|
|
急性ST段抬高型心肌梗死合并恶性肿瘤患者的临床特征和预后分析
|
Abstract:
目的：目前关于急性心肌梗死合并恶性肿瘤患者的相关临床资料相对匮乏。本研究主要探讨急性ST段抬高型心肌梗死(STEMI)合并恶性肿瘤的患者的临床特征及预后，以期为这类患者的临床监测、治疗和预后提供临床依据。方法：本研究收集了2021年1月~2021年12月于青岛大学附属烟台毓璜顶医院心内科住院的确诊为急性STEMI的男性吸烟患者。根据合并恶性肿瘤与否，分为合并肿瘤组和未合并肿瘤组。记录并分析研究人群的基线临床资料、冠脉造影结果、肿瘤类型和冠心病二级预防药物等治疗情况。对研究人群随访1年，记录研究终点的发生情况(终点事件包括：全因死亡、再发急性心肌梗死、住院治疗的不稳定型心绞痛、住院治疗的心功能不全)。结果：本研究共收集265例STEMI的男性吸烟患者，其中30例(11.3%)合并恶性肿瘤病史，最终纳入合并肿瘤组30例和未合并肿瘤组65例。在本研究人群中，最常见的恶性肿瘤分别是结直肠癌(20.0%)、肺癌(16.7%)、胃癌(13.3%)和肾癌(10.0%)。与未合并肿瘤组相比，合并肿瘤患者年龄更大(72.60 ± 8.23岁vs 64.06 ± 10.46岁，P < 0.001)，B型脑钠肽[156.01 (73.15, 329.56) vs 55.52 (27.83, 241.25), P = 0.019]水平更高和血红蛋白(125.17 ± 19.50 vs 142.25 ± 24.34, P = 0.001)水平更低。此外，与未合并肿瘤患者相比，合并肿瘤患者在冠脉介入时机上更倾向于选择择期手术(60.0% vs 7.7%, P < 0.001)。随访1年，两组间全因死亡率、再发急性心肌梗死、需要住院的不稳定心绞痛和心功能不全发生率比较差异无统计学意义。结论：STEMI合并恶性肿瘤的男性吸烟患者相对高龄，B型脑钠肽水平更高，血红蛋白水平更低，且在介入手术时机上倾向于选择择期手术，两组患者1年临床预后没有明显差异。
Objective: Currently, there is relatively limited clinical data on patients with acute myocardial infarction and malignant tumors. This study mainly explores the clinical characteristics and prognosis of patients with malignant tumors in acute ST segment elevation myocardial infarction (STEMI), in order to provide clinical basis for clinical monitoring, treatment, and prognosis of such patients. Methods: This study collected male smoking patients diagnosed with acute STEMI who were hospitalized in the cardiology department of the Affiliated Yantai Yuhuangding Hospital of Qingdao University from January 2021 to December 2021. According to whether malignant tumors are merged or not, they are divided into tumor group and no tumor group: Record and analyze baseline clinical data, coronary angiography results, tumor types, and treatment status of secondary preventive drugs for coronary heart disease in the study population; follow up the study population for 1 year and record the occurrence of study endpoints (endpoint events include all-cause mortality, recurrent acute myocardial infarction, unstable angina treated in hospital, and cardiac dysfunction treated in hospital). Results: A total of 265 male smokers with acute STEMI were included in this study, of which 30 (11.3%) were complicated with malignant tumors. Ultimately, 30 cases were included in the tumor group and 65 cases were included in the no tumor group. In this study population, the most common malignant tumors were colorectal cancer (20.0%), lung cancer (16.7%), gastric cancer (13.3%), and kidney cancer (10.0%).
