Treatment Effect of Primary Percutaneous Coronary Intervention on In-Hospital Outcomes of Active Cancer Patients Presenting With ST-Elevation Myocardial Infarction

Abstract

Background Primary percutaneous coronary intervention (pPCI) is the optimal strategy for coronary revascularization in patients presenting with ST-segment elevation myocardial infarction (STEMI). However, there are limited data on the utility of pPCI for STEMI in patients with active cancer, both in terms of treatment rates and efficacy, compared with those without cancer. Methods All STEMI hospitalizations between 2004 and 2015 from the National Inpatient Sample were retrospectively analyzed and stratified by the presence or absence of prevalent current cancer types. We compared the rates of pPCI within each study group as well as the average treatment effect (ATE) of pPCI on in-hospital outcomes. Results Of 1,870,815 STEMI patients, 38,932 (2.1%) had a prevalent current cancer diagnosis (hematologic: 11,251 [28.9% of all cancers], breast: 4,675 [12.0%], lung: 9,538 [24.5%], colon: 3,749 [9.6%], and prostate: 9,719 [25.0%]). Patients with current cancer were less likely to receive pPCI than those without cancer (from 54.2% for lung cancer to 70.6% for hematologic vs 82.3% for no cancer), and those who underwent pPCI in the cancer groups were younger, less comorbid, and more critically unwell. The ATE of pPCI was strongly protective for major adverse cardiovascular and cerebral events (MACCEs) and mortality, with lower adjusted probabilities of MACCEs and all-cause mortality, in the cancer groups as the no cancer group, without an increase in probabilities of major bleeding or acute stroke in any of the study groups, except in colon cancer patients who had a higher risk of stroke. (Full coefficients to be presented in meeting due to limit on word count.) Conclusion pPCI is underused in STEMI patients with current cancer despite its significant reduction of in-hospital all-cause mortality and MACCEs that is comparable with patients without cancer. pPCI was not associated with an increase in the risk of in-hospital major bleeding or acute stroke, although further work is required to assess the long-term benefit and safety of pPCI in this high-risk group.