Cancer Patients Have Higher Readmission Rates for Heart Attack, Bleeding After PCI
NEW YORK (Reuters Health) – Cancer patients have an increased risk for readmission for acute myocardial infarction (AMI) and bleeding following percutaneous coronary intervention (PCI) compared with patients without a malignancy, a new study shows.
The magnitude of risk depends on both the type of cancer and the presence of metastasis, researchers report in the European Heart Journal.
There is growing evidence that patients with PCI and a history of cancer have poor outcomes with more cardiovascular events and bleeding complications, although much of the previous literature has been limited to in-hospital outcomes. The post-discharge outcomes of patients with cancer who undergo PCI are less clear, the study team notes.
Using the U.S. National Readmission Database, they evaluated rates of readmissions within 90 days for AMI and bleeding among close to 2 million patients who underwent PCI from 2010 to 2014, including 2.7% with active cancer and 6.8% with previous history of cancer.
They found that 90-day readmission rates for AMI and bleeding following PCI were much higher in patients with active cancer than in patients with no cancer, with an approximate two- and three-fold increase, respectively.
For patients without cancer, rates of readmission for AMI and bleeding were 5.6% and 0.6%, respectively, compared with 9.1% and 1.6%, respectively, when considering all cancers, report Dr. Chun Shing Kwok of Keele University, in Stoke-on-Trent, in the U.K., and colleagues.
For patients with active prostate cancer, readmission rates for AMI and bleeding were 7.0% and 1.4%, respectively, while for active breast cancer, the rates were 7.5% and 0.6%, respectively.
Those with active colon cancer had high rates of readmission for both AMI (10.8%) and bleeding (4.2%), while patients with active lung cancer had high rates of AMI (12.1%) and less so for bleeding (1.5%).
The average time to readmission for AMI ranged from 26.7 days for lung cancer to 30.5 days for colon cancer, while the average time to bleeding readmission ranged from 38.2 days for colon cancer to 42.7 days for breast cancer.
The presence of metastases is also “an important determinant of future AMI and major bleeding risk, with the presence of metastases generally increasing the risk of adverse outcomes,” the authors say.
“Future attempts at personalization of antiplatelet regimens in this population of cancer patients should take into consideration both ischemic and major bleeding risk according to cancer type and the presence of metastasis and take into account the risk profile of different cancer types,” they suggest in their article.
SOURCE: https://bit.ly/2N25U6e European Heart Journal, online March 3, 2021.
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