Treatment and outcomes of acute coronary syndrome in the cancer population Full Text
Yusuf SW et al. – In this study of cancer patients with myocardial infarction, medical therapy with aspirin and (beta)–blockers was associated with improved survival.Methods
- After approval by the institutional review board, the authors retrospectively reviewed all patients with a discharge diagnosis of acute MI who were admitted to the University of Texas MD Anderson Cancer Center between December 2000 and October 2006 and evaluated the association between cardiac treatments with survival outcomes.
- A total of 456 patients with a discharge diagnosis of acute MI were identified and included in the study, of which 386 had non–ST–segment elevation MI (NSTEMI) and 70 had ST–segment elevation MI (STEMI).
- Compared with patients with NSTEMI, patients who had STEMI were more often prescribed aspirin (66% vs 43%; P = 0.004), β–blockers (61% vs 46%; P = 0.018), and thrombolytic therapy (9% vs 0.3%; P = 0.0001).
- Compared with patients with NSTEMI, patients who had STEMI were more often prescribed aspirin (66% vs 43%; P = 0.004), Β–blockers (61% vs 46%; P = 0.018), and thrombolytic therapy (9% vs 0.3%; P = 0.0001).
- In the multivariable analysis, aspirin use was associated with a 23% decreased risk of death (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.60–0.98, P = 0.033) and β–blocker use was associated with a 36% decreased risk of death (HR: 0.64, 95% CI: 0.51–0.81, P = 0.0002).
- Statins (HR: 0.82, P = 0.18) and catheter–based revascularization (HR: 0.57, P = 0.09) did not have an impact on the risk of death.
- Compared with patients with limited cancer, advanced cancer patients were twice as likely to die (HR: 2.12, 95 CI: 1.47–3.04, P < 0.0001).
- Previous chemotherapy (P = 0.005) and chest radiotherapy (P = 0.017) were associated with increased 1–year mortality, whereas hyperlipidemia (P = 0.018) was protective.