| Abstract | Uvod: Akutni koronarni sindrom (AKS) sve se češće dijagnosticira u onkoloških bolesnika. Posljedica je to boljeg liječenja onkoloških bolesnika zbog čega im se produžuje život, ali i činjenice da ti bolesnici imaju brojne čimbenike rizika za razvoj kardiovaskularnih (KV) bolesti. Zadnjih desetljeća, u Hrvatskoj i ostalim razvijenijim zemljama, dva najveća i najznačajnija uzroka smrtnosti upravo su KV bolesti te maligne neoplazme.
Cilj istraživanja: Analiza pristupa liječenju onkoloških bolesnika s AKS-om ovisno o tipu AKSa te utjecaj liječenja (konzervativni odnosno invazivni pristup) na ishod bolesnika. Nadalje, istraživan je utjecaj primarnog sijela karcinoma na prognozu nakon AKS-a te utjecaj kliničkih karakteristika bolesnika na ishod liječenja.
Metode i ispitanici: Ova retrospektivno monocentrično istraživanje uključilo je 269 bolesnika hospitaliziranih u Kliničkom bolničkom centru Zagreb s kliničkom slikom AKS-a u 11-godišnjem periodu. Uključeni su samo bolesnici koji su u trenutku hospitalizacije ili u petogodišnjem razdoblju prije hospitalizacije imali aktivnu tumorsku bolest.
Rezultati: Bolesnici s NSTE-AKS-om češće su liječeni konzervativno (50,4%) dok su bolesnici sa STEMI-jem najčešće bili podvrgnuti perkutanoj koronanoj intervenciji - PCI (74,6%) (P<0,001). Bolesnici liječeni konzervativno imali su veću smrtnost u bolnici u odnosu na invazivno liječene (12,4% vs 4%) (p=0,032). Sukladno tome invazivno liječeni bolesnici češće su preživjeli dulje od 6 mjeseci (79% vs 52,8%) (P<0,001). Najučestalije primarno sijelo karcinoma bila su pluća (22,8%). Metastatska bolest je značajno utjecala na ishod bolesnika s AKS-om. Zabilježena je veća smrtnost u bolnici (16,5% vs 5,2%) (P=0,003) i veća smrtnost unutar 6 mjeseci zbog progresije onkološke bolesti (12,7% vs 4,6%) (P=0,021) te posljedično tome manje preživljenje dulje od 6 mjeseci (53,2% vs 74,1%) (P=0,001).
Zaključak: Onkološki bolesnici s AKS-om imaju povišeni KV rizik i veću smrtnosti u odnosu na neonkološke bolesnike. U ovom retrospektivnom istraživanju četvrtina bolesnika sa STEMIjem, te polovica s NSTEMI-jem liječena je konzervativno što je negativno utjecalo na njihovo preživljenje. S druge strane, intervencijsko ili kirurško liječenje imalo je pozitivan učinak na prognozu onkoloških bolesnika s AKS-om neovisno o primarnom sijelu tumora, osim u bolesnika s aktivnom metastatskom tumorskom bolesti. Smatramo da u svakodnevnoj kliničkoj praksi ima prostora za poboljšanje liječenja onkoloških bolesnika s AKS-om. |
| Abstract (english) | Introduction: Acute coronary syndrome (ACS) is increasingly diagnosed in oncology patients. This is a result of better treatment of oncology patients, which prolongs their lives, as well as the fact that these patients have numerous risk factors for developing cardiovascular (CV) diseases. In recent decades, in Croatia and other more developed countries, the two most common and significant causes of mortality are CV diseases and malignant neoplasms.
Research Objective: To analyze the treatment approach (conservative or invasive) for oncology patients with ACS depending on the type of ACS and the influence of the treatment choice on patient outcomes. Additionally, we examined how the primary cancer site and patients clinical characteristics affect prognosis after ACS.
Methods and Subjects: This retrospective single-center study included 269 patients hospitalized in University Hospital Centre Zagreb with clinical presentation of ACS over an 11-year period. Only patients who had active tumor disease at the time of hospitalization or within the five-year period prior to hospitalization were included.
Results: Patients with NSTE-ACS were more frequently treated conservatively (50.4%), while patients with STEMI were most often subjected to percutaneous coronary interventions- PCI (74.6%) (P<0.001). Conservatively treated patients had higher in-hospital mortality compared to those treated invasively (12.4% vs. 4%) (p=0.032). Accordingly, invasively treated patients more often survived longer than 6 months (79% vs. 52.8%) (P<0.001). The most common primary cancer site was the lung (22.8%). Metastatic disease significantly affected the outcome of patients with ACS. Higher in-hospital mortality was recorded (16.5% vs. 5.2%) (P=0.003) and higher mortality within 6 months due to oncological disease progression (12.7% vs. 4.6%) (P=0.021), consequently leading to lower survival rate after 6 months (53.2% vs. 74.1%) (P=0.001). Conclusion: Oncology patients with ACS have a higher CV risk and mortality rate compared to non-oncology patients. In our retrospective study, a quarter of STEMI patients and half of NSTEMI patients were treated conservatively, which led to a higher mortality rate. On the other hand, interventional or surgical treatment had a positive effect on patients survival regardless of the primary tumor site, except in patients with metastatic tumor disease. There is room in everyday practice for improving the treatment of oncology patients with ACS. |
