Leiva Orly, Cheng Richard K, Pauwaa Sunil, Katz Jason N, Alvarez-Cardona Jose, Bernard Samuel, Alviar Carlos, Yang Eric H
Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
Division of Cardiology, University of Washington, Seattle, Washington.
J Soc Cardiovasc Angiogr Interv. 2023 Nov 13;3(3Part A):101208. doi: 10.1016/j.jscai.2023.101208. eCollection 2024 Mar.
Cardiogenic shock (CS) is the leading cause of death among patients with acute myocardial infarction (AMI) and is managed with temporary mechanical circulatory support (tMCS) in advanced cases. Patients with cancer are at high risk of AMI and CS. However, outcomes of patients with cancer and AMI-CS managed with tMCS have not been rigorously studied.
Adult patients with AMI-CS managed with tMCS from 2006 to 2018 with and without cancer were identified using the National Inpatient Sample. Propensity score matching (PSM) was performed for variables associated with cancer. Primary outcome was in-hospital death, and secondary outcomes were major bleeding and thrombotic complications.
After PSM, 1287 patients with cancer were matched with 12,870 patients without cancer. There was an increasing temporal trend for prevalence of cancer among patients admitted with AMI-CS managed with tMCS ( < .001). After PSM, there was no difference in in-hospital death (odds ratio [OR], 1.00; 95% CI, 0.88-1.13) or thrombotic complications (OR, 1.10; 95% CI, 0.91-1.34) between patients with and without cancer. Patients with cancer had a higher risk of major bleeding (OR, 1.29; 95% CI, 1.15-1.46).
Among patients with AMI-CS managed with tMCS, cancer is becoming increasingly frequent and associated with increased risk of major bleeding, although there was no difference in in-hospital death. Further studies are needed to further characterize outcomes, and inclusion of patients with cancer in trials of tMCS is needed.
心源性休克（CS）是急性心肌梗死（AMI）患者死亡的主要原因，在晚期病例中采用临时机械循环支持（tMCS）进行治疗。癌症患者发生AMI和CS的风险较高。然而，采用tMCS治疗的癌症合并AMI-CS患者的预后尚未得到严格研究。
利用全国住院患者样本确定2006年至2018年接受tMCS治疗的患有和未患有癌症的成人AMI-CS患者。对与癌症相关的变量进行倾向评分匹配（PSM）。主要结局是住院死亡，次要结局是大出血和血栓形成并发症。
PSM后，1287例癌症患者与12870例非癌症患者相匹配。在接受tMCS治疗的AMI-CS患者中，癌症患病率呈上升趋势（P<0.001）。PSM后，癌症患者和非癌症患者在住院死亡（优势比[OR]，1.00；95%CI，0.88-1.13）或血栓形成并发症（OR，1.10；95%CI，0.91-1.34）方面没有差异。癌症患者发生大出血的风险更高（OR，1.29；95%CI，1.15-1.46）。
在接受tMCS治疗的AMI-CS患者中，癌症越来越常见，且与大出血风险增加相关，尽管住院死亡没有差异。需要进一步研究以进一步明确结局，并且需要将癌症患者纳入tMCS试验。
