Management Strategies and Clinical Outcomes of Acute Myocardial Infarction in Leukemia Patients: Insights from Nationwide United States Hospitalizations.

Abstract

BACKGROUND: Patients with leukemia are at increased risk of cardiovascular events. There are limited outcomes data for patients with a history of leukemia who present with an acute myocardial infarction (AMI). METHODS: We queried the Nationwide Inpatient Sample (2004-2014) for patients with a primary discharge diagnosis of AMI, and a concomitant diagnosis of leukemia, and further stratified according to the subtype of leukemia. Multivariable logistic regression was conducted to identify the association between leukemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. RESULTS: Out of 6,750,878 AMI admissions, a total of 21,694 patients had a leukemia diagnosis. The leukemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukemia was independently associated with increased odds of MACCE (OR 1.26[1.20,1.31]) and mortality (OR 1.43[1.37,1.50]) without an increased risk of bleeding (OR 0.86[0.81,0.92]). Acute myeloid leukemia (AML) was associated with approximately three-fold risk of MACCE (OR 2.81[2.51, 3.13]) and a four-fold risk of mortality (OR 3.75[3.34, 4.22]). Patients with leukemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukemia. CONCLUSION: Patients with leukemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukemia. A multi-disciplinary approach between cardiologists and hematology oncologists may improve the outcomes of patients with leukemia after AMI.