Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium.
Division of Cardiology, Loma Linda University Health, California, USA.
Int J Cardiol. 2023 Oct 15;389:131154. doi: 10.1016/j.ijcard.2023.131154. Epub 2023 Jul 11.
This study aimed to investigate the prevalence, clinical characteristics and outcomes of type 2 myocardial infarction (T2AMI) in patients with versus without cancer.
All hospitalizations with a primary discharge diagnosis of T2AMI were stratified according to cancer status (secondary diagnosis of any-cancer vs cancer-free) using data from the US National Inpatient Sample (2016-2019). The primary outcome was in-hospital all-cause mortality while secondary outcomes were in-hospital major adverse cardiovascular and cerebrovascular events (MACCE).
Among 61,305 included hospitalizations with primary diagnosis of T2AMI, 3745 (6.1%) were associated with a diagnosis of cancer. Patients with T2AMI and cancer presented more frequently with acute respiratory failure (23.2% vs 18.1%), acute pulmonary embolism (3.7% v 1.3%), major bleeding (6.8% vs 4.1%) and renal failure (51.0% vs 46.8%), compared to patients without. On adjusted analysis, diagnosis of cancer was associated with lower odds of invasive coronary angiography (aOR 0.75, 95% CI 0.60 to 0.93, p = 0.009) but greater odds of mortality (aOR 1.95, 95% C.I. 1.26-2.99 p = 0.002). Among the different types of cancer, adjusted risk of all-cause mortality was higher in patients with colorectal (aOR 4.17 95% CI 1.68-10.32, p = 0.002), lung (aOR 3.63, 95% CI 1.83-7.18, p < 0.001) and haematologic (aOR 2.48, 95% CI 1.22-5.05, p = 0.001) cancer.
Patients with cancer presenting with T2AMI have lower odds of management with invasive diagnostic coronary angiography and have higher rates of in-hospital all-cause death. Further studies are warranted to improve overall care and outcomes of cancer patients and cardiovascular diseases.
本研究旨在调查伴有和不伴有癌症的 2 型心肌梗死（T2AMI）患者的患病率、临床特征和结局。
利用美国国家住院患者样本（2016-2019 年）的数据，根据癌症状态（任何癌症的次要诊断与无癌症）对所有主要诊断为 T2AMI 的住院患者进行分层。主要结局是住院全因死亡率，次要结局是住院期间主要不良心血管和脑血管事件（MACCE）。
在纳入的 61305 例主要诊断为 T2AMI 的住院患者中，有 3745 例（6.1%）与癌症诊断有关。与无癌症患者相比，T2AMI 合并癌症患者更常出现急性呼吸衰竭（23.2% vs 18.1%）、急性肺栓塞（3.7% vs 1.3%）、大出血（6.8% vs 4.1%）和肾功能衰竭（51.0% vs 46.8%）。在调整分析中，癌症诊断与接受侵入性冠状动脉造影的可能性降低相关（调整比值比 0.75，95%置信区间 0.60 至 0.93，p=0.009），但死亡风险更高（调整比值比 1.95，95%置信区间 1.26 至 2.99，p=0.002）。在不同类型的癌症中，结直肠癌（调整比值比 4.17，95%置信区间 1.68 至 10.32，p=0.002）、肺癌（调整比值比 3.63，95%置信区间 1.83 至 7.18，p<0.001）和血液系统癌症（调整比值比 2.48，95%置信区间 1.22 至 5.05，p=0.001）患者的全因死亡率调整风险更高。
患有 T2AMI 的癌症患者接受侵入性诊断性冠状动脉造影的可能性较低，住院全因死亡率较高。需要进一步研究以改善癌症患者和心血管疾病的整体护理和结局。
