P6499Cancer history is associated with delayed percutaneous coronary intervention and poorer angiographic results in patients with acute coronary syndrome

Abstract

Introduction: Demographic data shows that one in ten patients with myocardial infarction has a history of cancer. However, most of the trials in cardiovascular field exclude patients with oncologic comorbidities. The question whether concomitant cancer causes delay in treatment of acute coronary syndrome remains controversial. Moreover, it is not clear, whether angiographic results in cancer population are similar to the cancer‐naive group. No guidelines have been established to address specific challenges inherent in this conjunction of conditions. Consequently, practitioners worldwide are left to their own devices in determining the optimal course of treatment in such cases, which may result in substandard outcomes. Objective: To assess the influence of cancer history on percutaneous coronary intervention (PCI) delay and angiographic results in patients with myocardial infarction. Methods: The following is a retrospective, single‐center, cohort study of all 2643 patients hospitalized from January 2009, through December 2013 with STsegment elevation myocardial infarction (STEMI) and non‐ST‐segment elevation myocardial infarction (NSTEMI). Out of those, we identified 97 patients (3.7%) with a history of active cancer. Door‐to‐baloon (D2B) and results of PCI (using TIMI Grade Flow scoring system) in these patients were compared with those of 97 cancer‐negative patients matched for age, sex, type of myocardial infarction (STEMI vs. NSTEMI), and localization of the infarction (anterior wall STEMI vs. other wall STEMI). Results: Postmaching baseline characteristics were similar between the groups. Cancer group was referred to the catheterization laboratory later than the controls (door‐to‐baloon time shorter than 90 minutes, D2B<90; 68.4% vs. 81.3%; P=0.041) and less often received optimal revascularization (TIMI flow 2 or 3; 78.9% vs. 92.7%; P=0.006) than controls. Patients with cancer had similar events as matched controls: major bleeding (3.1% vs. 1%; P=0.31), thrombotic (6.2% vs. 4.1%; P=0.52) and intra‐hospital mortality (9.3% vs. 6.2%; P=0.42). Conclusion: Patients with active cancer received Percutaneous Coronary Intervention (PCI) later than cancer‐naive patients and had poorer angiographic results.