作者
Hussein Bashar,Ofer Kobo,Nick Curzen,Mamas A. Mamas
摘要
Abstract Aims Over time, cardiovascular disease (CVD) deaths increasingly exceed those from malignancy among cancer survivors. However, the association of myocardial injury with long-term survival (beyond 3 years) in cancer patients has not been previously described. Methods and results The high-sensitivity cardiac troponin (hs-cTn) and morbidities databases from the National Health and Nutrition Examination Survey (1999–2004) were linked with the latest mortality dataset isolating records were respondents reported cancer diagnosis by a healthcare professional. Myocardial injury was then determined by elevated hs-cTn. A total of 16 225 560 weighted records (1058 unweighted) were included in this observational study, with myocardial injury identified in 14.2%. Those with myocardial injury had progressively worse survival at 5 (51.6 vs. 89.5%), 10 (28.3 vs. 76.0%), and 15 years (12.6 vs. 61.4%) compared with those without myocardial injury. After adjusting for baseline characteristics, those with myocardial injury had an adjusted hazard ratio (aHR) of 2.10 [95% confidence interval (CI) 2.09–2.10, P < 0.001] for all-cause mortality, 2.23 (2.22–2.24, P < 0.001) for cardiovascular mortality, and 1.59 (95% CI 1.59–1.60, P < 0.001) for cancer mortality compared with those without myocardial injury. Among patients with no pre-existing CVD, the hs-cTn I Ortho assay was a strong independent predictor of all-cause (aHR 6.29, 95% CI 6.25–6.33, P < 0.001), CVD (aHR 11.38, 95% CI 11.23–11.54, P < 0.001), and cancer (aHR 5.02, 95% CI 4.96–5.07, P < 0.001) mortalities. Conclusion As a marker for myocardial injury, hs-cTns were independently associated with worse long-term survival among cancer patients with a stronger relationship with all-cause, cardiovascular, and cancer mortalities using hs-cTn I Ortho assay.