Background

Cancer patients are less likely to undergo percutaneous coronary intervention (PCI) after cardiac arrest, although they demonstrate improved mortality benefit from the procedure. We produced the largest nationally representative analysis of mortality of cardiac arrest and PCI for patients with cancer versus non-cancer.

Methods

Propensity score adjusted multivariable regression for mortality was performed in this case-control study of the United States’ largest all-payer hospitalized dataset, the 2016 National Inpatient Sample. Regression models of mortality and PCI weighted by the complex survey design were fully adjusted for age, race, income, cancer metastases, NIS-calculated mortality risk by Diagnosis Related Group (DRG), acute coronary syndrome, and likelihood of undergoing PCI.

Results

Of the 30,195,722 hospitalized adult patients, 15.43% had cancer, and 0.79% of the whole sample presented with cardiac arrest (of whom 20.57% underwent PCI). In fully adjusted regression analysis among patients with cardiac arrest, PCI significantly reduced mortality (OR 0.15, 95 %CI 0.13–0.19; p < 0.001) among patients with cancer greater than those without it (OR 0.21, 95 %CI 0.20–0.23; p < 0.001).

Conclusions

This nationally representative study suggests that post-cardiac arrest PCI is underutilized among patients with cancer despite its significant mortality reduction for such patients (independent of clinical acuity).

中文翻译：

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心脏骤停后 PCI 在癌症患者中未得到充分利用：机器学习增强了对 3000 万住院患者的全国代表性病例对照研究

背景

癌症患者在心脏骤停后不太可能接受经皮冠状动脉介入治疗 (PCI)，尽管他们证明该手术可提高死亡率。我们对癌症与非癌症患者的心脏骤停和 PCI 死亡率进行了最大的全国代表性分析。

方法

在这项针对美国最大的全付费住院数据集（2016 年全国住院患者样本）的病例对照研究中，对死亡率进行了倾向评分调整后的多变量回归。由复杂调查设计加权的死亡率和 PCI 回归模型已针对年龄、种族、收入、癌症转移、NIS 计算的诊断相关组 (DRG) 死亡风险、急性冠状动脉综合征和接受 PCI 的可能性进行了全面调整。

结果

在 30,195,722 名住院成年患者中，15.43% 患有癌症，整个样本中有 0.79% 出现心脏骤停（其中 20.57% 接受了 PCI）。在心脏骤停患者的完全校正回归分析中，PCI 显着降低了癌症患者的死亡率（OR 0.15, 95 %CI 0.13–0.19；p < 0.001），高于未接受 PCI 的患者（OR 0.21, 95 %CI 0.20–0.23； p < 0.001)。

结论

这项具有全国代表性的研究表明，尽管癌症患者的死亡率显着降低（独立于临床敏锐度），但心脏骤停后 PCI 在癌症患者中并未得到充分利用。