Abstract 13119: Recent Malignancy Predicts Early and Late Cardiac Mortality in Patients with ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

Abstract

Background: Although coronary artery disease and cancer are the most common causes of death in the Western world, little is known about the influence of malignancy on myocardial infarction.

Objectives: To evaluate cardiac mortality after primary percutaneous coronary intervention (PCI) for STEMI in patients with a history of malignancy.

Methods: A multicenter registry of patients treated with primary PCI for STEMI in 3 Dutch hospitals. Non-melanoma skin cancer did not count as malignancy. Vital status was obtained through municipality records and cause of death through chart review or contact with general practitioners. Cox regression was used to adjust for confounders, incorporating univariable predictors of cardiac mortality.

Results: In total, 210 patients had a history of malignancy (42% <3 years ago, 17% 3-5 years ago and 39% >5 years ago) and 3213 patients did not. Breast/female genital organs (20%), digestive- (19%) and urinary organs (17%) were common locations of malignancy. Patients with history of malignancy were older (69.6 vs. 62.8 years, p<0.01), less often male (67.6% vs. 75.5%, p=0.01), more often had renal insufficiency (8.2% vs. 3.4%, p<0.01) , previous MI (17.3% vs. 10.4%, p=0.02) and peripheral vascular disease (8.7% vs. 4.5%, p=0.01). TIMI flow ≥2 post-procedure was less common in the malignancy group (95.2% vs. 98.0%, p=0.01). Malignancy patients showed higher cardiac mortality (7 day: 9.5% vs. 3.1%, p=<0.001, 1 year: 11.0% vs. 5.3%, p=0.001). Cox analysis showed that active malignancy in the last 5 years predicted 7 day cardiac mortality (HR 2.87, 95% CI 1.59-5.18, p<0.001). Moreover, malignancy <3 years ago predicted both 7 day (HR 3.3, 95% CI 1.74-6.20, p<0.001) and 1 year cardiac mortality (HR 2.02, 95% CI 1.11-3.67, p=0.022) after adjustment for clinical and angiographic confounders.

Conclusions: In STEMI patients, active malignancy in the previous 5 years predicted early cardiac death after primary PCI. Furthermore, malignancy activity in the previous 3 years predicted both early and 1 year cardiac death. One possible explanation is a hypercoagulable state in malignancy patients. Additional research is needed to clarify the mechanism and optimal therapeutic approach.