Acute myocardial infarction in patients with cancer: outcomes and P2Y12 inhibition

Abstract

Cancer patients are at an elevated risk of bleeding and ischemic events. There are limited comparative real-world data on outcomes of all-comer cancer patients after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) compared with non-cancer patients. There are also limited comparative data to guide P2Y12 inhibitor choice in cancer patients undergoing PCI. We queried the TriNetX research database from 2015 to 2023 to identify adult patients who received PCI for AMI. AMI patients were then stratified into cancer and non-cancer patients. Propensity score matching was used to account for imbalances in baseline characteristics. Cancer patients were further categorized into those who received dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel in addition to aspirin. Outcomes of interest included all-cause mortality and major bleeding at 30-days and 1-year. Of 139,342 patients who underwent PCI for AMI, 6,766 (4.9%) had a history of cancer. Compared with AMI patients without cancer, cancer patients had higher 1-year all-cause mortality (20.1% vs. 12.7%; HR 1.59; 95% CI, 1.46-1.73) and major bleeding (16.9% vs. 10.2%; HR 1.69; 95% CI 1.54-1.86). Among cancer patients with AMI, those treated with ticagrelor-based DAPT after PCI had similar incidence of bleeding complications compared with those treated with clopidogrel (HR 1.04; 95% CI 0.77-1.40). Cancer is an adverse prognostic marker for AMI outcomes and is independently associated with substantially higher mortality and bleeding risk. Among cancer patients undergoing PCI for AMI, ticagrelor use is associated with similar bleeding events compared with clopidogrel.

Keywords: Cancer; Cardio-oncology; Dual antiplatelet therapy; High bleeding risk; Myocardial infarction.