Racial disparities in acute myocardial infarction outcomes in patients with cancer: A nationwide analysis.
Authors: Soe Winn, Sajog Kansakar, Shreeja Shikhrakar, Ashish Guragain, Dilichukwu Chudy-Onwugaje
Journal: Journal of Clinical Oncology (2024)

e24031 Background: Cancer patients and survivors face an elevated risk of coronary artery disease due to shared risk factors. Risk is further heightened by cancer itself as well as its treatment. Acute myocardial infarction (AMI) is becoming a leading cause of death among this demographic, owing to significant advancements in cancer survival in recent decades. While racial disparities in outcomes and resource utilization in AMI hospitalizations are well-documented, data on patients with cancer remain limited. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions with a principal diagnosis of AMI and a cancer diagnosis using ICD-10 codes. Patients were stratified by their race as – White, Black, Hispanic, Asian and others. Multivariate logistic regression was performed to assess outcomes while adjusting for hospital characteristics, patient demographics and comorbidities between the groups. The primary outcome was inpatient mortality. Results: Out of 3,190,929 admissions for AMI, 93,279 (2.9%) had co-morbid cancer. Among this subset, the majority were White patients (70.9%), followed by Black (11.0%), Hispanic (8.5%), Asian (2.7%), and others (6.9%). Asian patients, compared to White patients, had higher in-hospital mortality (adjusted odds ratio [aOR] 1.52, 95% CI 1.12-2.07, p &lt; 0.01). There was no difference in mortality among other racial groups. There were no differences in complications such as respiratory failure, acute kidney injury, stroke, and vascular complications between the cohorts, although Black patients had lower odds of cardiogenic shock (aOR 0.78, 95% CI 0.62-0.98, p = 0.03) compared to White patients. Compared to White patients, there were lower odds of undergoing coronary angiogram in Black (aOR 0.75, 95% CI 0.68-0.83, p &lt; 0.01), Hispanic (aOR 0.87, 95% CI 0.76-0.99, p = 0.43), and Asian patients (aOR 0.64, 95% CI 0.53-0.79, p &lt; 0.01). Similarly, there were lower odds of undergoing percutaneous coronary intervention (PCI) in Black (aOR 0.64, 95% CI 0.57-0.72, p &lt; 0.01), Hispanic (aOR 0.79, 95% CI 0.68-0.91, p &lt; 0.01), and Asian patients (aOR 0.71, 95% CI 0.56-0.88, p &gt; 0.01). Likewise, there were lower odds of undergoing coronary artery bypass grafting (CABG) in Black (aOR 0.58, 95% CI 0.45-0.76, p &lt; 0.01) and Hispanic patients (aOR 0.70, 95% CI 0.50-0.98, p &lt; 0.04). Conclusions: Cancer patients presenting with AMI experience similar mortality and complications across all races, although in-hospital mortality for Asian was higher compared to White patients. However, significant racial disparities exist in interventions being performed in this patient population. Coronary angiogram, PCI and CABG was performed more often in White patients than other races. Additional research is required to identify the factors contributing to this racial disparity and provide guidance for interventions aimed at improving outcomes.