Acute Myocardial Infarction is Associated With Poor Inpatient Survival in Esophageal Cancer Patients Undergoing Surgery

Purpose: Fatigue may be a commonly experienced symptom of acute myocardial infarction (AMI); however, there is a disturbing lack of data about the fatigue that occurs among men and women at the time of AMI. The purpose of this study was to characterize the fatigue experienced among men and women during AMI using three validated fatigue questionnaires. Method: Ninety AMI patients were recruited from six Midwestern hospitals. The Profile of Mood States (POMS), Fatigue Severity Index (FSI), and the Short Form 36 Health Survey (SF-36) were completed by each hemodynamically stable subject. Results: The sample included 76% men (mean age = 61, SD = 10), 24% women (mean age = 59, SD = 13); 78% non-Hispanic white. Subjects scored 1.7 on the POMS fatigue subscale (0 = none, 4 = extremely), 47.3 on the SF-36 vitality subscale (0 = most, 100 = least), and 6.4 on the “most fatigued” item of the FSI (0 = not fatigued at all, 10 = as fatigued as I could be). Scores from AMI subjects were compared to published scores in other populations. Compared to older adult male subjects, AMI subjects had higher levels of fatigue on the POMS fatigue subscale (M = 0.71, t = 7.2, p < 0.001) and the SF-36 vitality subscale (M = 51.0, t = 2.85, p < 0.01). In addition, AMI patients were more fatigued on the “most fatigued” item of the FSI compared to cancer patients in active treatment (M = 5.5, t = 2.28, p = 0.05). Men and women reported similar levels of fatigue across all three measures; however, women reported that fatigue caused more disruption of activities of daily living (p < 0.001), more difficulty with physical activities (p < 0.01), poorer rating of general health (p < 0.05), and more interference with social activities (p < 0.05). Conclusion: To date, fatigue as a symptom of AMI has focused on using qualitative methods in women. This study used three well-established measures of fatigue to demonstrate that fatigue is commonly experienced by both men and women and at levels that are higher than a healthy older adult sample and cancer patients. Interestingly, fatigue had a greater negative impact on women’s lives.

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Abstract 17321: Aspirin Use is Associated With Improved Survival in Severely Thrombocytopenic Cancer Patients With Acute Myocardial Infarction

Circulation ◽

10.1161/circ.132.suppl_3.17321 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Attila Feher ◽

Rekha Parameswaran ◽

Eytan M Stein ◽

Dipti Gupta

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients ◽

Major Bleeding ◽

Hematologic Malignancy ◽

Hematologic Malignancies ◽

Categorical Variables ◽

Cancer Center ◽

Rank Statistic ◽

Severe Thrombocytopenia

Objective: Patients with hematologic malignancies are at risk for severe thrombocytopenia (sTP). The risk and benefit of aspirin therapy is not known in thrombocytopenic cancer patients who experience an acute myocardial infarction (AMI). Methods: Medical records of patients with hematologic malignancies diagnosed with AMI at Memorial Sloan Kettering Cancer Center during 2005-2014 were reviewed. sTP was defined as platelet count <50 cells k/μL within 7 days of AMI. Demographics, aspirin use, survival and bleeding outcomes were collected. T-tests and Fisher exact tests were used to compare continuous and categorical variables. Survival rates were calculated using the Kaplan-Meier product limit method; groups were compared with log-rank statistic. Results: 118 patients with hematologic malignancies had AMI. 58/118 (49%) had sTP. 25/58 (43%) of those with sTP received aspirin. Patients were mostly male (70%, n=83), mean age 69±11 years, mean follow up 3.6 years. Non-Hodgkin’s lymphoma was the most common hematologic diagnosis (36%, n=42). Survival was significantly worse in patients with sTP vs. no sTP (23% vs. 50% at 1 year, log rank p=0.008). When compared to no sTP with AMI, patients with sTP and AMI were less likely to receive aspirin (83% vs 43%, p=0.0001), thienopyridine (27% vs 3%, p=0.0005) and to undergo coronary angiography (30% vs. 5%, p=0.0005) and revascularization (17% vs. 3%, p=0.03). Cancer patients with sTP and AMI who received aspirin had improved survival when compared to those not treated with aspirin, (92% vs. 70% at 7 days, 72% vs. 33% at 30 days and 32% vs. 13% at 1 year, log rank p=0.008). No fatal bleeding events occurred. Thrombolysis in Myocardial Infarction (TIMI) major bleeding occurred in one patient without sTP. Conclusions: In hematologic malignancy patients with AMI and sTP the use of aspirin was associated with improved survival without increase in major bleeding.

