br Our findings are consistent with previous reports detailing CPR
Our findings are consistent with previous reports detailing CPR utilization rates in patients with cancer.10,25 Reported IHCA survival among patients with cancer has lagged behind that of non-cancer patients. However, many of these prior studies are smaller in scope, stem from analyses conducted prior to widespread use of standard post-IHCA
Table 1 – Hospitalization characteristics of all subjects.
Characteristic No cancer
Comorbidities (n, %)
a Abbreviations: ACS, acute coronary syndromes; CAD, coronary artery disease; CHF, congestive RSL3 failure; CKD, chronic kidney disease; IQR, interquartile range; PAD, peripheral artery disease.
Fig. 2 – Cardiopulmonary resuscitation utilization rates, by cancer status in a propensity matched cohort.
Fig. 3 – (A) Procedural utilization among cancer hospitalizations within the propensity-matched 2012–2015 cohort. P values (all comparisons saw P-values < 0.001). (B) Procedural utilization in the high-survival cancer matched cohort. For this analysis, subjects with a history of cancer with a favorable five-year survival (thyroid, breast, prostate and testicular cancers or non-Hodgkin lymphoma) were matched to two controls without a history of cancer. Utilization of some procedures differed by co-diagnosis of cancer: P = 0.0498 for CPR use, P = 0.0337 for angiography use, P = 0.0151 for PCI use, P = 0.0804 for TTM use, P = 0.0543 for IABP use and P = 0.0080 for ICD implantation. (C) Procedural utilization among subjects with and without a cancer with presenting diagnosis of MI. *All comparisons were significant, expect for CPR use.
measures, and predate the emergence of more novel cancer therapeu-tics associated with improved cancer survival rates.26 The rise in post-IHCA survival has largely correlated with standardized implementation of post-resuscitation measures. Critical to this has been the increased use of TTM, coronary angiography, and PCI. However, we notethe rate of use of these measures in the presence of a cancer history has remained low, despite improving cancer survival overall.
Previously, restricted use of PCI was advised on the basis of elevated bleeding risk, potential for provocation of coronary thrombosis and futility of intervention in those with underlying cancers. However, recent data does not appear to support these concerns. In this study ventral is demonstrated that AMI was diagnosed less in cancer patients but once diagnosed, these patients received adequate care in terms of angiography and PCI. There is a likelihood that cancer
Fig. 4 – Discharge disposition of hospitalizations following IHCA (p < 0.0001 for each pairwise comparison).
patients either have delay or lack of effort in diagnosing this life-threatening condition due to bias. A recent publication by Potts et al.27 showed that there has been increase in overall use of PCI for various primary diagnoses which supports this current finding. Furthermore, there are no definite contraindications to their use, outside of expected survival of less than 6 months in persons with cancer.28 Even in the presence of thrombocytopenia, coronary angiography and PCI can generally be safely performed in cancer patients.29 In a review of more than 15,000 real-world patients referred for PCI during a 15-year period, cancer was not associated with worse cardiovascular outcomes or intervention failure following PCI.30 Finally, among patients presenting with out-of-hospital cardiac arrest, the use of a more aggressive post-arrest management strategies, including PCI, was associated with improved outcomes in the setting of cancer.31 Given the preponderance of data showing cardiac catheterization followed by an intervention appears to be associated with improved outcomes in those with both ACS and cardiac arrest, greater efforts at diagnosing AMI and increasing post-resuscitation measures in non-AMI IHCA patients is warranted. Prospective studies and cardio-oncology registries are needed to more completely study this phenomenon in the future.