Cancer patients are at a heightened risk of heart attacks, formally known as acute coronary syndrome (ACS). Whilst the gold standard therapy for ACS is percutaneous coronary intervention (PCI), using a stent to open narrowed or blocked arteries, for reduction in cardiovascular mortality and morbidity. There is a caution among cardiologists when offering this treatment to cancer patients due to their high bleeding risk, which could be equally fatal. My previous work has suggested that PCI in cancer patients presenting with heart attacks is associated with reduced in-hospital deaths without an added risk of major bleeding. However, most bleeding events after ACS occur post-discharge. It is, therefore, unclear whether the benefits of PCI outweigh the risk of major bleeding in this high-risk population that is frequently under-represented in trials. Furthermore, the COVID-19 pandemic has had a significant impact on the care for cancer patients especially in the context of ACS. Therefore, an understanding of how cancer patients presenting with ACS were managed (conservative vs. PCI) during and after the COVID-19 pandemic is essential.
The proposed project aims to retrospectively analyse national electronic health record data to systematically examine and compare longer-term outcomes (at 30-days and 1-year) of cancer patients presenting with heart attacks (ACS) who undergo PCI (stents) or medical management with blood thinning medications (antiplatelet therapy) alone, including heart-related deaths (cardiac mortality) and recurrent heart attacks (reinfarction), major bleeding, and hospital readmissions over three time periods: pre-COVID (before March 2020), COVID (March 2022-April 2022) and post-COVID (April 2022 onwards). Furthermore, this project will assess the performance of traditional ACS risk scores (GRACE and CRUSADE) for predicting mortality and major bleeding, respectively, in the cancer population.
The findings from this work are expected to have important clinical implications by providing cardiologists and oncologists (cancer specialists) with valuable outcomes data to guide their clinical decisions when managing this high-risk and increasingly encountered population. It will also build the case for prospective work on the recalibration of existing risk scores to incorporate cancer as part of the risk prediction models and, therefore, improve the risk assessment of this underrepresented population.