Features of comorbidities and their effect on prognosis in cancer patients hospitalized with acute coronary syndrome

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OBJECTIVE

To analyze the features of comorbidities and their effect on prognosis in cancer patients hospitalized with acute coronary syndrome (ACS).

MATERIAL AND METHODS

The study was conducted in 3 stages. At the 1^st stage, 2 groups of ACS patients were formed: the main group (n=88) — ACS with cancer (verification of cancer within previous 10 years), the control group (n=88) — ACS without cancer. Mean age of patients was 66.6±9.5 years. Men prevailed (57%). ACS without ST elevation was diagnosed in 60% of patients. At the 2^nd stage, we assessed therapeutic comorbidities in patients with ACS and cancer. At the 3^rd stage, we evaluated their impact on the incidence of in-hospital and long-term adverse events in these patients. Differences were considered significant at p-value <0.05.

RESULTS AND DISCUSSION

The most common comorbidities in patients with ACS and cancer were hypertension (100%), chronic kidney disease (24%, GFR 44.4±11.2 ml/min/1.73 m²), anemia (35%, HGB 93.4±19.3 g/l), type 2 diabetes mellitus (22%), obesity (27%, BMI 33.5±3.2 kg/m²), COPD (18%). Risk factors were dyslipidemia (73%), smoking (35%). CKD (p=0.08) and anemia (p=0.0002) were more common in patients with ACS and cancer compared to those without cancer. Comorbid background in ACS patients with active and previous cancer had no significant differences. In-hospital urgent complications were diagnosed in 39% of patients with ACS and cancer (n=34). Risk of these events was associated with active cancer (OR 2.3497 95% CI 0.9753—5.6606, p=0.05) and COPD (OR 3.2407 95% CI 0.8704—12.0668, p=0.07). In-hospital mortality and/or recurrent myocardial infarction were observed in 11% (n=10) of patients, long-term events (throughout 6 months) — in 28% (n=21) of patients with ACS and cancer. Anemia significantly increased the risk of in-hospital mortality and/or recurrent MI in these patients (OR 4.6579 95% CI 1.1875—18.2707, p=0.027).

CONCLUSION

Comorbid status should be considered to determine the optimal management of patients with ACS and cancer.

Keywords:

therapeutic comorbidity

acute coronary syndrome

cancer

Authors:

Shalenkova M.A.

Municipal Clinical Hospital No. 38

Ivanov A.V.

Institute of General Pathology and Pathophysiology

Klimkin P.F.

Municipal Clinical Hospital No. 5

Received:

09.06.2021

Accepted:

08.09.2021

List of references:

Demograficheskij ezhegodnik Rossii. 2019: Statisticheskiy sbornik. Rosstat. M. 2019. Accessed September 17, 2021. (In Russ.). https://rosstat.gov.ru/folder/210/document/13207
Strelnikova MV, Sineglazova A V, Sigitova ON. Therapeutic comorbidity in men with acute coronary syndrome. Vestnik sovremennoj klinicheskoj mediciny. 2019;12(4):39-44. (In Russ.). https://doi.org/10.20969/vskm.2019.12(4).39-44
Luboyatnikova ES, Duplyakov DV. Acute coronary syndrome in malignancy patients. Rossiyskiy kardiologicheskiy jurnal. 2017;143(3):140-144. (In Russ.). https://doi.org/10.15829/1560-4071-2017-3-140-144
Velders MA, Boden H, Hofma SH, Osanto S, Hoeven BL, Heestermans AA, Cannegieter SC, Jukema JW, Umans VA, Schalij MJ, Boven AJ. Outcome after ST elevation myocardial infarction in patients with cancer treated with primary percutaneous coronary intervention. The American Journal of Cardiology. 2013;112(12):1867-1872. https://doi.org/10.1016/j.amjcard.2013.08.019
Iannaccone M, D’Ascenzo F, Vadalà P, Wilton SB, Noussan P, Colombo F, Raposeiras Roubín S, Abu Assi E, González-Juanatey JR, Simao Henriques JP, Saucedo J, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Song XT, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Garbo R, Huczek Z, Nie SP, Fujii T, Correia LC, Kawashiri MA, García Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Gaita F, Yamagishi M, Kalpak O, Kedev S. Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy. European Heart Journal. Acute Cardiovascular Care. 2018;7(7):631-638. https://doi.org/10.1177/2048872617706501
Shalenkova MA, Ivanov AV, Klimkin PF. The clinical peculiarities of acute coronary syndrome in patients with oncological disease. Klinicheskaya medicina. 2020;98(4):275-281. (In Russ.). https://doi.org/10.30629/0023-2149-2020-98-4-275-281
Shalenkova MA, Ivanov AV, Terekhova VV. The particularities of biomarker GDF-15 concentration in patients presenting acute coronary syndrome and cancer in anamnesis. Medicinskij al’manah. 2020;62(1):66-72. (In Russ.).
StatSoft, Inc. Electronic textbook on statistics. M.: StatSoft; 2012. Accessed May 25, 2021. (In Russ.). https://www.statsoft.ru/home/textbook/default.htm
Erlikh AD, Gratsianskyi NA. Treatment specifics and clinical outcomes in patients with acute coronary syndrome and anaemia: RECORD Registry results. Rossiyskiy kardiologicheskiy jurnal. 2012;5:12-16. (In Russ.).
Chumakova GA, Pokutnev AP, Veselovskaya NG. Specifics of myocardial infarction in obesity. Rossiyskiy kardiologicheskiy jurnal. 2017;144(4):75-80. (In Russ.). https://doi.org/10.15829/1560-4071-2017-4-75-80
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen M, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for themanagement of dyslipidaemias: lipid modification to reduce cardiovascular risk. Rossiyskiy kardiologicheskiy jurnal. 2020;25(5):3826. (In Russ.). https://doi.org/10.15829/1560-4071-2020-3826
Batiushin MM. Chronic Kidney Disease: Current State of the Problem. Racional’naya farmakoterapiya v kardiologii. 2020;16(6):938-947. (In Russ.). https://doi.org/10.20996/1819-6446-2020-11-06
Luboyatnikova ES, Kiselev AR, Komarova MV, Rodionova VA, Kapp EV, Duplyakov DV. ST-Elevation myocardial infarction in patients with malignancies. Kardiologija. 2018;58(12):5-12. (In Russ.). https://doi.org/10.18087/cardio.2018.12.10204

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