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Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies-A Real-World Analysis
Stefan A Lange1, Christoph Schliemann2, Christiane Engelbertz1
1Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, D-48149 Muenster, Germany.
Insights
Patients with hematologic malignancies (HM) and acute coronary syndrome (ACS) have lower long-term survival. This may be due to less frequent percutaneous coronary intervention (PCI) because of bleeding concerns.
Area of Science:
- Cardiology
- Oncology
- Health Services Research
Background:
- The interplay between coronary heart disease (CHD) and cancer, particularly hematologic malignancies (HM), is not well understood.
- Understanding HM's impact on acute coronary syndrome (ACS) prognosis is crucial.
Purpose of the Study:
- To investigate how hematologic malignancies (HM) influence the prognosis of patients with acute coronary syndrome (ACS).
- To analyze short- and long-term survival and major adverse cardiac events (MACE) in ACS patients with and without HM.
Main Methods:
- Analysis of German health insurance data (AOK) for patients hospitalized with ACS between 2010-2018.
- Patients with ACS were matched by age, sex, and comorbidities to assess survival and MACE.
- Comparison of procedural rates (coronary angiography, PCI) and bleeding events between groups.
Main Results:
- 0.5% of 439,716 ACS patients had an HM; myelodysplastic/myeloproliferative disorders, lymphocytic leukemias, and multiple myeloma were most common.
- HM patients were older, had more comorbidities, and less often STEMI compared to non-HM ACS patients.
- HM patients underwent less frequent coronary angiography and PCI, with no significant increase in bleeding events, but had reduced long-term survival after risk adjustment.
Conclusions:
- Survival for patients with both ACS and HM is significantly lower.
- Reduced long-term survival in HM patients with ACS may stem from avoiding PCI due to perceived bleeding risks.
- Short-term survival did not differ significantly, especially in STEMI patients.
Background:
The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood.
Objective:
The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE).
Results:
Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients' risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001.
Conclusion:
Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.
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