Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study

Abstract

AIMS: To assess processes of care and clinical outcomes in cancer patients with ST elevation myocardial infarction (STEMI) according to cancer type. METHODS: This is a national population-based study of patients admitted with STEMI in England and Wales between January 2005 and March 2019. Data was obtained from the National Heart attack MINAP registry and HES registry. RESULTS: We identified 353 448 STEMI indexed admissions between 2005 and 2019. Of those, 8581(2.4%) had active cancer. Prostate cancer (29% of STEMI patients with cancer) was the most common cancer followed by hematologic malignancies (14%) and lung cancer (13%). Cancer patients were less likely to receive invasive coronary revascularization (60.0%, vs. 71.6% p < 0.001) and had higher in-hospital death (OR 1.39, 95% CI 1.25-1.54) and bleeding (OR 1.23, 95% CI 1.03-1.46). Cancer patients had higher mortality at 30 days (HR 2.39, 95% CI 2.19-2.62) and 1 year (HR 3.73, 95% CI 3.58-3.89). lung cancer was the cancer associated with highest risk of death in hospital (OR 1.75, 95% CI 1.39-2.22) and at one year (OR 8.08, 95% CI 7.44-8.78). Colon cancer (OR 1.98, 95% CI 1.24-3.14) was the main cancer associated with major bleeding. All common cancer types were associated with higher mortality at 1 year. Cardiovascular death (62%) was the main cause of death in the first 30 days while cancer (52%) was the main cause of death within one year. CONCLUSION: STEMI patients with cancer have higher risk of short- and long-term mortality, particularly lung cancer. Colon cancer is the main cancer associated with major bleeding. Cardiovascular disease was the main cause of death in the first month whereas cancer was the main cause of death within one year.