Ischemic and bleeding risk after ST-elevation myocardial infarction in patients with active cancer; a nationwide study

Dafaalla, Mohamed; Costa, Francesco; Jia, Haibo; Wijeysundera, Harindra; Rashid, Muhammad; Graham, Michelle M; Wojakowski, Wojtek; Chieffo, Alaide; Mintz, Gary S; Mamas, Mamas A

Abstract

Background Treatment of patients with cancer presenting with ST-elevation myocardial infarction (STEMI) is complex given the increased risk of both thrombotic and major bleeding complications. Methods A nationally-linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project and the UK national Hospital Episode Statistics Admitted Patient Care registries. The primary outcomes were major bleeding and re-infarction at 1 year following admission with STEMI. Major bleeding was defined as bleeding events that require hospital admission. Re-infarction was defined as acute MI according to the 4th Universal Definition of Myocardial Infarction. Results A total of 322,776 STEMI indexed admissions were identified between Jan 2005 and March 2019. Of those, 7050 (2.2%) patients were diagnosed with active cancer. Cancer patients were older with more cardiovascular comorbidities. Cancer patients received invasive coronary angiography (62.2% vs 72.7%, p<0.001) and PCI (58.4% vs 69.5%, p<0.001) less often compared to patients without cancer and were less likely to be prescribed DAPT (85% vs 95.4%, p<0.001). The incidence of major bleeding (6.5% vs 3.5%, p <0.001) and re-infarction (cancer 5.7%, no cancer 5.1%, p = 0.01) were higher in cancer patients at one year. After adjustment for differences in baseline covariates, a similar risk of re-infarction (SHR 1.10, 95% CI 0.94-1.27) and a 50% increased risk of major bleeding (SHR 1.49, 95% CI 1.30-1.71) were observed in cancer patients. Conclusion Compared to non-cancer patients, cancer patients have a higher risk of major bleeding but not of re-infarction. Mitigating bleeding risk in STEMI patients with cancer is of paramount importance to improve outcomes.

Citation

Dafaalla, M., Costa, F., Jia, H., Wijeysundera, H., Rashid, M., Graham, M. M., Wojakowski, W., Chieffo, A., Mintz, G. S., & Mamas, M. A. (in press). Ischemic and bleeding risk after ST-elevation myocardial infarction in patients with active cancer; a nationwide study. European Heart Journal Open, Article oeaf012. https://doi.org/10.1093/ehjopen/oeaf012

• Journal Article Type: Article
• Acceptance Date: Feb 6, 2025
• Online Publication Date: Feb 12, 2025
• Deposit Date: Feb 27, 2025
• Journal: European Heart Journal Open
• Print ISSN: 2752-4191
• Electronic ISSN: 2752-4191
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: oeaf012
• DOI: https://doi.org/10.1093/ehjopen/oeaf012
• Keywords: bleeding, reinfarction, cancer, outcomes
• Public URL: https://keele-repository.worktribe.com/output/1078501