| [1] | 邰宵辉, 李红玲, 党春艳, 等. 抗肿瘤药物致心脏毒性41例临床分析[J]. 中国心血管病研究, 2022, 20(5): 422-426. |
| [2] | Spoon, D.B., Psaltis, P.J., Singh, M., Holmes, D.R., Gersh, B.J., Rihal, C.S., et al. (2014) Trends in Cause of Death after Percutaneous Coronary Intervention. Circulation, 129, 1286-1294. https://doi.org/10.1161/circulationaha.113.006518 |
| [3] | Dai, L., Li, R., Hao, Q., Bao, Y., Hu, L., Zhang, Y., et al. (2023) Breast Cancer Is Associated with Coronary Heart Disease: A Cross-Sectional Survey of NHANES 1999-2018. Frontiers in Cardiovascular Medicine, 10, Article 1274976. https://doi.org/10.3389/fcvm.2023.1274976 |
| [4] | Willems, R.A.L., Winckers, K., Biesmans, C., de Vos-Geelen, J. and ten Cate, H. (2022) Evolving Data on Cardiovascular Complications in Cancer. Thrombosis Research, 213, S87-S94. https://doi.org/10.1016/j.thromres.2022.01.003 |
| [5] | Manohar, H., Potter, A.S., Koutroumpakis, E., Deswal, A. and Palaskas, N.L. (2022) Can We Mitigate Coronary Heart Disease Risk in Patients with Cancer? Current Atherosclerosis Reports, 24, 599-606. https://doi.org/10.1007/s11883-022-01035-5 |
| [6] | Giza, D.E., Iliescu, G., Hassan, S., Marmagkiolis, K. and Iliescu, C. (2017) Cancer as a Risk Factor for Cardiovascular Disease. Current Oncology Reports, 19, Article No. 39. https://doi.org/10.1007/s11912-017-0601-x |
| [7] | 中华医学会心血管病学分会, 中国抗癌协会整合肿瘤心脏病学分会, 中华心血管病杂志编辑委员会. 恶性肿瘤患者冠心病预防与管理中国专家共识[J]. 中华心血管病杂志, 2022, 50(11): 1047-1057. |
| [8] | Bell, C.F., Lei, X., Haas, A., Baylis, R.A., Gao, H., Luo, L., et al. (2023) Risk of Cancer after Diagnosis of Cardiovascular Disease. JACC: CardioOncology, 5, 431-440. https://doi.org/10.1016/j.jaccao.2023.01.010 |
| [9] | Lv, S., Liu, W., Zhou, Y., Liu, Y., Shi, D., Zhao, Y., et al. (2018) Hyperuricemia and Smoking in Young Adults Suspected of Coronary Artery Disease ≤ 35 Years of Age: A Hospital-Based Observational Study. BMC Cardiovascular Disorders, 18, Article No. 178. https://doi.org/10.1186/s12872-018-0910-5 |
| [10] | Larsen, G.K., Seth, M. and Gurm, H.S. (2013) The Ongoing Importance of Smoking as a Powerful Risk Factor for St-Segment Elevation Myocardial Infarction in Young Patients. JAMA Internal Medicine, 173, 1261-1262. https://doi.org/10.1001/jamainternmed.2013.6075 |
| [11] | 赵立群, 王归真, 马思蕊, 等. 男性吸烟者急性心肌梗死患者血脂特点[J]. 临床医学, 2008, 28(1): 43-45. |
| [12] | 王辰, 肖丹, 池慧. 《中国吸烟危害健康报告2020》概要[J]. 中国循环杂志, 2021, 36(10): 937-952. |
| [13] | Lee, S.N., Choi, I.J., Lim, S., Choo, E.H., Hwang, B., Kim, C.J., et al. (2021) Effects of Smoking on Long-Term Clinical Outcomes and Lung Cancer in Patients with Acute Myocardial Infarction. Korean Circulation Journal, 51, 336-348. https://doi.org/10.4070/kcj.2020.0430 |
| [14] | Milazzo, V., Cosentino, N., Campodonico, J., Lucci, C., Cardinale, D., Cipolla, C.M., et al. (2020) Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. Journal of Clinical Medicine, 9, Article 3642. https://doi.org/10.3390/jcm9113642 |
| [15] | Malmborg, M., Christiansen, C.B., Schmiegelow, M.D., Torp-Pedersen, C., Gislason, G. and Schou, M. (2018) Incidence of New Onset Cancer in Patients with a Myocardial Infarction—A Nationwide Cohort Study. BMC Cardiovascular Disorders, 18, Article No. 198. https://doi.org/10.1186/s12872-018-0932-z |
