Five-year retrospective analysis of invasive vs. conservative strategies for non-ST elevation myocardial infarction in critically ill cancer patients.

BACKGROUND

Management of non-ST segment elevation myocardial infarction (NSTE-MI) in critically ill cancer patients is challenging due competing risks such as bleeding, thrombocytopenia, organ dysfunction, and overall frailty. Evidence guiding the choice between interventional and pharmacological treatment strategies in this high-risk population is limited. This study aimed to compare in-hospital outcomes between interventional and pharmacological treatment strategies in critically ill cancer patients who developed NSTE-MI during intensive care unit follow-up.

METHODS

This retrospective study was conducted in the intensive care unit of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, a tertiary referral center, between January 2020 and December 2024. All consecutive adult patients with an active or prior cancer diagnosis who developed non-ST-elevation myocardial infarction (MI) during their intensive care unit (ICU) stay were included. Patients with ST-elevation MI or incomplete medical records precluding confirmation of diagnosis or outcome assessment were excluded. Patients were managed according to the initial treatment strategy determined by the treatment team. Demographics, clinical parameters, and in-hospital mortality rates were analyzed. Multivariable logistic regression was performed to identify factors independently associated with in-hospital mortality, acknowledging that causality cannot be inferred due to the study design.

RESULTS

A total of 99 patients were included; 39 underwent interventional management and 60 received pharmacological therapy. Pharmacologically treated patients more often had elevated serum creatinine, hemodynamic instability, and a history of recent cancer surgery. Among the interventional group, 12 patients underwent percutaneous coronary intervention (PCI), with a mortality rate of 16.7%. Overall, hospital mortality was observed lower in the interventional group compared with the pharmacological group (13/39, 33.3% vs. 41/60, 68.3%, P<0.001). Multivariable analysis indicated that metastatic disease [odds ratio (OR) =4.46, 95% confidence interval (CI): 1.55-12.86, P=0.006] and treatment type (interventional vs. pharmacological) (OR =0.25, 95% CI: 0.09-0.70, P=0.008) were independently associated with in-hospital mortality. These results suggest a possible association between interventional management and lower in-hospital mortality in critically ill cancer patients, though baseline differences and the retrospective design require cautious interpretation.

CONCLUSIONS

In this retrospective analysis, an interventional treatment strategy was associated with lower in-hospital mortality in critically ill cancer patients with NSTE-MI. When clinically feasible, this approach may provide a survival benefit; however, prospective studies are needed to confirm these findings and optimize patient selection and treatment strategies in this high-risk population.