Abstract 12839: Anti-Thrombotic Therapy, Bleeding, and Mortality in Patients With Acute Myocardial Infarction and a History of Cancer: A Report From JAMIR, the Multi-Center, Nationwide Prospective Registry
Ayumi Adachi, Kazuma Oyama, Jun Takahashi, Satoshi Honda, Nishihira Kensaku, Sunao Kojima, Misa Takegami, Yasuhide Asaumi, Jun Yamashita, Mike Saji, Kiyoshi Hibi, Yasuhiko Sakata, Morimasa Takayama, Tetsuya Sumiyoshi, Hisao Ogawa, Kazuo Kimura, Satoshi Yasuda- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: The relationship between a history of cancer and clinical outcomes including bleeding in acute myocardial infarction (AMI) patients remains unclear in a contemporary cohort.
Aims: This study aimed to analyze clinical outcomes of patients following AMI according to the history of cancer.
Methods: Consecutive patients with spontaneous onset of AMI were enrolled between December 2015 and May 2017 at 50 institutions in the Japan AMI Registry (JAMIR), a multi-center, nationwide prospective registry. The outcomes of interest were all-cause death, major bleeding defined as BARC type 3 or 5, and composite ischemic events defined as cardiovascular (CV) death, MI, and ischemic stroke.
Results: A total of 3,411 AMI patients were enrolled, and followed for a median of 358 days. Among those, 292 patients (8.6%) had a history of cancer. They were older, had more comorbidities, and were more likely to use clopidogrel but not prasugrel than those without. They had a similar risk of composite ischemic events, and major bleeding compared with those without, whereas were at higher risk for all-cause mortality (adjHR 1.64 [95% CI 1.16-2.32], P=0.005; Figure 1 ). While no between-group difference in CV death was observed, non-CV death and death due to cancer were higher in the cancer group than in the no-cancer group (adjHR 2.05 [95% CI 1.24-3.39], P=0.005; adjHR 18.16 [95% CI 6.74-48.97], P<0.001, respectively; Figure 2 ). When further stratified by age, the difference in all-cause mortality became pronounced in the group aged<75 years but not in the group aged>75 years (adjHR 3.32 [1.88-5.85] and 1.26 [0.81-1.96], respectively; P for interaction=0.008; Figures 1 and 3 ).
Conclusion: The nationwide multi-center registry, JAMIR demonstrated that a history of cancer was associated with increased mortality in AMI patients aged<75 years. These results might suggest the need for a multidisciplinary approach to improving the prognosis of younger AMI patients with a history of cancer.