Outcomes of patients with cancer with acute coronary syndrome-associated cardiogenic shock

Authors

Orly Leiva, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America; Section of Cardiology - Heart Failure, Department of Medicine, University of Chicago, Chicago, IL, United States of America. Electronic address: oleiva@bu.edu.
Sunil Rao, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Richard K. Cheng, Division of Cardiology, University of Washington, Seattle, WA, United States of America.
Sunil Pauwaa, Advocate Health - MidwestFollow
Jason N. Katz, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Jose Alvarez-Cardona, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Samuel Bernard, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Carlos Alviar, Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
Eric H. Yang, UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America. Electronic address: EHyang@mednet.ucla.edu.

Recommended Citation

Leiva O, Rao S, Cheng RK, et al. Outcomes of patients with cancer with acute coronary syndrome-associated cardiogenic shock. Cardiovasc Revasc Med. Published online April 15, 2025. doi:10.1016/j.carrev.2025.04.020

Affiliations

Advocate Christ Medical Center

Abstract

Background:Cardiogenic shock (CS) is a common complication of acute coronary syndrome (ACS) and is associated with significant morbidity and mortality. Revascularization has been shown to reduce mortality in ACS-CS. Patients with cancer are at high risk of ACS and CS. However, patients with cancer are often undertreated with invasive procedures and outcomes of patients with cancer and ACS-CS have not been thoroughly characterized.

Methods:Patients with ACS-CS from 2014 to 2020 with and without cancer were identified using the National Readmission Database (NRD). Primary outcome was death at 90-days. Secondary outcomes were 90-day cardiovascular (CV) and bleeding readmissions, and index hospitalization major bleeding and thrombotic complications. Patients with cancer were compared to patients without cancer using multivariable logistic and Cox proportional hazards regression. Temporal trends in revascularization among patients with and without cancer were examined. Effect of revascularization among patients with cancer and ACS-CS was assessed using propensity score weighting (PSW).

Results:A total of 140,205 patients were identified, of whom 6118 (4.4 %) with cancer were identified. Patients with cancer were less likely to undergo percutaneous coronary intervention (45.5 % vs 53.5 %) or be managed with mechanical circulatory support (36.6 % vs 46.0 %). After multivariable logistic regression, there was no difference in primary outcome (adjusted OR 0.98, 95 % CI 0.92-1.06) but patients with cancer had higher risk of 90-day CV (HR 1.11, 95 % CI 1.01-1.22) and bleeding readmissions (HR 1.39, 95 % CI 1.10-1.76). Among patients with cancer and ACS-CS, revascularization was associated with lower primary outcome (OR 0.54, 95 % CI 0.50-0.58) and 90-day CV readmission (HR 0.68, 95 % CI 0.59-0.77) after PSW.

Conclusions:Among patients with ACS-CS, patients with cancer have similar 90-day death but higher risk of 90-day CV and bleeding readmissions. Additionally, revascularization was associated with improved outcomes among patients with cancer and ACS-CS. Further studies are needed to optimize patient selection for invasive management among patients with cancer.

Type

Article

PubMed ID

40268570