Comorbidities muddy acute MI diagnosis in patients with cancer presenting with chest pain
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Key takeaways:
- Patients with cancer had a higher rate of acute MI when presenting to the ED with chest pain.
- More CV complications in patients with cancer may reduce the efficacy of troponin algorithms to detect acute MI.
Patients with a history of or active cancer had a higher rate of acute MI when presenting to the ED with chest pain, a speaker reported.
The European Society of Cardiology 0/1-hour algorithms demonstrated high safety for the detection of acute MI in patients with cancer compared with no cancer; however, their efficacy was reduced due to more patients with cancer remaining in the observation zone, according to a secondary analysis of the APACE study presented at the ESC Congress and simultaneously published in JACC: CardioOncology.
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Paolo Bima, MD, of the Cardiovascular Research Institute Basel and department of cardiology at University Hospital Basel, Switzerland, and colleagues conducted the present study to evaluate the prevalence of acute MI, noncardiac chest pain and hospitalization among consecutive patients with a history of cancer presenting to the ED with acute chest pain enrolled in the APACE study.
The researchers also evaluated the diagnostic accuracy of high-sensitive cardiac troponin T (Elecsys, Roche) and high-sensitive cardiac troponin I (Architect Stat, Abbott) to rule out acute MI and the performance of the ESC 0/1-hour algorithms.
The findings were independently validated in the multicenter TRAPID-AMI cohort.
Among 8,267 patients who presented to the ED with acute chest pain, 8.6% had active or a history of cancer.
The researchers noted that patients with cancer and acute chest pain were more often older with more CV risk factors.
Patients with active or past cancer had a higher incidence of non-STEMI (24% vs. 17%) and hospitalization (50% vs. 34%) compared with those without cancer, but a had a lower rate of noncardiac chest pain (45% vs. 56%).
High-sensitivity cardiac troponin T had lower diagnostic accuracy for detecting acute MI in patients with cancer compared with those without cancer (area under the receiver operating characteristic curve [AUROC], 0.89 vs. 0.94; P < .001), whereas high-sensitivity cardiac troponin I had higher diagnostic accuracy by comparison and was similar between the two groups (AUROC for patients with cancer, 0.93; AUROC for patients with no cancer, 0.95; P = .12).
Moreover, the ESC algorithms demonstrated high safety for the detection of acute MI in patients with cancer; however, their efficacy was reduced due to more patients with cancer remaining in the observation zone compared with patients without cancer (high-sensitivity cardiac troponin T, 39% vs. 20%; high-sensitivity cardiac troponin I, 36.9% vs. 22.8%).
“Patients with cancer have a substantially higher prevalence of acute MI when presenting with acute chest discomfort to the ED,” Bima and colleagues wrote in a poster presentation. “Higher hospitalization rate further document the increased complexity of their workup. ... Higher burden of chronic cardiac disease related or unrelated to cancer and cancer therapy increased the prevalence of chronic cardiomyocyte injury and thereby reduced the efficacy, but not the safety of the ESC 1/0-hour algorithm.”
Reference:
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Bima P, et al. Cardiovascular complications in patients with cancer. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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