Simone M Mrotzek1, Alessia Lena2,3,4,5, Sara Hadzibegovic2,3,4,5, Ria Ludwig1, Fadi Al-Rashid1, Amir A Mahabadi1, Raluca I Mincu1, Lars Michel1, Laura Johannsen1, Lena Hinrichs1, Martin Schuler6,7, Ulrich Keller8,9,10, Stefan D Anker2,4,5, Ulf Landmesser3,4,5, Tienush Rassaf1, Markus S Anker2,3,4,5, Matthias Totzeck11. 1. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. 2. Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany. 3. Department of Cardiology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany. 4. Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany. 5. DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany. 6. Department of Medical Oncology, Medical Faculty, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. 7. German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. 8. Department of Hematology, Oncology and Tumor Immunology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany. 9. German Cancer Consortium (DKTK), Partner Site, Berlin, Germany. 10. Max-Delbrück Center for Molecular Medicine, Berlin, Germany. 11. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany. Matthias.Totzeck@uk-essen.de.
Abstract
BACKGROUND: With improvement of cancer-specific survival, comorbidities and treatment-related side effects, particularly cardiovascular toxicities, need close attention. The aim of the present study was to evaluate clinical characteristics and outcomes of cancer patients requiring coronary angiography during inpatient care. METHODS: We performed a retrospective analysis of patients hospitalized between 02/2011 and 02/2018 in our two university hospital cancer centers. From a cohort of 60,676 cancer patients, we identified 153 patients (65.7 ± 11.6 years, 73.2% male), who underwent coronary angiography and were eligible for analysis. These were compared to a control group of 153 non-cancer patients pair-matched with respect to age, sex, and indication for catheterization. RESULTS: Cancer patients presented in 66% with an acute coronary syndrome (ACS). The most prevalent cancer entities were lymphoma (19%) and lung cancer (18.3%). The rate of primary percutaneous coronary interventions (PCI) was significantly lower in the cancer cohort (40.5% vs. 53.6%, p = 0.029), although manifestation of coronary artery disease (CAD) and PCI results were comparable (SYNergy between PCI with TAXus and cardiac surgery (SYNTAX)-score, delta pre- and post-PCI - 9.8 vs. - 8.0, p = 0.2). Mortality was remarkably high in cancer patients (1-year mortality 46% vs. 8% in non-cancer patients, p < 0.001), particularly with troponin-positive ACS (5-year mortality 71%). CONCLUSION: Strategies to effectively control cardiovascular risks in cancer patients are needed. Additionally, suspected CAD in cancer patients should not prevent prompt diagnostic clarification and optimal revascularization as PCI results in cancer patients are comparable to non-cancer patients and occurrence of troponin-positive ACS leads to a significantly increased risk of mortality.
BACKGROUND: With improvement of cancer-specific survival, comorbidities and treatment-related side effects, particularly cardiovascular toxicities, need close attention. The aim of the present study was to evaluate clinical characteristics and outcomes of cancerpatients requiring coronary angiography during inpatient care. METHODS: We performed a retrospective analysis of patients hospitalized between 02/2011 and 02/2018 in our two university hospital cancer centers. From a cohort of 60,676 cancerpatients, we identified 153 patients (65.7 ± 11.6 years, 73.2% male), who underwent coronary angiography and were eligible for analysis. These were compared to a control group of 153 non-cancerpatients pair-matched with respect to age, sex, and indication for catheterization. RESULTS:Cancerpatients presented in 66% with an acute coronary syndrome (ACS). The most prevalent cancer entities were lymphoma (19%) and lung cancer (18.3%). The rate of primary percutaneous coronary interventions (PCI) was significantly lower in the cancer cohort (40.5% vs. 53.6%, p = 0.029), although manifestation of coronary artery disease (CAD) and PCI results were comparable (SYNergy between PCI with TAXus and cardiac surgery (SYNTAX)-score, delta pre- and post-PCI - 9.8 vs. - 8.0, p = 0.2). Mortality was remarkably high in cancerpatients (1-year mortality 46% vs. 8% in non-cancerpatients, p < 0.001), particularly with troponin-positive ACS (5-year mortality 71%). CONCLUSION: Strategies to effectively control cardiovascular risks in cancerpatients are needed. Additionally, suspected CAD in cancerpatients should not prevent prompt diagnostic clarification and optimal revascularization as PCI results in cancerpatients are comparable to non-cancerpatients and occurrence of troponin-positive ACS leads to a significantly increased risk of mortality.
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Authors: Simone M Mrotzek; Alessia Lena; Sara Hadzibegovic; Ria Ludwig; Fadi Al-Rashid; Amir A Mahabadi; Raluca I Mincu; Lars Michel; Laura Johannsen; Lena Hinrichs; Martin Schuler; Ulrich Keller; Stefan D Anker; Ulf Landmesser; Tienush Rassaf; Markus S Anker; Matthias Totzeck Journal: Clin Res Cardiol Date: 2020-08-02 Impact factor: 5.460