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Left ventricular systolic dysfunction after ST-segment elevation myocardial infarction: long-term cancer incidence and mortality
Session:
Posters (Sessão 1 - Écran 2) - Cardio-oncologia
Speaker:
David Sá Couto
Congress:
CPC 2023
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
David Sá Couto; André Alexandre; Andreia Campinas; André Frias; André Luz; Raquel Santos; Bruno Brochado; João Silveira; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><u>Background</u>: </span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">Myocardial infarction and heart failure have been linked to an excess risk of cancer, especialy for patients with moderate-to-severe left ventricular systolic dysfunction (MSLVSD). </span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">We aimed to study if MSLVSD after ST-segment elevation myocardial infarction (STEMI) was associated with a higher incidence of cancer and cancer-related mortality on a long-term follow-up of STEMI survivors.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><u>Methods</u>: </span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">A consecutive series of patients admitted with STEMI from 2008 until 2013, <span style="color:black">who were discharged alive, </span>was followed for 8 years. MSLVSD was defined by a left ventricular ejection fraction (LVEF) < 40%. Patients were grouped according to their LVEF at discharge: < 40% (MSLVSD group) vs ≥ 40%. The primary endpoints were cancer diagnosis and cancer-related death. Secondary endpoints included all-cause and cardiovascular (CV) death.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><u>Results</u>: </span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">From a total of 584 cases, 529 were considered for the analysis, excluding missing cases and in-hospital deaths. 391 (73.9%) were males, mean age was 62.2 years and mean follow-up time was 6.54 (+/- 2.68) years. 180 (34%) patients had MSLVSD. At end follow-up, cancer was diagnosed in 43 (8,1%) patients, 40% of gastrointestinal origin. Cancer incidence was approximately 1250/100000people.year, with 21% of the diagnosis occurring in the first year. Overall, 52 (10.7%) patients died, 23 (44%) from CV causes, 10 (19%) from cancer. There were no significant differences in the incidence of cancer (hazard ratio (HR) 0.83; 95%CI [0.42 – 1.61]; p=0.568) or cancer-related mortality (HR 2.20; 95%CI [0.64 – 7.59]; p=0.219) between the groups. There was a higher risk of all-cause (HR 2.72; 95%CI [1.57 – 4.70]; p<0.001) and CV death (HR 2.59; 95%CI [1.12 – 6.00]; p=0.027) in the MSLVSD group.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><u>Conclusions</u>:</span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"> </span></span></span><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000">MSLVSD post-STEMI was related to a higher mortality rate but not to increased cancer incidence or cancer-related death. However, cancer incidence appears to be higher than in the general population, which might be explained by shared risk factors with ischemic heart disease and increased surveillance of post-infarct patients. It is plausible that the detection rate of gastrointestinal cancer might be a reflection of exposure to potent antithrombotic drugs during the first year.</span></span></span></p>
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