Abstract 12866: Risk Factors For Major Adverse Cardiovascular Events Post-Acute Coronary Syndrome Hospitalization in Patients With Myeloproliferative Neoplasms

Abstract

Introduction: Myeloproliferative neoplasms (MPNs) are clonal stem cell neoplasms associated with increased thrombotic risk. However, long-term outcomes after acute coronary syndrome (ACS) and identification of MPN-specific risk factors have not been characterized. Methods: Single-center, retrospective cohort of patients with MPN admitted for ACS from 2000 to 2020 (n = 41). Primary outcomes were major adverse cardiac events (MACE) and bleeding. MACE was composite of cardiovascular (CV) death, myocardial infarction, ischemic stroke, and heart failure (HF) hospitalization. Patients with and without MACE and bleeding were compared to identify risk factors; univariable and multivariable Cox proportional hazards and competing-risk regression models were used. Results: Patient characteristics described in Table 1. After a median follow-up of 80 months, 28 patients had MACE and 14 experienced bleeding. Patients with MACE had shorter median time to index ACS event (35 mos vs 76) and higher rates of JAK2 mutation (82% vs 54%), history of HF (46% vs 15%), and median white blood cell count (WBC, 13 vs 8) at index event compared with patients without MACE. Patients with bleeding had higher rates of JAK2 mutation (93% vs 63%) and WBC (17 vs 10), and lower hydroxyurea use (50% vs 85%) compared with patients without bleeding. Cox and competing-risk regression results in Table 2. Conclusions: Patients with MPN and ACS are at high risk of MACE and bleeding. JAK2 mutation and elevated WBC count (≥ 20 K/μL) at time of index ACS were associated with MACE and bleeding. ACS event occurring within 12 months of MPN diagnosis was associated with MACE. Larger studies are needed to confirm our results.