Background: The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood. Objective: The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE). Results: Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p= 0.22). After adjustment for the patients’ risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, *p< 0.001. Conclusion: Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.
背景：冠心病（CHD）与癌症，特别是血液系统恶性肿瘤（HM）之间的相互影响仍不明确。目的：本研究旨在阐明HM如何影响急性冠脉综合征（ACS）患者的预后。我们分析了2010年1月至2018年12月期间德国11个地区法定医疗保险机构（AOK）中因ACS住院患者的医疗数据，通过年龄、性别及所有合并症进行匹配，比较其短期与长期生存率及主要不良心脏事件（MACE）。结果：在439,716例ACS患者中，2104例（0.5%）同时患有HM，其中以骨髓增生异常/骨髓增殖性疾病（27.7%）、淋巴细胞白血病（24.8%）和多发性骨髓瘤（22.4%）为主。这些患者平均年龄约大6岁（78岁 vs. 72岁*），ST段抬高型心肌梗死（STEMI）发生率较低（18.2% vs. 34.9%*），而非ST段抬高型心肌梗死（NSTEMI）更常见（81.8% vs. 65.1%*）。除血脂异常外，这些患者伴随及既往心血管疾病更多，纽约心脏协会（NYHA）心功能分级更差。他们接受冠状动脉造影（65.3% vs. 71.6%*）和经皮冠状动脉介入治疗（PCI，44.3% vs. 52.0%*）的比例较低，尽管出血事件数量未见显著增加（p=0.22）。经患者风险特征校正后，HM与长期生存率降低相关，但短期生存率无此差异。在STEMI患者中，短期生存率亦无统计学差异（*p<0.001）。结论：合并HM的ACS患者生存率显著降低，可能与临床因顾虑出血风险增加而避免PCI治疗有关。
Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies—A Real-World Analysis
肿瘤(癌症)患者之家