Cancer patients have increased risk of STEMI-associated mortality

Cancer, especially lung cancer, increases the risk of short- and long-term death in ST elevation myocardial infarction (STEMI) patients, says an article published in European Heart Journal - Quality of Care and Clinical Outcomes.

Mohamed Dafaalla and colleagues conducted this study to evaluate clinical outcomes and care processes in cancer individuals with ST elevation myocardial infarction relative to cancer type.

The patients hospitalized with STEMI in the UK during January 2005 and March 2019 are the subject of this population-based study on a nationwide scale. Data were gathered from the Hospital Episode Statistics registry and the National Heart Attack Myocardial Infarction National Audit Project (MINAP) registry. Researchers found 353 448 STEMI-indexed admissions between 2005 and 2019 in this investigation. 8581 (2.4%) of them had cancer that was active. The most frequent malignancy was lung cancer (13%), followed by haematologic malignancies (14%) and prostate cancer (29% of STEMI patients with cancer).

The key findings of this study were:

Cancer patients had lower rates of invasive coronary revascularization (60.0% vs. 71.6%, P 0.001) and higher rates of in-hospital mortality (1.39 OR, 95% CI 1.25-1.54), as well as bleeding (1.23 OR, 95% CI 1.03-1.46). 

After 30 days (HR 2.39, 95% CI 2.19-2.62), and at 1 year (HR 3.73, 95% CI 3.58-3.89), cancer patients had increased mortality rates. 

The malignancy with the greatest risk of mortality during hospitalization (OR 1.75, 95% CI 1.39-2.22) and at one year (OR 8.08, 95% CI 7.44-8.78) was lung cancer. 

The most common malignancy linked to significant bleeding was colon cancer (OR 1.98, 95% CI 1.24-3.14). All prevalent cancer types were linked to greater 1-year fatality rates.

Cardiovascular disease (62%) and cancer (52%) were the two leading causes of mortality within the first 30 days, respectively.

In conclusion, the principal malignancy linked to significant bleeding is colon cancer. The leading cause of death in the first month was cardiovascular disease, whereas the leading cause in the next 12 months was cancer.

Reference: 

Dafaalla, M., Abdel-Qadir, H., Gale, C. P., Sun, L., López-Fernández, T., Miller, R. J. H., Wojakowski, W., Nolan, J., Rashid, M., & Mamas, M. A. (2023). Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study. In European Heart Journal - Quality of Care and Clinical Outcomes. Oxford University Press (OUP). https://doi.org/10.1093/ehjqcco/qcad012