Outcomes of Patients With Cancer With Myocardial Infarction-Associated Cardiogenic Shock Managed With Mechanical Circulatory Support

Abstract

Background: Cardiogenic shock (CS) is the leading cause of death among patients with acute myocardial infarction (AMI) and is managed with temporary mechanical circulatory support (tMCS) in advanced cases. Patients with cancer are at high risk of AMI and CS. However, outcomes of patients with cancer and AMI-CS managed with tMCS have not been rigorously studied.

Methods: Adult patients with AMI-CS managed with tMCS from 2006 to 2018 with and without cancer were identified using the National Inpatient Sample. Propensity score matching (PSM) was performed for variables associated with cancer. Primary outcome was in-hospital death, and secondary outcomes were major bleeding and thrombotic complications.

Results: After PSM, 1287 patients with cancer were matched with 12,870 patients without cancer. There was an increasing temporal trend for prevalence of cancer among patients admitted with AMI-CS managed with tMCS (P _trend < .001). After PSM, there was no difference in in-hospital death (odds ratio [OR], 1.00; 95% CI, 0.88-1.13) or thrombotic complications (OR, 1.10; 95% CI, 0.91-1.34) between patients with and without cancer. Patients with cancer had a higher risk of major bleeding (OR, 1.29; 95% CI, 1.15-1.46).

Conclusions: Among patients with AMI-CS managed with tMCS, cancer is becoming increasingly frequent and associated with increased risk of major bleeding, although there was no difference in in-hospital death. Further studies are needed to further characterize outcomes, and inclusion of patients with cancer in trials of tMCS is needed.

Keywords: acute myocardial infarction; cardio-oncology; cardiogenic shock; mechanical circulatory support.

Graphical abstract

Figure 1

Outcomes of patients hospitalized for acute myocardial infarction and cardiogenic shock (AMI–CS) managed with mechanical circulatory support (MCS) with vs without cancer. Patient outcomes after propensity score matching of patients with vs without cancer hospitalized for AMI–CS managed with MCS. Logistic regression modeling used to estimate odds ratio (OR) and 95% CI of outcomes in patients with cancer compared with patients without cancer. ATE, aortic thromboembolism; VTE, venous thromboembolism.

Figure 2

Risk factors for in-hospital death, thrombotic complications, and major bleeding among patients with cancer. Forest plots of risk factors for (A) in-hospital death, (B) thrombotic complications, (C) and major bleeding. CABG, coronary artery bypass grafting; ECMO, extracorporeal membrane oxygenation; GI, gastrointestinal; MDS, myelodysplastic syndrome; MPN, myeloproliferative neoplasm; STEMI, ST-elevation myocardial infarction; pLVAD, peripheral left ventricular assist device; PVD, peripheral vascular disease; VTE, venous thromboembolism.

Figure 3

Temporal trends of patients with cancer and AMI–CS managed with MCS. (A) Bar graph depicting number of admissions of AMI–CS managed with MCS with and without cancer. (B) There has been a temporal increase in the proportion of patients with AMI–CS managed with MCS with cancer. (C) Among patients with cancer, there has a been a temporal trend in decreased IABP use and increased pLVAD and ECMO use. AMI, acute myocardial infarction; CS, cardiogenic shock; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; MCS, mechanical circulatory support; pLVAD, peripheral left ventricular assist device; tMCS, temporary mechanical circulatory support.

Central Illustration

In-hospital outcomes and trends among patients with cancer with AMI–CS managed with tMCS. (A) Among patients admitted for AMI–CS managed with MCS, patients with cancer were associated with increased risk of major bleeding but not in-hospital death or thrombotic complications. After stratifying for solid cancer (B) and hematologic cancer (C), patients with cancer were associated with increased risk of major bleeding but not death, thrombotic complications, sepsis, or catheter-related infections. (D) There was and increased temporal trend of prevalence of patients with cancer among patients admitted for AMI–CS managed with MCS. (E) Among patients with cancer, there was a temporal trend of decreased IABP use and increase in pLVAD and ECMO use. AMI, acute myocardial infarction; CS, cardiogenic shock; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; MCS, mechanical circulatory support; OR, odds ratio; tMCS, temporary mechanical circulatory support.