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Impact of cancer history on non-ST-segment elevation myocardial infarction (NSTEMI) prognosis – a propensity-score matching (PSM) analysis
Session:
Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker:
Carla Oliveira Ferreira
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Carla Oliveira Ferreira; Maria Manuela Gomes; Fernando Mané; Rodrigo Silva; Inês Macedo Conde; Ana Sofia Fernandes; Mónica Dias; Filipe Silva Vilela; Carlos Galvão Braga; Cátia Costa Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Introduction:</span></u><span style="color:black"> The impact of cancer on patients’ prognosis after NSTEMI is controversial. The incidence of acute coronary syndrome is higher in patients with cancer, however the current evidence on treatment and prognosis is scarce.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Aims</span></u><span style="color:black">: To describe NSTEMI patients according to history of cancer, and to assess whether it is an independent predictor of mortality.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Methods</span></u><span style="color:black">: It was conducted a </span>retrospective, observational and analytical longitudinal study with a<span style="color:black">ll patients admitted for NTSEMI between 2011 and June 2020 at a Portuguese intensive coronary care unit. Data on cancer, comorbidities, management, and 1-year outcomes were collected from hospital records.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Results</span></u><span style="color:black">: Among 3011 patients, 234 (7.77%) had a documented history of cancer. They were older (71.5±9.7vs.64.4±12.5; p<.001) and showed greater comorbidity with diabetes (41.5%vs.33.3%; p=.015), hypertension (73.1%vs.66.4%; p=.044), stroke (12.0%vs.6.1%; p=.001), previous bypass (9.0%vs.5.1%; p=.019) and chronic kidney disease (12.4%vs5.2%; p<.001). Pain (89.3%vs.93.4%; p=.028) and Killip class I (79.9%vs.86.6%; p=.006) were less frequent at admission. Higher GRACE (145.5±35.5vs.129.9±36.4; p<.001) and CRUSADE (35.2±17vs.28.2±17.1; p=018) scores, lower hemoglobin (13.1±1.9vs.13.9±1.7; p<.001), and higher creatinine levels (1.1[0.9-1.4] vs.0.9[0.8-1.1]; p<.001) were also observed. Multivessel disease was more common in the cancer group (52.6%vs.45.6%; p=.047), but the use of percutaneous coronary intervention (43.2%vs.50.5%; p=.038), stents (0.45±0.59vs.0.56±0.64; p=.005), and drug-eluting stents (40.6%vs.49.0%; p=.016) was lower, as was aspirin (87.2%vs.93.4%; p=.001) and statin (91.9%vs.95.4%; p=.027) prescription at discharge. Cancer patients showed higher rates of 1-year all-cause (15.0%vs.7.2%; p<.001), cardiovascular (CV) (9.0%vs.5.6%; p=.042), and non-CV mortality (6.0%vs.1.5%; p<.001). In multivariate analysis, cancer history increased the risk of 1-year non-CV death by almost three-fold (HR=2.87[1.42-5.81]; p=.003), but not all-cause or CV mortality. Consistent results were found after PSM for baseline characteristics and in-hospital management.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Conclusion</span></u><span style="color:black">: Cancer patients had worse prognosis after NSTEMI, with most deaths being of CV origin; however, history of cancer did not independently predict 1-year all-cause or CV mortality. Therefore, an individualized cardio-oncologist approach may improve their short-term CV-outcome.</span></span></span></p>
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