Association of myocardial injury with adverse long-term survival among cancer patients.

Bashar, Hussein; Kobo, Ofer; Curzen, Nick; Mamas, Mamas A

Abstract

Over time, cardiovascular disease (CVD) deaths increasingly exceed those from malignancy among cancer survivors. However, the association of myocardial injury with long-term survival (beyond three years) in cancer patients has not been previously described. The National Health and Nutrition Examination Survey high-sensitivity cardiac troponin (hs-cTn) and morbidities databases (1999-2004) were linked with the latest mortality dataset isolating records were respondents reported cancer diagnosis by a healthcare professional. Myocardial injury was then determined by elevated hs-cTn. 16,225,560 weighted records (1,058 unweighted) were included in this observational study, with myocardial injury identified in 14·2%. Those with myocardial injury had progressively worse survival at 5 (51·6% vs. 89·5%), 10 (28·3% vs. 76·0%), and 15 years (12·6% vs. 61·4%) compared to those without myocardial injury. After adjusting for baseline characteristics, those with myocardial injury had an adjusted hazard ratio (aHR) of 2·10 (95% CI 2·09-2·10, p<0·001) for all-cause mortality, 2·23 (2·22-2·24, p<0·001) for cardiovascular mortality, and 1·59 (95% CI 1·59-1·60, p<0·001) for cancer mortality compared to those without myocardial injury. Among patients with no pre-existing CVD, the hs-cTn I Ortho assay was a strong independent predictor of all cause (aHR 6·29, 95% CI 6·25-6·33, p<0·001), CVD (aHR 11·38, 95% CI 11·23-11·54, p<0·001), and cancer (aHR 5·02, 95% CI 4·96-5·07, p<0·001) mortality. As a marker for myocardial injury, hs-cTn/s were independently associated with worse long-term survival among cancer patients with a stronger relationship with all-cause, cardiovascular, and cancer mortality using hs-cTn I ortho assay. [Abstract copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.]

Citation

Bashar, H., Kobo, O., Curzen, N., & Mamas, M. A. (in press). Association of myocardial injury with adverse long-term survival among cancer patients. European Journal of Preventive Cardiology, Article zwae116. https://doi.org/10.1093/eurjpc/zwae116

• Journal Article Type: Article
• Acceptance Date: Mar 19, 2024
• Online Publication Date: Mar 21, 2024
• Deposit Date: Apr 8, 2024
• Journal: European journal of preventive cardiology
• Print ISSN: 2047-4873
• Electronic ISSN: 2047-4881
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Article Number: zwae116
• DOI: https://doi.org/10.1093/eurjpc/zwae116
• Keywords: long-term, Troponin, cardiac biomarkers, all-cause mortality, myocardial damage, myocardial injury