| [16] | Inohara, T., Endo, A. and Melloni, C. (2019) Unmet Needs in Managing Myocardial Infarction in Patients with Malignancy. Frontiers in Cardiovascular Medicine, 6, Article 57. https://doi.org/10.3389/fcvm.2019.00057 |
| [17] | Iliescu, C.A., Grines, C.L., Herrmann, J., Yang, E.H., Cilingiroglu, M., Charitakis, K., et al. (2016) SCAI Expert Consensus Statement: Evaluation, Management, and Special Considerations of Cardio‐Oncology Patients in the Cardiac Catheterization Laboratory (Endorsed by the Cardiological Society of India, and Sociedad Latino Americana De Cardiologıa Intervencionista). Catheterization and Cardiovascular Interventions, 87, E202-E223. https://doi.org/10.1002/ccd.26379 |
| [18] | Giza, D.E., Marmagkiolis, K., Mouhayar, E., Durand, J. and Iliescu, C. (2017) Management of CAD in Patients with Active Cancer: The Interventional Cardiologists’ Perspective. Current Cardiology Reports, 19, Article No. 56. https://doi.org/10.1007/s11886-017-0862-x |
| [19] | Zamorano, J.L., Lancellotti, P., Rodriguez Muñoz, D., Aboyans, V., Asteggiano, R., Galderisi, M., et al. (2016) 2016 ESC Position Paper on Cancer Treatments and Cardiovascular Toxicity Developed under the Auspices of the ESC Committee for Practice Guidelines: The Task Force for Cancer Treatments and Cardiovascular Toxicity of the European Society of Cardiology (ESC). European Journal of Heart Failure, 19, 9-42. https://doi.org/10.1002/ejhf.654 |
| [20] | Brennan, J.M., Curtis, J.P., Dai, D., Fitzgerald, S., Khandelwal, A.K., Spertus, J.A., et al. (2013) Enhanced Mortality Risk Prediction with a Focus on High-Risk Percutaneous Coronary Intervention: Results from 1,208,137 Procedures in the NCDR (National Cardiovascular Data Registry). JACC: Cardiovascular Interventions, 6, 790-799. https://doi.org/10.1016/j.jcin.2013.03.020 |
| [21] | Thygesen, K., Alpert, J.S., Jaffe, A.S., Chaitman, B.R., Bax, J.J., Morrow, D.A., et al. (2018) Fourth Universal Definition of Myocardial Infarction (2018). Journal of the American College of Cardiology, 72, 2231-2264. https://doi.org/10.1016/j.jacc.2018.08.1038 |
| [22] | 路航. 冠脉多支病变相关危险因素分析[J]. 湖北科技学院学报(医学版), 2019, 33(1): 26-28. |
| [23] | Oren, O. and Herrmann, J. (2018) Arterial Events in Cancer Patients—The Case of Acute Coronary Thrombosis. Journal of Thoracic Disease, 10, S4367-S4385. https://doi.org/10.21037/jtd.2018.12.79 |
| [24] | Iannaccone, M., D’Ascenzo, F., Vadalà, P., Wilton, S.B., Noussan, P., Colombo, F., et al. (2017) Prevalence and Outcome of Patients with Cancer and Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A BleeMACS Substudy. European Heart Journal: Acute Cardiovascular Care, 7, 631-638. https://doi.org/10.1177/2048872617706501 |
| [25] | Velders, M.A., Boden, H., Hofma, S.H., Osanto, S., van der Hoeven, B.L., Heestermans, A.A.C.M., et al. (2013) Outcome after ST Elevation Myocardial Infarction in Patients with Cancer Treated with Primary Percutaneous Coronary Intervention. The American Journal of Cardiology, 112, 1867-1872. https://doi.org/10.1016/j.amjcard.2013.08.019 |
