Treatment of patients with myocardial infarction depends on history of cancer

Abstract

Although cancer treatment considerably affects cardiovascular health, little is known about how cancer patients are treated for an acute myocardial infarction. We aimed to investigate whether acute myocardial infarction patients with a history of cancer received the same guideline recommended treatment as those acute myocardial infarction patients without and whether they differ with respect to inhospital outcome. All patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, enrolled between 2002 and mid-2015 in the acute myocardial infarction in Switzerland (AMIS Plus) registry with comorbidity data based on the Charlson comorbidity index were analysed. Patients were classified as having cancer if one of the cancer diseases of the Charlson comorbidity index was indicated. Immediate treatment strategies and inhospital outcomes were compared between groups using propensity score matching. Of 35,249 patients, 1981 (5.6%) had a history of cancer. After propensity score matching for age, gender, Killip class >2, ST-segment elevation myocardial infarction and renal disease (1981 patients per group), significant differences were no longer found for a history of acute myocardial infarction, hypertension, diabetes, heart failure and cerebrovascular disease between cancer and non-cancer patients. However, cancer patients underwent percutaneous coronary intervention less frequently (odds ratio (OR) 0.76; 95% confidence interval (CI) 0.67-0.88) and received P2Y12 blockers (OR 0.82; 95% CI 0.71-0.94) and statins (OR 0.87; 95% CI 0.76-0.99) less frequently. Inhospital mortality was significantly higher in cancer patients (10.7% vs. 7.6%, OR 1.45; 95% CI 1.17-1.81). However, the main cause of death was cardiac in both groups ( P=0.06). Acute myocardial infarction patients with a history of cancer were less likely to receive guideline recommended treatment and had worse inhospital outcomes than non-cancer patients.