Acute coronary syndromes in patients with active hematologic malignancies – Incidence, management, and outcomes

Jae Yoon Park, Wei Guo, Mohammed Al-Hijji, Abdallah El Sabbagh, Kebede Begna, Thomas Matthew Habermann, Thomas Elmer Witzig, Bradley R. Lewis, Amir Lerman, Joerg Herrmann

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Hematologic Neoplasms
Acute Coronary Syndrome
Incidence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Troponin
Mortality
Angiotensin Receptor Antagonists
Unstable Angina
Percutaneous Coronary Intervention
Coronary Angiography
Angiotensin-Converting Enzyme Inhibitors
Developed Countries
Anticoagulants
Aspirin
Registries
Cause of Death
Lymphoma
Leukemia
Cohort Studies
Cardiovascular Diseases

Keywords

  • Acute coronary syndrome
  • Hematologic malignancy
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{82185374ab8846bdbac1361f6f7cea4b,
title = "Acute coronary syndromes in patients with active hematologic malignancies – Incidence, management, and outcomes",
abstract = "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.",
keywords = "Acute coronary syndrome, Hematologic malignancy, Prognosis",
author = "Park, {Jae Yoon} and Wei Guo and Mohammed Al-Hijji and {El Sabbagh}, Abdallah and Kebede Begna and Habermann, {Thomas Matthew} and Witzig, {Thomas Elmer} and Lewis, {Bradley R.} and Amir Lerman and Joerg Herrmann",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2018.10.008",
language = "English (US)",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Acute coronary syndromes in patients with active hematologic malignancies – Incidence, management, and outcomes

AU - Park, Jae Yoon

AU - Guo, Wei

AU - Al-Hijji, Mohammed

AU - El Sabbagh, Abdallah

AU - Begna, Kebede

AU - Habermann, Thomas Matthew

AU - Witzig, Thomas Elmer

AU - Lewis, Bradley R.

AU - Lerman, Amir

AU - Herrmann, Joerg

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Acute coronary syndrome

KW - Hematologic malignancy

KW - Prognosis

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U2 - 10.1016/j.ijcard.2018.10.008

DO - 10.1016/j.ijcard.2018.10.008

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