Chest Pain in Cancer Patients: Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac
Paolo Bima1,2,3, Pedro Lopez-Ayala1,2, Luca Koechlin1,2,4
1Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
Patients with cancer presenting with chest pain have a higher prevalence of acute myocardial infarction (AMI). Diagnostic tools show reduced accuracy and efficacy in this population, impacting emergency department stays and hospitalizations.
Area of Science:
- Cardiology
- Oncology
- Emergency Medicine
Background:
- Limited understanding of cancer patients with acute chest discomfort in emergency departments (ED).
- Cancer patients often have higher cardiovascular risk factors and pre-existing cardiac disease.
Purpose of the Study:
- Assess acute myocardial infarction (AMI) prevalence in cancer patients with chest pain.
- Evaluate outcomes and diagnostic tool utility in this specific population.
- Validate findings in an independent cohort.
Main Methods:
- Prospective international multicenter diagnostic study with central adjudication.
- External validation in an independent multicenter cohort.
- Assessment of cancer status and details.
Main Results:
- 8.6% of patients had cancer, with higher AMI prevalence (26.8% vs 21.1%).
- Cancer patients experienced longer ED stays and higher hospitalization rates.
- High-sensitivity troponin T (hs-cTnT) showed lower diagnostic accuracy for non-ST-segment elevation myocardial infarction; European Society of Cardiology algorithms had reduced efficacy.
Conclusions:
- Cancer patients have a substantially higher prevalence of AMI as a cause of chest pain.
- ED length of stay and hospitalization rates are increased in cancer patients.
- Diagnostic performance of hs-cTnT and efficacy of ESC algorithms are reduced in cancer patients.
Background:
Little is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED).
Objectives:
The aim of this study was to assess the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population.
Methods:
Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort.
Results:
Among 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer [26.8%] vs 1,561 of 7,407 without cancer [21.1%]; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non-ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 [95% CI: 0.86-0.92] vs 0.94 [95% CI: 0.93-0.94] [P < 0.001]; for hs-cTnI, area under the curve: 0.93 [95% CI: 0.91-0.95] vs 0.95 [95% CI: 0.94-0.95] [P = 0.10]). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort.
Conclusions:
Patients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
More Related Videos
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Angina III: Clinical Manifestations and Assessment
01:30Acute Coronary Syndrome I: Introduction
01:19Pericarditis II: Clinical Features and Diagnostic Tests
01:27Myocarditis II: Clinical Features and Diagnostic Tests