2477 - Antecedent of cancer and mortality after the first ST segment elevation acute myocardial infarction treated with primary coronary angioplasty. A prospective cohort study

Background

ST-segment myocardial infarction (STEMI) and a history of cancer can coexist because both are highly incident and prevalent. We sought to investigate if a previous diagnosis of cancer influences the outcome of patients with STEMI treated with primary coronary angioplasty.

Methods

We included 917 patients in a prospective cohort observational study, 53 of them (5.8%) cancer survivors. The primary end-point was total mortality.

Results

Out of the 53 patients with history of cancer, all which have been included in the analysis, 12 (23.0%) were treated with chemotherapy, 38 (72.0%) with radiotherapy and 12 (23.0%) had surgical treatment. Cancer locations were: breast cancer in 10 patients (18.9%), gastrointestinal tract in 11 (20.8%), prostate in 10 (18.9%), urologic in 7 (13.2%), hematologic malignancies in 5 (9.4%), respiratory tract in 5 (9.4%) and other locations in 3 (5.7%). One hundred patients died during a median follow-up of 643 days (interquartile range 258 to 1015 days), 88 (10.2%) in patients without cancer and 12 (22.6%) in patients with cancer, being this difference significant (log-rank test=8.4, p = 0.004). Cancer patients were older: 73.4 (11.5) vs 65.2 (13.8) years (p < 0.001), with a lower prevalence of previous stroke: 1.1% vs 2.2%, p = 0.002. The hemoglobin concentration was also lower: 13.4 (2.1) vs 14.4 (1.7) g/L, p = 0.001. No significant differences were found in the data gleaned from the primary angioplasty, although a trend towards a lower use of coronary stents in cancer survivors was noted (p = 0.061). Cancer was associated with a high probability of death, HR = 2.37 (95% confidence interval 1.30 to 4.34), p = 0.005. When confounding variables were included in a multivariate Cox regression model, this association was no longer significant: HR = 1.63 (0.84-3.18), p = 0.150.

Conclusions

We failed to demonstrate a survival advantage of patients with ST-segment myocardial infarction treated with primary coronary angioplasty when patients did not have a previous cancer. The finding of a difference in crude mortality rate can be explained by the baseline differences between both groups.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.