Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality After Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

Feilong Wang, Rajiv Gulati, Ryan J. Lennon, Bradley R. Lewis, Jae Park, Gurpreet S Sandhu, R. Scott Wright, Amir Lerman, Joerg Herrmann

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Patients and Methods In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1%) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. Results Patients with cancer had higher in-hospital noncardiac (1.9% vs 0.4%; P=.03) but similar cardiac (5.8% vs 4.6%; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95% CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2% vs 5.8%; HR=1.27; 95% CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15% vs 10%; HR=1.72; 95% CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0% vs 11.0%; HR=3.01; 95% CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. Conclusion One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.

Original languageEnglish (US)
Pages (from-to)1680-1692
Number of pages13
JournalMayo Clinic Proceedings
Volume91
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Percutaneous Coronary Intervention
Mortality
Neoplasms
Registries
Hospitalization
Heart Failure
ST Elevation Myocardial Infarction
Coronary Artery Disease
Cohort Studies
Retrospective Studies
Guidelines

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{585340373cef4db1b2dcc9585fa3940c,
title = "Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality After Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction",
abstract = "Objective To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Patients and Methods In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1{\%}) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. Results Patients with cancer had higher in-hospital noncardiac (1.9{\%} vs 0.4{\%}; P=.03) but similar cardiac (5.8{\%} vs 4.6{\%}; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95{\%} CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2{\%} vs 5.8{\%}; HR=1.27; 95{\%} CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15{\%} vs 10{\%}; HR=1.72; 95{\%} CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0{\%} vs 11.0{\%}; HR=3.01; 95{\%} CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. Conclusion One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.",
author = "Feilong Wang and Rajiv Gulati and Lennon, {Ryan J.} and Lewis, {Bradley R.} and Jae Park and Sandhu, {Gurpreet S} and Wright, {R. Scott} and Amir Lerman and Joerg Herrmann",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.mayocp.2016.06.029",
language = "English (US)",
volume = "91",
pages = "1680--1692",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "12",

}

TY - JOUR

T1 - Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality After Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

AU - Wang, Feilong

AU - Gulati, Rajiv

AU - Lennon, Ryan J.

AU - Lewis, Bradley R.

AU - Park, Jae

AU - Sandhu, Gurpreet S

AU - Wright, R. Scott

AU - Lerman, Amir

AU - Herrmann, Joerg

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Objective To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Patients and Methods In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1%) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. Results Patients with cancer had higher in-hospital noncardiac (1.9% vs 0.4%; P=.03) but similar cardiac (5.8% vs 4.6%; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95% CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2% vs 5.8%; HR=1.27; 95% CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15% vs 10%; HR=1.72; 95% CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0% vs 11.0%; HR=3.01; 95% CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. Conclusion One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.

AB - Objective To define the effect of a history of cancer on in-hospital and long-term mortality after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Patients and Methods In this retrospective cohort study of 2346 patients with STEMI enrolled in the Mayo Clinic PCI registry from November 1, 2000, through October 31, 2010, we identified 261 patients (11.1%) with a history of cancer. The in-hospital and long-term outcomes (median follow-up, 6.2 years; interquartile range=4.3-8.5 years), including cardiac and noncardiac death and heart failure hospitalization, of these patients were compared with those of 1313 cancer-negative patients matched on age, sex, family history of coronary artery disease, and date of STEMI. Results Patients with cancer had higher in-hospital noncardiac (1.9% vs 0.4%; P=.03) but similar cardiac (5.8% vs 4.6%; P=.37) mortality as matched controls. The group at highest acute mortality risk were those diagnosed as having cancer within 6 months before STEMI (hazard ratio [HR]=7.0; 95% CI, 1.4-34.4; P=.02). At 5 years, patients with cancer had similar cardiac mortality (4.2% vs 5.8%; HR=1.27; 95% CI, 0.77-2.10; P=.35) despite more heart failure hospitalizations (15% vs 10%; HR=1.72; 95% CI, 1.18-2.50; P=.01) but faced higher noncardiac mortality (30.0% vs 11.0%; HR=3.01; 95% CI, 2.33-3.88; P<.001) than controls, attributable solely to cancer-related deaths. Conclusion One in 10 patients in this contemporary registry of patients undergoing primary PCI for STEMI has a history of cancer. These patients have more than a 3 times higher acute in-hospital and long-term noncardiac mortality risk but no increased acute or long-term cardiac mortality risk with guideline-recommended cardiac care.

UR - http://www.scopus.com/inward/record.url?scp=85002725790&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85002725790&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2016.06.029

DO - 10.1016/j.mayocp.2016.06.029

M3 - Article

C2 - 27916154

AN - SCOPUS:85002725790

VL - 91

SP - 1680

EP - 1692

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 12

ER -