Management Strategies and Clinical Outcomes of Acute Myocardial Infarction in Leukemia Patients: Insights from Nationwide United States Hospitalizations.

BACKGROUND: Patients with leukemia are at increased risk of cardiovascular events. There are limited outcomes data for patients with a history of leukemia who present with an acute myocardial infarction (AMI). METHODS: We queried the Nationwide Inpatient Sample (2004-2014) for patients with a primary discharge diagnosis of AMI, and a concomitant diagnosis of leukemia, and further stratified according to the subtype of leukemia. Multivariable logistic regression was conducted to identify the association between leukemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. RESULTS: Out of 6,750,878 AMI admissions, a total of 21,694 patients had a leukemia diagnosis. The leukemia group experienced higher rates of MACCE (11.8% vs. 7.8%), mortality (10.3% vs. 5.8%) and bleeding (5.6% vs. 5.3%). Following adjustments, leukemia was independently associated with increased odds of MACCE (OR 1.26[1.20,1.31]) and mortality (OR 1.43[1.37,1.50]) without an increased risk of bleeding (OR 0.86[0.81,0.92]). Acute myeloid leukemia (AML) was associated with approximately three-fold risk of MACCE (OR 2.81[2.51, 3.13]) and a four-fold risk of mortality (OR 3.75[3.34, 4.22]). Patients with leukemia were less likely to undergo coronary angiography (CA) (48.5% vs. 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs. 42.9%) compared to those without leukemia. CONCLUSION: Patients with leukemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared to those without leukemia. A multi-disciplinary approach between cardiologists and hematology oncologists may improve the outcomes of patients with leukemia after AMI

Prevalence of pulmonary hypertension in myelofibrosis.

Pulmonary hypertension (PH) has been described in myelofibrosis (MF), but it is rare and typically found in advanced disease. Although the etiology of PH in MF is unclear, early predictors may be detected by echocardiogram. The goals of our study were to evaluate the prevalence of PH as determined by echocardiography in a cohort of MF patients and to identify clinical risk factors for PH. We performed a retrospective review of MF patients from October 2015 to May 2017 at MD Anderson Cancer Center in the ambulatory clinic, and those with echocardiogram were included. Clinical, echocardiographic, and laboratory data were reviewed. Patients with and without PH were compared using a chi-square or Fisher's exact test, and logistic regression was performed with an outcome variable of PH. There were 143 patients with MF who underwent echocardiogram, and 20 (14%) had echocardiographic findings consistent with PH. Older age, male gender, hypertension, hyperlipidemia, coronary artery disease, dyspnea, hematocrit, brain natriuretic peptide (BNP), and N-terminal prohormone BNP (NT-proBNP) were significantly different between those without PH and those with PH (p < 0.05). Female gender was protective (OR 0.21, 95% CI 0.049-0.90, p = 0.035), and NT-proBNP was a significant clinical predictor of PH (OR 1.07, CI 1.02 = 1.12, p = 0.006). PH in MF is lower than previously reported in our MF cohort, but many patients had cardiac comorbidities. PH due to left-sided heart disease may be underestimated in MF. Evaluation of respiratory symptoms and elevated NT-proBNP should prompt a baseline echocardiogram. Early detection of PH with a multidisciplinary approach may allow treatment of reversible etiologies