急性冠状动脉综合征合并血液系统恶性肿瘤患者的生存情况——一项真实世界分析

Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies-A Real-World Analysis.

作者信息

Lange Stefan A, Schliemann Christoph, Engelbertz Christiane, Feld Jannik, Makowski Lena, Gerß Joachim, Dröge Patrik, Ruhnke Thomas, Günster Christian, Reinecke Holger, Köppe Jeanette

机构信息

Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany.

Department of Medicine A, University Hospital Muenster, D-48149 Muenster, Germany.

出版信息

Cancers (Basel). 2023 Oct 12;15(20):4966. doi: 10.3390/cancers15204966.

DOI:10.3390/cancers15204966

PMID:37894332

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10605274/

Abstract

BACKGROUND

The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood.

OBJECTIVE

The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE).

RESULTS

Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased ( = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * < 0.001.

CONCLUSION

Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.

摘要

背景

冠心病（CHD）与癌症，尤其是血液系统恶性肿瘤（HM）并存的影响仍知之甚少。

目的

本分析旨在阐明HM如何影响急性冠脉综合征（ACS）的预后。我们分析了2010年1月至2018年12月期间因ACS住院的患者的德国健康保险数据，这些患者来自11个地区的地方健康保险机构（AOK），并按年龄、性别和所有合并症进行匹配，以分析短期和长期生存情况以及主要不良心脏事件（MACE）。

结果

在439,716例ACS患者中，2104例（0.5%）同时患有HM。骨髓增生异常/骨髓增殖性疾病（27.7%）、淋巴细胞白血病（24.8%）和多发性骨髓瘤（22.4%）最为常见。这些患者年龄约大6岁（78岁对72岁*）。他们发生ST段抬高型心肌梗死（STEMI，18.2%对34.9%）的频率较低，而非STEMI（NSTEMI，81.8%对65.1%）的频率较高。除血脂异常外，这些患者有更多的合并心血管疾病和既往心血管疾病，且纽约心脏协会（NYHA）分级更差。他们接受冠状动脉造影（65.3%对71.6%）和经皮冠状动脉介入治疗（PCI，44.3%对52.0%）的可能性较小，尽管出血事件的数量没有显著增加（P = 0.22）。在对患者的风险特征进行调整后，HM与长期生存率降低相关。然而，短期生存情况并非如此。在STEMI患者中，两者无差异，*P < 0.001。