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Characteristics and outcomes of patients with cancer presenting with acute myocardial infarction

Itzhaki Ben Zadok, Osnata,b; Hasdai, Davida,b; Gottlieb, Shmueld,e; Porter, Avitala,b; Beigel, Royb,f; Shimony, Avig,h,✠; Cohen, Tali; Shlomo, Niri; Shohat, Tamyj; Silverman, Barbaraj; Kornowski, Rana,b; Iakobishvili, Zazab,c

doi: 10.1097/MCA.0000000000000733
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Background Limited data are available regarding the optimal management of patients with cancer in the acute myocardial infarction (AMI) setting.

Patients and methods We studied consecutive patients with AMI included in a national registry (years 2010, 2016) with the diagnosis of past or active malignancy and followed them for 1 year.

Results Our cohort consisted of 2937 cancer-naive patients and 152 patients with cancer, of whom 35% presented with active malignancies. Compared with cancer-naive patients, patients with cancer were older, with female predominance, and presented more often with a history of hypertension and chronic kidney disease (P<0.001 for all comparisons). The rate of ST-elevation AMI was comparable (P=0.067). GRACE score more than 140 was more common in the cancer group (P<0.001). Most patients with cancer were referred to coronary angiography, though less than cancer-naive patients (87 vs. 93%; P=0.004). The rate of percutaneous coronary intervention was similar (P=0.265). Propensity score matching demonstrated similar rates of in-hospital complications between groups, and no mortality or major cardiac adverse event differences were noted at 30 days. Moreover, short-term mortality was similar between patients with active versus past malignancies, and between patients with solid and nonsolid tumors. However, cancer in patients with AMI was found to predict an increased mortality risk at 1 year by multivariable analysis (hazard ratio=2.52; P<0.001).

Conclusion Patients with cancer and AMI have a more complicated clinical presentation, yet their short-term prognosis is similar to cancer-naive patients. Nevertheless, 1-year outcome is worse.

aDepartment of Cardiology, Rabin Medical Center, Petah Tikva

bSackler Faculty of Medicine, Tel Aviv University

cTel-Aviv-Jaffa District, Clalit Health Services, Tel-Aviv

dDepartment of Cardiology, Shaare Zedek Medical Center

eFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem

fDepartment of Cardiology, Sheba Medical Center, Ramat Gan

gDepartment of Cardiology, Soroka University Medical Center

hFaculty of Medicine, Ben Gurion University of the Negev, Beersheba

iIsraeli Center of Cardiovascular Research

jIsrael Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel

✠ Deceased.

Correspondence to Osnat Itzhaki Ben Zadok, MD, MSc, Cardiology Department, Rabin Medical Center, 39 Jabotinsky St., 49100 Petah Tikva, Israel Tel: +972 3937 7111; fax: +972 3921 3221; e-mail: osnat.itzhaki@gmail.com

Received October 7, 2018

Received in revised form January 18, 2019

Accepted February 18, 2019

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