% hematological; 0.5% lung; 0.4% prostate; 0.2% breast; and 0.1% colon). Compared with patients without cancer, patients with cancer were about 6 to 10 years older and had a higher proportion of atrial fibrillation, valvular heart disease, previous stroke, and a greater co-morbidity burden. Of all cancer types, only active breast cancer (adjusted odds ratios 1.82, 95% CI 1.11 to 2.98) was found to be significantly associated with elevated odds of readmission for major bleeding; no such association was observed for recurrent AMI. In conclusion, AMI in patients with breast cancer is associated with significantly greater odds of readmission for major bleeding within 30 days after discharge. Management of patients with concomitant AMI and cancer is challenging but should be based on a multidisciplinary approach and estimation of an individual patient's risk of major coronary thrombotic and bleeding events.
在患有急性心肌梗死（AMI）且合并活动性癌症的患者中，关于缺血性和主要出血事件再入院的数据有限。我们的研究目的是评估 AMI 合并活动性癌症患者中，按癌症类型分类的因复发性 AMI 和主要出血而再次入院的住院特征和 30 天再入院率。2016 年至 2018 年，纳入 Nationwide Readmission Database 中因 AMI 住院且患有合并活动性结肠、肺、乳腺、前列腺和血液恶性肿瘤的患者。报告了 30 天因复发性 AMI 和主要出血的再入院率。在 1,524,677 例 AMI 指数住院中，35,790 例（2.2%）患有癌症（0.9%血液恶性肿瘤；0.5%肺癌；0.4%前列腺癌；0.2%乳腺癌；0.1%结肠癌）。与无癌症的患者相比，患有癌症的患者年龄大 6 至 10 岁，心房颤动、心脏瓣膜病、既往中风和合并症负担的比例更高。在所有癌症类型中，只有活动性乳腺癌（调整后的优势比 1.82，95%置信区间 1.11 至 2.98）与因主要出血再入院的风险增加显著相关；复发性 AMI 则无此相关性。总之，患有乳腺癌的 AMI 患者在出院后 30 天内因主要出血再入院的风险显著增加。合并 AMI 和癌症的患者的管理具有挑战性，但应基于多学科方法，并评估个体患者发生主要冠状动脉血栓和出血事件的风险。
