Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, University of Maryland, Baltimore.
Tex Heart Inst J. 2022 Sep 1;49(5). doi: 10.14503/THIJ-21-7598.
There are limited data on the outcomes of acute myocardial infarction-cardiogenic shock (AMI-CS) in patients with concomitant cancer.
A retrospective cohort of adult AMI-CS admissions was identified from the National Inpatient Sample (2000-2017) and stratified by active cancer, historical cancer, and no cancer. Outcomes of interest included in-hospital mortality, use of coronary angiography, use of percutaneous coronary intervention, do-not-resuscitate status, palliative care use, hospitalization costs, and hospital length of stay.
Of the 557,974 AMI-CS admissions during this 18-year period, active and historical cancers were noted in 14,826 (2.6%) and 27,073 (4.8%), respectively. From 2000 to 2017, there was a decline in active cancers (adjusted odds ratio, 0.70 [95% CI, 0.63-0.79]; P < .001) and an increase in historical cancer (adjusted odds ratio, 2.06 [95% CI, 1.89-2.25]; P < .001). Compared with patients with no cancer, patients with active and historical cancer received less-frequent coronary angiography (57%, 67%, and 70%, respectively) and percutaneous coronary intervention (40%, 47%, and 49%%, respectively) and had higher do-not-resuscitate status (13%, 15%, 7%%, respectively) and palliative care use (12%, 10%, 6%%, respectively) (P < .001). Compared with those without cancer, higher in-hospital mortality was found in admissions with active cancer (45.9% vs 37.0%; adjusted odds ratio, 1.29 [95% CI, 1.24-1.34]; P < .001) but not historical cancer (40.1% vs 37.0%; adjusted odds ratio, 1.01 [95% CI, 0.98-1.04]; P = .39). AMI-CS admissions with cancer had a shorter hospitalization duration and lower costs (all P < .001).
Concomitant cancer was associated with less use of guideline-directed procedures. Active, but not historical, cancer was associated with higher mortality in patients with AMI-CS.
目前关于同时患有癌症的急性心肌梗死合并心原性休克（AMI-CS）患者的结局数据有限。
从国家住院患者样本（2000-2017 年）中确定了急性心肌梗死合并心原性休克住院患者的回顾性队列，并按活动性癌症、既往癌症和无癌症进行分层。研究的主要结局包括院内死亡率、冠状动脉造影、经皮冠状动脉介入治疗、不复苏状态、姑息治疗使用率、住院费用和住院时间。
在这 18 年期间，557974 例 AMI-CS 住院患者中，分别有 14826 例（2.6%）和 27073 例（4.8%）患有活动性癌症和既往癌症。从 2000 年到 2017 年，活动性癌症的比例下降（调整后比值比，0.70 [95%置信区间，0.63-0.79]；P <.001），而既往癌症的比例增加（调整后比值比，2.06 [95%置信区间，1.89-2.25]；P <.001）。与无癌症患者相比，患有活动性和既往癌症的患者接受冠状动脉造影（分别为 57%、67%和 70%）和经皮冠状动脉介入治疗（分别为 40%、47%和 49%）的频率较低，不复苏状态（分别为 13%、15%和 7%）和姑息治疗使用率（分别为 12%、10%和 6%）较高（P <.001）。与无癌症患者相比，患有活动性癌症的 AMI-CS 患者的院内死亡率更高（45.9% vs 37.0%；调整后比值比，1.29 [95%置信区间，1.24-1.34]；P <.001），但既往癌症患者的死亡率没有差异（40.1% vs 37.0%；调整后比值比，1.01 [95%置信区间，0.98-1.04]；P =.39）。患有癌症的 AMI-CS 患者的住院时间更短，住院费用更低（均 P <.001）。
同时患有癌症与指南推荐的治疗方法使用率降低有关。急性心肌梗死合并心原性休克患者中，活动性癌症而不是既往癌症与死亡率升高有关。
