When Heart Attack Strikes, Cancer Patients Often Miss Out on Lifesaving Treatment
Too few cancer patients who have a heart attack are receiving emergency angioplasties that could save their lives, a new study finds.
"This is an important study, which underscores the broader issue in cardio-oncology of cancer patients too often being passed over for potentially beneficial procedures," said Dr. Robert Copeland-Halperin, a cardiologist unconnected to the new research.
While cancer patients may be at higher risk for some complications, there's "the potential [of angioplasty] to not only open the artery or valve, but open the future for these patients, by enabling them to receive more effective treatment for their cancer," said Copeland-Halperin. He's a specialist in cardio-oncology at Northwell Health Cancer Institute in Lake Success, N.Y.
Because cancer and heart disease often occur in the same person, "what we want is to help the patient, and hence a cardiologist and an oncologist must work together to produce the best results for the patient," Copeland-Halperin said.
In the new study, published Feb. 4 in European Heart Journal -- Acute Cardiovascular Care, British researchers compared rates of what's formally known as "primary percutaneous coronary intervention" (PCI) -- also called coronary angioplasty -- in heart attack patients with and without cancer. They also assessed the effectiveness and safety of the treatment in the two groups of patients.
PCI involves a stent being placed in a blocked artery to help restore blood flow to the heart. Ideally, the procedure should be performed within two hours to minimize heart muscle damage.
Primary PCI is the standard of care for heart attack patients. But there's been anecdotal evidence that patients with cancer are less likely to receive it, and the benefits of PCI in heart attack patients was unclear, explained study lead author Dr. Mohamed Mohamed, of Keele University in England.
As Copeland-Halperin explained, cancer and its treatments can raise risks during heart procedures. "Cancer patients are undoubtedly a high-risk cohort, with increased incidence of bleeding," as well as an increased odds for heart attacks and strokes, re-hospitalization, and death. But he said that's true "in essentially any [medical] context."
To find out if discrepancies in heart attack care exist, Mohamed's team analyzed 2004-2015 data from more than 1.8 million adults treated for heart attacks in the United States. All had what's known as an "ST-elevation myocardial infarction" (STEMI) heart attack, which is caused by a blockage of an artery that supplies blood to the heart.
"It's key that this analysis included patients with STEMI," Copeland-Halperin noted, because "for STEMI, the evidence and guidelines are much more straightforward: Early primary PCI is preferred when available."
The study found that rates of stent/angioplasty treatment was used in more than 82% of heart attack patients without cancer, but usage was much lower among patients with cancer, ranging from about 54% for lung cancer patients to about 71% for blood cancer patients.
However, the effectiveness of angioplasty for patients turned out to be similar for patients, regardless of whether they had cancer or not. There was one exception: The probability of major bleeding associated with PCI was higher among patients with cancer than those without the disease, according to the British researchers.
However, cancer patients who received PCI did not have more major bleeding than those who didn't undergo the procedure, Mohamed's team noted. That suggests that the angioplasty per se was not associated with an increased risk of bleeding.
All of this means that following a heart attack, cancer patients need to get the same consideration as those without cancer, Mohamed believes.
"These findings have significant implications for patients with cancer," he said in a journal news release. "The results should prompt cardiologists to offer the same intervention given to those without cancer, with the knowledge that it is equally effective and safe."
Copeland-Halperin agreed, but the stressed that most angioplasties are currently used after non-STEMI heart attacks, and treatment guidelines in those cases "are more nuanced." But he said that certainly, more care must be given to help cancer patients get proper treatment if heart attack strikes.
"To me, this is the future in cardio-oncology: Reframing these patients as those in whom the potential benefits of these interventions actually outweigh the risks," Copeland-Halperin said.
The U.S. National Heart, Lung, and Blood Institute has more on PCI.
SOURCES: Robert Copeland-Halperin, MD, cardiologist specializing in cardio-oncology, Northwell Health Cancer Institute, Lake Success, N.Y.; European Heart Journal, news release, Feb. 3, 2021
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