Key result
Cancer was not associated with a difference in in-hospital death (OR 1.00, 95% CI 0.88-1.13) compared to no cancer among patients with AMI-CS managed with tMCS, but was associated with an increased risk of major bleeding.
Why the study?
Patients with cancer are at high risk of AMI and cardiogenic shock, but outcomes of those managed with tMCS have not been rigorously studied.
Does active cancer affect in-hospital mortality or bleeding risks in adult patients with AMI-CS managed with temporary mechanical circulatory support?
Cohort (n=42,034)
Does active cancer affect in-hospital mortality or bleeding risks in adult patients with AMI-CS managed with temporary mechanical circulatory support?
In patients presenting with AMI-associated cardiogenic shock, concurrent cancer does not negatively impact in-hospital survival when managed with temporary mechanical circulatory support, although bleeding precautions are warranted.
Bleeding vigilance may be prudent in cancer patients with AMI-CS on tMCS; this cohort study leaves open causal effects and longer-term outcomes.
Background: Cardiogenic shock (CS) is the leading cause of death among patients with acute myocardial infarction (AMI) and is managed with temporary mechanical circulatory support (tMCS) in advanced cases. Patients with cancer are at high risk of AMI and CS. However, outcomes of patients with cancer and AMI-CS managed with tMCS have not been rigorously studied. Methods: Adult patients with AMI-CS managed with tMCS from 2006 to 2018 with and without cancer were identified using the National Inpatient Sample. Propensity score matching (PSM) was performed for variables associated with cancer. Primary outcome was in-hospital death, and secondary outcomes were major bleeding and thrombotic complications. After PSM, there was no difference in in-hospital death (odds ratio [OR], 1.00; 95% CI, 0.88-1.13) or thrombotic complications (OR, 1.10; 95% CI, 0.91-1.34) between patients with and without cancer. Patients with cancer had a higher risk of major bleeding (OR, 1.29; 95% CI, 1.15-1.46). Conclusions: Among patients with AMI-CS managed with tMCS, cancer is becoming increasingly frequent and associated with increased risk of major bleeding, although there was no difference in in-hospital death. Further studies are needed to further characterize outcomes, and inclusion of patients with cancer in trials of tMCS is needed.
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Leiva et al. (2023) conducted a cohort in Acute myocardial infarction-associated cardiogenic shock (AMI-CS) managed with temporary mechanical circulatory support (n=42,034). Cancer vs. No cancer was evaluated on In-hospital death (OR 1.00, 95% CI 0.88-1.13). Cancer was not associated with a difference in in-hospital death (OR 1.00, 95% CI 0.88-1.13) compared to no cancer among patients with AMI-CS managed with tMCS, but was associated with an increased risk of major bleeding.
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