Abstract 18547: Utilization of Percutaneous Coronary Intervention in Cancer Patients With Acute Coronary Syndrome - A Nationwide Analysis

Abstract

Background: Patients with active cancer represent an increasingly significant subset of patients presenting with acute coronary syndromes (ST elevation and Non ST elevation myocardial infarction). These patients are underrepresented in clinical trials. We sought to identify utilization of percutaneous coronary intervention (PCI) in patients with various cancers. Methods: We used the Nationwide inpatient sample to identify all patients that presented with STEMI and NSTEMI from the years 2002-2012. Patients with various cancers were identified with appropriate ICD-9 codes. Results: There were an estimated 3,120,957 STEMI admissions during the study period, of which 4.9% (140,008) had an associated cancer diagnosis. PCI was done in 48.3% of STEMI patients without cancer, but only in 32.9% of patients with cancer. We identified a total of 5,422,406 NSTEMI admissions during the same period. 5.6% (303,751) of NSTEMI patients had cancer. PCI utilization in NSTEMI patients without cancer was 27.8% and 19% in patients with cancer. Among individual cancers, patients with pancreatic, liver and gastric cancers had the lowest rates of PCI (table) Conclusion: Our study demonstrates significantly lower rates of PCI in patients with various cancers. Malignancies with a poor overall survival seem to be associated with lower PCI rates. With lack of clinical trial data on management of ACS in patients with various cancers and with improvements in cancer survivors overall, further studies are required to identify gaps in knowledge in appropriate selection of cancer patients for PCI.