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Treatment of patients with myocardial infarction depends on history of cancer

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617729636 ◽

2017 ◽

Vol 7 (7) ◽

pp. 639-645 ◽

Cited By ~ 21

Author(s):

Sabine Rohrmann ◽

Fabienne Witassek ◽

Paul Erne ◽

Hans Rickli ◽

Dragana Radovanovic

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Recommended Treatment ◽

St Segment ◽

History Of ◽

Comorbidity Index ◽

History Of Cancer

Background: Although cancer treatment considerably affects cardiovascular health, little is known about how cancer patients are treated for an acute myocardial infarction. We aimed to investigate whether acute myocardial infarction patients with a history of cancer received the same guideline recommended treatment as those acute myocardial infarction patients without and whether they differ with respect to inhospital outcome. Methods: All patients with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction, enrolled between 2002 and mid-2015 in the acute myocardial infarction in Switzerland (AMIS Plus) registry with comorbidity data based on the Charlson comorbidity index were analysed. Patients were classified as having cancer if one of the cancer diseases of the Charlson comorbidity index was indicated. Immediate treatment strategies and inhospital outcomes were compared between groups using propensity score matching. Results: Of 35,249 patients, 1981 (5.6%) had a history of cancer. After propensity score matching for age, gender, Killip class >2, ST-segment elevation myocardial infarction and renal disease (1981 patients per group), significant differences were no longer found for a history of acute myocardial infarction, hypertension, diabetes, heart failure and cerebrovascular disease between cancer and non-cancer patients. However, cancer patients underwent percutaneous coronary intervention less frequently (odds ratio (OR) 0.76; 95% confidence interval (CI) 0.67–0.88) and received P2Y12 blockers (OR 0.82; 95% CI 0.71–0.94) and statins (OR 0.87; 95% CI 0.76–0.99) less frequently. Inhospital mortality was significantly higher in cancer patients (10.7% vs. 7.6%, OR 1.45; 95% CI 1.17–1.81). However, the main cause of death was cardiac in both groups ( P=0.06). Conclusion: Acute myocardial infarction patients with a history of cancer were less likely to receive guideline recommended treatment and had worse inhospital outcomes than non-cancer patients.

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Aspirin Is Associated with Improved Survival in Severely Thrombocytopenic Cancer Patients with Acute Myocardial Infarction

The Oncologist ◽

10.1634/theoncologist.2016-0110 ◽

2017 ◽

Vol 22 (2) ◽

pp. 213-221 ◽

Cited By ~ 8

Author(s):

Attila Feher ◽

Polydoros N. Kampaktsis ◽

Rekha Parameswaran ◽

Eytan M. Stein ◽

Richard Steingart ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients

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Mo-P2:207 Effect of aspirin in cancer patients with acute myocardial infarction: Influence of thrombocytopenia

Atherosclerosis Supplements ◽

10.1016/s1567-5688(06)80341-7 ◽

2006 ◽

Vol 7 (3) ◽

pp. 91-92

Author(s):

D.J. Lenihan ◽

M.G. Sarkiss ◽

C. Warneke ◽

G.H. Botz ◽

J.B. Durand

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients

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Comparison of treatment and outcome of acute myocardial infarction between cancer patients and non-cancer patients

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.11.009 ◽

2013 ◽

Vol 167 (5) ◽

pp. 2335-2337 ◽

Cited By ~ 32

Author(s):

