Clinical Characteristics And Analysis Of Prognosis In Patients Of Coronary Heart Disease With A History Of Cancer

Objective:291 patients of coronary heart disease(CHD)with a history of cancer(including these patients who were accompanied with caner or diagnosed within1 year after diagnosis of CHD)in the First affiliated Hospital of Dalian Medical University were enrolled and followed up.Clinical characteristics and related factors associated with prognosis were investigated,providing the basis for clinical monitor,treatment and prognosis intervention.Methods:8610 patients with CHD in the First affiliated Hospital of Dalian Medical University between January 1,2015 and December 31,2017,they were followed up with 27 months(Median time).291 cases had a history of cancer,192 males and 99 females.Clinical characteristics,diagnosis of coronary computed tomography or angiography,and treatments were all hunted.The end-points were defined as all-cause mortality,acute myocardial infarction,unstable angina requiring hospitalization and heart failure requiring hospitalization.265 cases were followed up,these patients were divided into two groups according to treatment:drug conservative treatment group(57cases)and revascularization group(208 cases).We compared the outcomes between two groups and evalucated related factors associated with prognosis.Results:1.The 3.8 percent of patients of CHD had a history of cancer.The median age of patients was(68)(62.5,74.0),most of them were male(66.3%),and more accompanied with hypertension(60.5%)or hyperlipidemia(35.1%).The lung cancer(21.3%),colorectal cancer(18.6%),breast cancer(14.1%)and gastric cancer(12.7%)were the most common cancers,and some patients(4.5%)were suffered from two or more types of cancer.Most of them(95.2%)underwent tumor surgery,while only a few(27.8%)received radiotherapy,or chemotherapy,or traditional Chinese medicine treatment or tumor targeted therapy.2.Some patients(37.2%)were acute myocardial infarction,and the proportion ofacute st-elevation myocardial infarction(STEMI)and acute non-st-elevation myocardial infarction(NSTEMI)was almost the same.More patients underwent revascularization than drug conservative treatment(78.0% vs.21.9%),and percutaneous coronary intervention(PCI)was the general choice(76.3%).The radial artery was more general route for intervention in PCI(84.5%).Aspirin(95.9%),clopidogrel(or ticagrelor)(91.1%)and statins(98.3%)were used widely.3.The number of patients with acute myocardial infarction who received revascularization was significantly higher than that received drug conservative treatment(45.2% vs.8.8%,P<0.01).There were no significant differences in other clinical characteristics between two groups(P >0.05).Patients with revascularization treatment showed significantly greater survive compared with those with drug conservative treatment(93.3% VS 80.7%,log-rank test P<0.05).While there were no differences between two groups in the incidence of acute myocardial infarction,unstable angina requiring hospitalization and heart failure requiring hospitalization.4.Drug conservative treatment was strongly accounting for the all-cause mortality in patients.Conclusion:Patients of coronary heart disease with a history of cancer were older and accompanied with several diseases.Revascularization was the preferred treatment to improve their prognosis,particularly for the patients with acute myocardial infarction.