| [26] | Pothineni, N.V., Shah, N.N., Rochlani, Y., Saad, M., Kovelamudi, S., Marmagkiolis, K., et al. (2017) Temporal Trends and Outcomes of Acute Myocardial Infarction in Patients with Cancer. Annals of Translational Medicine, 5, Article 482. https://doi.org/10.21037/atm.2017.11.29 |
| [27] | Rohrmann, S., Witassek, F., Erne, P., Rickli, H. and Radovanovic, D. (2017) Treatment of Patients with Myocardial Infarction Depends on History of Cancer. European Heart Journal: Acute Cardiovascular Care, 7, 639-645. https://doi.org/10.1177/2048872617729636 |
| [28] | Yusuf, S.W., Daraban, N., Abbasi, N., Lei, X., Durand, J. and Daher, I.N. (2012) Treatment and Outcomes of Acute Coronary Syndrome in the Cancer Population. Clinical Cardiology, 35, 443-450. https://doi.org/10.1002/clc.22007 |
| [29] | Bharadwaj, A., Potts, J., Mohamed, M.O., Parwani, P., Swamy, P., Lopez-Mattei, J.C., et al. (2019) Acute Myocardial Infarction Treatments and Outcomes in 6.5 Million Patients with a Current or Historical Diagnosis of Cancer in the USA. European Heart Journal, 41, 2183-2193. https://doi.org/10.1093/eurheartj/ehz851 |
| [30] | 马越, 刘放, 孙岩, 等. 急性冠状动脉综合征合并恶性肿瘤患者经皮冠状动脉介入术后远期预后的研究[J]. 中国医药, 2019, 14(1): 10-14. |
| [31] | Landes, U., Kornowski, R., Bental, T., Assali, A., Vaknin-Assa, H., Lev, E., et al. (2017) Long-Term Outcomes after Percutaneous Coronary Interventions in Cancer Survivors. Coronary Artery Disease, 28, 5-10. https://doi.org/10.1097/mca.0000000000000429 |
| [32] | Kwok, C.S., Wong, C.W., Kontopantelis, E., Barac, A., Brown, S., Velagapudi, P., et al. (2021) Percutaneous Coronary Intervention in Patients with Cancer and Readmissions within 90 Days for Acute Myocardial Infarction and Bleeding in the USA. European Heart Journal, 42, 1019-1034. https://doi.org/10.1093/eurheartj/ehaa1032 |
| [33] | Libby, P. and Ridker, P.M. (2004) Inflammation and Atherosclerosis: Role of C-Reactive Protein in Risk Assessment. The American Journal of Medicine, 116, 9-16. https://doi.org/10.1016/j.amjmed.2004.02.006 |
| [34] | Herrmann, J. (2020) Vascular Toxic Effects of Cancer Therapies. Nature Reviews Cardiology, 17, 503-522. https://doi.org/10.1038/s41569-020-0347-2 |
| [35] | McGale, P., Darby, S.C., Hall, P., Adolfsson, J., Bengtsson, N., Bennet, A.M., et al. (2011) Incidence of Heart Disease in 35,000 Women Treated with Radiotherapy for Breast Cancer in Denmark and Sweden. Radiotherapy and Oncology, 100, 167-175. https://doi.org/10.1016/j.radonc.2011.06.016 |
| [36] | Miller, D.D., Waters, D.D., Dangoisse, V. and David, P. (1983) Symptomatic Coronary Artery Spasm Following Radiotherapy for Hodgkin’s Disease. Chest, 83, 284-285. https://doi.org/10.1378/chest.83.2.284 |
| [37] | Shobayo, F., Bajwa, M., Koutroumpakis, E., Hassan, S.A., Palaskas, N.L., Iliescu, C., et al. (2022) Acute Coronary Syndrome in Patients with Cancer. Expert Review of Cardiovascular Therapy, 20, 275-290. https://doi.org/10.1080/14779072.2022.2063840 |
