Characteristics and outcomes of 795 patients with renal cell cancer following hospitalization for acute myocardial infarction.
Authors: Ramphul Kamleshun , Verma Renuka , Chennapragada Suma Sri , Dandwani Mehndi , Sharma Shivani , Pagidipally Alekhya , Arti Fnu , Sombans Shaheen , Sanikommu Sailaja , Ramphul Yogeshwaree , Pekyi-Boateng Prince Kwabla , Dhillon Balkiranjit Kaur , Mejias Stephanie G. , Kumar Vijay , Elmahal Mohammed , Lohana Petras 
Published: June 2023

e16516

Background: Renal cell cancer (RCC), as with many cancers, is associated with a hypercoagulable state as well as the potential risk of anemia that can lead to various cardio/cerebrovascular complications. Some of the treatments used in RCC like vascular endothelial growth factor (VEGF) inhibitors increase the thrombotic risk. Thus, the management of RCC patients following an episode of Acute Myocardial Infarction (AMI) can be more complex than that of the general population. We, therefore, conducted an in-depth analysis to study the characteristics and outcomes of AMI among RCC patients in the United States. Methods: We used the 2019 National Inpatient Sample (NIS), a yearly set of hospitalization records from the United States. Patients with a primary diagnosis of AMI and a diagnosis of RCC were identified. We excluded all patients below the age of 18 and those with other malignancies. Multiple patient characteristics were compared via Chi-Square tests. We also compared the odds of requiring Coronary artery bypass graft surgery (CABG) and Percutaneous coronary intervention (PCI) among the two groups. The overall mortality rate and adjusted odds ratios were estimated. Results: Our study found 633410 cases of AMI among adults in the United States in 2019. Among them, 795 (0.1%) had a diagnosis of RCC. A higher number of RCC patients were Male (75.5% vs. 62.7%, p < 0.01), racially classified as White (77.1% vs. 73.0%, p < 0.01), aged 60 or more (88.7% vs. 69.8%, p < 0.01), covered by Medicare (72.3% vs. 56.1%, p < 0.01), had hypertension (66.7% vs. 82.7%, p < 0.01), were diabetics (45.9% vs. 41.4%, p < 0.01) or had anemia (42.1% vs. 22.1%, p < 0.01). A lower percentage of RCC patients underwent various procedures following their AMI, as only 6.3% underwent CABG (vs. 7.5% in the non-RCC group), and 27.6% (vs. 45.8% in the non-RCC group) underwent PCI. Patients with RCC were also older (71.62 years vs. 66.64 years, p < 0.01), had a longer hospitalization (5.51 days vs.4.34 days, p < 0.01), which was also associated with a more expensive mean hospital charge ($114572.98 vs. $106241.24). Unfortunately, we also found that the presence of RCC among AMI patients was also linked with a higher odds ratio of mortality (7.5% vs. 4.4%, aOR 1.643, 95% CI 1.249- 2.160, p < 0.01). Conclusions: Our study confirms various differences in patient characteristics among AMI cases with and without RCC. While fewer RCC patients underwent procedures such as CABG or PCI, they experienced a less favorable outcome, including a longer and more costly stay and higher odds of in-hospital death. It is thus vital to screen RCC patients for potential risk factors for AMI, promote primary and secondary prevention measures, and improve hospitalization protocols to identify potential complications.