Analysis of outcomes of percutaneous coronary intervention in metastatic cancer patients with acute coronary syndrome over a 10-year period.

Abstract

Early medical palliative care has been shown to improve overall survival of patients with metastatic cancer, but the role of cardiac surgical interventions in such patients is not clear. The limited life expectancy of these patients often poses a dilemma to clinicians and involves a detailed analysis of the risks and benefits of such interventions. This study examines the outcomes of percutaneous coronary intervention (PCI) in patients with metastatic cancer. The National Inpatient Database of USA was used to identify patients aged ≥ 1 8 years who had a diagnosis of metastatic cancer and acute coronary syndrome (ACS) between 2000 and 2009 using ICD-9-CM codes. These were categorized into ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). The utilization of PCI was also identified using ICD-9-CM codes. The outcomes studied were in-hospital mortality, length of hospital stay and discharge disposition. The association between various outcomes and use of cardiac catheterization was assessed using multivariate regression models. There were 49,515 patients with metastatic disease who were discharged with a diagnosis of ACS. Of these, 15,964 had STEMI and 33,551 had NSTEMI. 3981 patients (24.9%) with STEMI and 3209 patients (9.6%) with NSTEMI received percutaneous coronary intervention. Caucasian male patients under age 65 years were more likely to receive PCI in the setting of an ACS. The hospital characteristics associated with higher use of PCI included academic affiliation, large bedsize, private for-profit hospitals and Midwestern and Western regions of USA. The adjusted odds of receiving PCI in this group of patient have gradually increased by 1.14 every year in last decade (95% CI 1.11-1.16). The beneficial effect of PCI on in-hospital mortality has declined in NSTEMI such that by 2009, there was no significant difference between patients who received PCI and those who did not receive PCI. This has remained unchanged for STEMI patients.C ONCLUSIONS: In metastatic cancer patients with ACS, the rate of PCI has increased over the last decade. In the current era, metastatic cancer patients with NSTEMI may perform equally well without PCI in terms of in-hospital mortality. The decision to provide such care may be considered on an individual basis based on the extent of their medical comorbidity and tumor burden.