Acute and Long-Term Outcomes of ST-Elevation Myocardial Infarction in Cancer Patients, a ‘Real World’ Analysis with 175,000 Patients

SIMPLE SUMMARY: Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases have improved, more cancer patients will also suffer an AMI. We examined anonymized data from the largest German public health insurance company of over 175,000 patients hospitalized for ST elevation myocardial infarction (STEMI) between 2010 and 2017 with a follow up until 2018. Of these STEMI patients, 15.5% had pre-existing cancer. The most common cancers, in descending order, were skin, prostate, colon, breast, urinary tract, and lung cancers. What is special about STEMI patients with malignant diseases—they were older, suffered more frequently from three-vessel coronary diseases, had more frequent atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular disease, and peripheral arterial occlusive disease (PAD). They were more likely to have had previous AMIs, previous percutaneous coronary interventions (PCI), heart surgery, and strokes. Despite these comorbidities, acute PCI was used only 2–6% less often than in patients without cancer. Cancer adverse events were more common in the hospital. The eight-year survival rate was 57.3 without cancer and ranged from 41.2% to 19.2% with different cancers. Advanced stage of PAD, lung cancer, existing metastasis, and a previous stroke had the greatest impact on all-cause mortality. ABSTRACT: Background: Acute myocardial infarction (AMI) and cancer are common and serious diseases. As the prognosis and treatment of both diseases has improved, more cancer patients will suffer an AMI. Unfortunately, data on these “double hit” patients is scarce. Methods: From the largest public German health insurance, anonymized data of all patients with pre-existing cancer who were hospitalized due to ST-elevation MI (STEMI) between 2010 and 2017 were analyzed and followed-up until 2018. Results: Of 175,262 STEMI patients, 27,213 had pre-existing cancer (15.5%). Most frequent were skin (24.9%), prostate (17.0%), colon (11.0%), breast (10.9%), urinary tract (10.6%), and lung cancer (5.2%). STEMI patients with malignancies were older and presented more often with coronary three-vessel disease, atrial arrhythmias, chronic kidney disease, chronic heart failure, cerebrovascular and peripheral artery disease (PAD, each p < 0.001). They showed more often previous AMI, percutaneous coronary interventions (PCI), cardiac surgery, and stroke (all p < 0.001). Acute PCIs were applied between 2 and 6% less frequently compared to those without cancer. In-hospital adverse events occurred more frequently in cancer. Eight-year survival was 57.3% (95% CI 57.0–57.7%) without cancer and ranged between 41.2% and 19.2% in distinct cancer types. Multivariable Cox regression for all-cause mortality found, e.g., lung cancer (HR 2.04), PAD stage 4–6 (HR 1.78), metastasis (HR 1.72), and previous stroke (HR 1.44) to have the strongest impact (all p < 0.001). Conclusion: In this large “real world” data, prognosis after STEMI in cancer patients was markedly reduced but differed widely between cancer types. Of note, no withholding of interventional treatments in cancer patients could be observed.