ST-Elevation Myocardial Infarction in Patients With Malignancies

Acute myocardial infarction (MI), the most severe complication of coronary artery disease, develops in 2-4% of patients with various malignancies.

Purpose: to explore the specific properties of ST-segment elevation myocardial infarction (STEMI) course in patients with cancer and its effect on short-term outcome.

Materials and methods. We included in this study 45 patients with STEMI and history of cancer hospitalized in the period from 01.01.2015 to 01.01.2017 (group I; 58% men, mean age 69.07±11.60 years). In the comparison group (group II) we selected 90 age and gender matched persons (58% men, mean age 68.16±11.75 years) from patients with STEMI without oncological diseases.

Results. There were no differences between groups in main risk factors of cardiovascular diseases, except greater proportion of patients with damage of peripheral arteries in group 1 (22.2% compared with 5.6% in group 2, p=0.025). There were also no differences between groups in clinical characteristics at admission. However values of the following parameters were significantly lower in group I: concentration of hemoglobin (115.56±23.07 vs. 133.70±16.45 g/l in group 2, р<0.001), red blood cell count (3.95±0.66x10¹²/l vs. 5.57±0.72x10¹²/l in group 2, р<0.001), platelets (93±0.97x10⁹/l vs 186±18.3x10⁹/l in group 2, p<0.001), total cholesterol (4.12±2.17 vs. 6.24±2.56 mmol/L in group 2, р<0.001). There were differences in the frequency of use of antiplatelet drugs: at prehospital stage acetylsalicylic acid was given to 48.9% and 77.8% of patients in groups 1 and 2, respectively (p=0.044); clopidogrel and ticagrelor were also significantly more rarely used in group 1. There was no difference in use of thrombolysis and percutaneous coronary interventions (4.4 and 53.3% vs 5.6 and 56.6% in groups 1 and 2, respectively). In group 2 greater portion of patients was given statins (68.9 vs. 77.8%, p=0.021) and angiotensin-converting enzyme inhibitors (55.6 vs. 82.2%, p=0.008). Inhospital mortality was the same in both groups (4.4%). Occurrence of complications (bleeding, pulmonary edema, cardiogenic shock), and frequency of use of intra-aortic balloon counterpulsation, temporary cardiac pacing were similar. However in group 1 greater portion of patients had ventricular tachyarrhythmias (15.6 vs 2.2% in group 2, р=0.007); the presence of cancer was the only independent predictor of their emergence in multiple logistic regression (OR 8.11 [1.11-40.83], p=0.011).

Conclusions. Rates of application of myocardial reperfusion in STEMI patients with and without history of cancer were the same. Despite similar hospital mortality revealed peculiarities of STEMI course could affect long-term outcomes. Confirmation of this hypothesis requires planned prospective studies.

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