Acute coronary syndromes in patients with active hematologic malignancies - Incidence, management, and outcomes
Jae Yoon Park1, Wei Guo2, Mohammed Al-Hijji1
1Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.
Insights
Acute coronary syndromes (ACS) are uncommon in patients with active hematologic malignancies but often undertreated. Management frequently deviates from guidelines, impacting patient outcomes.
Area of Science:
- Cardiology
- Hematology
- Oncology
Background:
- Cancer and cardiovascular diseases are leading causes of death.
- Managing life-threatening presentations of both diseases is challenging.
- This study focuses on acute coronary syndromes (ACS) in patients with active hematological malignancies.
Purpose of the Study:
- To determine the incidence of ACS in patients with active hematologic malignancies.
- To analyze the management strategies for ACS in this patient population.
- To evaluate the outcomes, including mortality, of ACS in patients with active hematologic malignancies.
Main Methods:
- Retrospective registry-based cohort study.
- Included adults with active leukemia or lymphoma hospitalized between 2004-2014.
- Diagnosis of myocardial infarction (MI) or unstable angina (UA) based on established criteria.
Main Results:
- 1.4% of patients with active hematologic malignancies were diagnosed with ACS.
- Management often lacked guideline adherence, particularly regarding antiplatelet, anticoagulant, and statin therapy.
- In-hospital and 1-year mortality rates were high (21.9% and 58.9%, respectively).
Conclusions:
- ACS is infrequent but serious in patients with active hematologic malignancies.
- Current management strategies for ACS in this population often do not align with established guidelines.
- Optimizing ACS care in hematologic malignancy patients is crucial for improving survival.
Background:
Cancer and cardiovascular diseases are the two leading causes of death in industrialized countries. Optimal management of life-threatening presentations of both of their diseases can pose significant challenges. The current study aimed to address the incidence, management, and outcome of acute coronary syndromes (ACS) in patients with active hematological malignancies.
Methods:
This retrospective registry-based cohort study included adults with active leukemia or lymphoma who were hospitalized at Mayo Clinic Rochester from 01/01/2004 to 12/31/2014. The diagnosis of ST-segment elevation MI (STEMI) or non-ST-segment elevation MI (NSTEMI) was made based on the 3rd Universal Definition for MI, or of unstable angina (UA) in the absence of cardiac troponin elevation. Main outcome measures included all-cause, cardiac, and non-cardiac death in-hospital and at one year.
Results:
Of 5300 adult patients with active hematological malignancies, 73 (1.4%) were diagnosed with an ACS (78.1% NSTEMI and 13.7% STEMI). 17.5% and 40% of NSTEMI and STEMI patients underwent coronary angiography, with percutaneous coronary intervention in 5.3% and 30%, respectively. While >80% of patients received β-blocker therapy, only half of all and <50% of patients managed "medically" received antiplatelet, anticoagulant, and/or statin therapy. The in-hospital and 1-year mortality was 21.9% and 58.9%, respectively, of which 25% and 15% were cardiac in etiology. Aspirin, beta-blocker, statins, and angiotensin-converting enzyme inhibitor/angiotensin-II receptor blocker were associated with better mortality outcomes.
Conclusions:
In a large, contemporary study of adults with active hematologic malignancies, ACS was uncommon, but commonly managed not in keeping with societal guideline recommendations.
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