Mohamed, MO ORCID: https://orcid.org/0000-0002-9678-5222, Van Spall, H, Kontopantelis, E, Alkhouli, M, Barac, A, Elgendy, I, Khan, SU, Kwok, CS ORCID: https://orcid.org/0000-0001-7047-1586, Shoaib, A, Bhatt, D and Mamas, M ORCID: https://orcid.org/0000-0001-9241-8890 (2021) Effect of primary percutaneous coronary intervention on in-hospital outcomes among active cancer patients presenting with ST-elevation myocardial infarction: a propensity score matching analysis. European Heart Journal: Acute Cardiovascular Care.

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STEMI PCI CANCER revision version.docx - Accepted Version
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Abstract

ims
Primary percutaneous coronary intervention (pPCI) is the gold standard, guideline-recommended revascularization strategy in patients presenting with ST-elevation myocardial infarction (STEMI). However, there are limited data on its use and effectiveness among patients with active cancer presenting with STEMI.

Methods and results
All STEMI hospitalizations between 2004 and 2015 from the National Inpatient Sample were retrospectively analysed, stratified by cancer type. Propensity score matching was performed to estimate the average treatment effect of pPCI in each cancer on in-hospital adverse events, including major adverse cardiovascular and cerebrovascular events (MACCE) and its individual components, and compare treatment effect between cancer and non-cancer patients. Out of 1 870 815 patients with STEMI, 38 932 (2.1%) had a current cancer diagnosis [haematological: 11 251 (28.9% of all cancers); breast: 4675 (12.0%); lung: 9538 (24.5%); colon: 3749 (9.6%); prostate: 9719 (25.0%)]. Patients with cancer received pPCI less commonly than those without cancer (from 54.2% for lung cancer to 70.6% for haematological vs. 82.3% in no cancer). Performance of pPCI was strongly associated with lower adjusted probabilities of MACCE and all-cause mortality in the cancer groups compared with the no cancer group. There was no significant difference in estimated average pPCI treatment effect between the cancer groups and non-cancer group.

Conclusion
Primary percutaneous coronary intervention is underutilized in STEMI patients with current cancer despite its significantly lower associated rates of in-hospital all-cause mortality and MACCE that is comparable to patients without cancer. Further work is required to assess the long-term benefit and safety of pPCI in this high-risk group.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Sage Publications at https://journals.sagepub.com/home/acc - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: percutaneous coronary intervention, cancer, heart failure
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC475 Therapeutics. Psychotherapy
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 10 Nov 2020 15:00
Last Modified: 16 Feb 2021 16:14
URI: https://eprints.keele.ac.uk/id/eprint/8878

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