Satoshi Kurisu ◽

Toshitaka Iwasaki ◽

Ken Ishibashi ◽

Naoya Mitsuba ◽

Yoshihiro Dohi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients

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Characterization of thromboembolic and bleeding risks in cancer patients with acute myocardial infarction under the use of guideline-recommended dual-antiplatelet therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.1537 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Hayashi ◽

Y Kataoka ◽

H Hosoda ◽

T Nakashima ◽

S Honda ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cancer Patients ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Atherosclerotic Cardiovascular Disease ◽

Current Guideline ◽

Bleeding Events ◽

Patients With Cancer ◽

Triple Antiplatelet Therapy

Abstract Background Atherosclerotic cardiovascular disease including acute myocardial infarction (AMI) has become one of major co-existing diseases in cancer patients due to their improved survival rate. Current guideline recommends dual-antiplatelet therapy (DAPT) in patients with AMI. Given that the presence of cancer elevates not only coagulability but bleeding risks, these substrate may further worsen cardiovascular outcomes and bleeding risks in cancer subjects with AMI receiving DAPT. Methods We retrospectively analyzed 712 AMI patients treated by primary PCI with drug-eluting stent and DAPT between 2007 and 2017. The diagnosis of cancer was determined through medical record review. Clinical characteristics, thromboembolic (=all-cause death+non-fatal MI+stroke) and bleeding events were compared in AMI subjects with vs. without cancer. Results Cancer was identified in 11.1% (=79/712) of study subjects. Of these, around 40% of them had gastrointestinal cancer (=35/79), followed by lung cancer (=5/79) and breast cancer (=8/79). Cancer patients were more likely to be older (77±7 v. 69±13 years, p<0.001) with a history of Af (25 v. 10%, p<0.001), CKD (eGFR<60: 60 v. 42%, p=0.002), anemia (hemoglobin: 12.8±1.8 v. 13.9±1.8 g/dl, p<0.001). Under anti-thrombotic (DAPT=86%, triple-antiplatelet therapy=14%) and optimal medical therapies (ACE-I=90%, beta-blocker=76%, statin=96%), more frequent occurrence of thromboembolic events was observed in patients with cancer (34.2 v. 12.6%, p=0.004, Picture). Furthermore, the presence of cancer was associated with more than four times greater risk of bleeding events compared to non-cancer subjects (18.9 v. 4.3%, p<0.001, Picture). In particular, the frequency of both major (10.1 vs. 3.3%, p=0.003) and minor (8.9 vs. 0.9%, p<0.001) bleeding events was significantly higher in patients with cancer. In multivariate analysis, cancer independently predicted bleeding events (Table). Conclusions Under the use of guideline recommended DAPT, the concomitance of cancer in AMI subjects was a predictor for thromboembolic as well as bleeding events. In particular, the relationship between cancer and bleeding was significant. These observations underscore the appropriate selection and duration of anti-thrombotic agents in AMI subjects with cancer. Cardiac/Bleeding Events in AMI Subjects Funding Acknowledgement Type of funding source: None

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An electron microscopic study of the intra-myocardial lesions in cases of acute myocardial infarction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010008328x ◽

1978 ◽

Vol 36 (2) ◽

pp. 484-485

Author(s):

Masahiro Ono ◽

Kaoru Aihara ◽

Gompachi Yajima

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Vessels ◽

Vascular Wall ◽

Vascular Changes ◽

Electron Microscopic ◽

Main Trunk ◽

Mechanical Destruction ◽

Transmission Electron ◽

Myocardial Lesions

The pathogenesis of the arteriosclerosis in the acute myocardial infarction is the matter of the extensive survey with the transmission electron microscopy in experimental and clinical materials. In the previous communication,the authors have clarified that the two types of the coronary vascular changes could exist. The first category is the case in which we had failed to observe no occlusive changes of the coronary vessels which eventually form the myocardial infarction. The next category is the case in which occlusive -thrombotic changes are observed in which the myocardial infarction will be taken placed as the final event. The authors incline to designate the former category as the non-occlusive-non thrombotic lesions. The most important findings in both cases are the “mechanical destruction of the vascular wall and imbibition of the serous component” which are most frequently observed at the proximal portion of the coronary main trunk.

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