Top

Supportive Care in Cancer

Published in:

01-02-2015 | Original Article

Is there coronary artery disease in the cancer patient who manifests with chest pain, shortness of breath and/or tachycardia? A retrospective observational cohort

Authors: Adam H. Miller, Maria Teresa Cruz Carreras, Stephan A. Miller, Hannah E. Miller, Valda D. Page

Published in: Supportive Care in Cancer | Issue 2/2015

Abstract

Objective

Cancer therapies lead to chest pain (CP), shortness of breath (SOB), and/or tachydysrhythmias (TACH Y) requiring cardiac risk stratification including coronary computed tomographic angiography (CCTA). We posit that cancer patients with CP, SOB and/or TACH Y have greater odds of having coronary artery disease (CAD) identified by CCTA than those that do not.

Methods

Eligibility for this IRB-approved retrospective observational cohort included those with cancer that had CCTA performed. Groups were stratified with and without CP, SOB, and/or TACH Y. Electronic medical records were mined for appropriate CPT codes from 01012010 to 08312013. Demographics, cancer type, and clinical outcomes were obtained. Standard t tests, odds ratios, and frequencies were used.

Results

Of 176 participants identified; 84 were male (48 %) and 118 were Caucasian (67 %). Of those, 100/176 (57 %) had CP, SOB, and/or TACH Y; 72/100 (72 %) had CP; 10/100 (10 %) had TACH Y; and 18/100 (18 %) had SOB. Of the 72 with CP, 40 (56 %) had CAD; of the 10 with TACH Y, 6 (60 %) had CAD; of the 18 with SOB, and 10 (56 %) had CAD. Thus, a 2.6-fold increased odds of having CAD (56/100 = 56 %) compared to 25/76 (33 %) in the group with cancer without CP, SOB, and/or TACH Y (95 % CI = 1.40 to 4.83; p = 0.003).

Conclusion

Cancer patients with CP, SOB, and/or TACH Y have a 2.6-fold increased odds of having CAD compared to cancer patients without CP, SOB, and/or TACH Y (95 % CI = 1.40 to 4.83; p = 0.003).

Nawar EW, Niska RW, Xu J (2007) National hospital ambulatory medical care survey: 2005 emergency department summary. Adv Data 386:1–32PubMed

Yeh ET, Bickford CL (2009) Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol 53(24):2231–2247. doi:10.1016/j.jacc.2009.02.050 PubMedCrossRef

Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342(16):1163–1170. doi:10.1056/NEJM200004203421603 PubMedCrossRef

Miller AH, Pepe PE, Peshock R, Bhore R, Yancy CC, Xuan L, Miller MM, Huet GR, Trimmer C, Davis R, Chason R, Kashner MT (2011) Is coronary computed tomography angiography a resource sparing strategy in the risk stratification and evaluation of acute chest pain? Results of a randomized controlled trial. Acad Emerg Med 18(5):458–467. doi:10.1111/j.1553-2712.2011.01066.x PubMedCentralPubMedCrossRef

Shreibati JB, Baker LC, Hlatky MA (2011) Association of coronary CT angiography or stress testing with subsequent utilization and spending among medicare beneficiaries. JAMA J Am Med Assoc 306(19):2128–2136. doi:10.1001/jama.2011.1652 CrossRef

Fesmire FM, Hughes AD, Stout PK, Wojcik JF, Wharton DR (2001) Selective dual nuclear scanning in low-risk patients with chest pain to reliably identify and exclude acute coronary syndromes. Ann Emerg Med 38(3):207–215. doi:10.1067/mem.2001.116594 PubMedCrossRef

Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O’Neill WW, O’Neil B (2007) The diagnostic accuracy of 64- slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients. Ann Emerg Med 49(2):125–136. doi:10.1016/j.annemergmed.2006.06.043 PubMedCrossRef

Karlsberg RP, Budoff MJ, Thomson LEJ, Friedman JD, Berman DS (2009) Integrated Coronary Computed Tomographic Angiography in an Office-Based Cardiology Practice. Reviews in Cardiovascular Medicine 10 (4):194−+. doi:10.3909/Ricm0450

deFilippi CR, Rosanio S, Tocchi M, Parmar RJ, Potter MA, Uretsky BF, Runge MS (2001) Randomized comparison of a strategy of predischarge coronary angiography versus exercise testing in low-risk patients in a chest pain unit: In-hospital and long-term outcomes. J Am Coll Cardiol 37(8):2042–2049. doi:10.1016/S0735-1097(01)01300-6 PubMedCrossRef

10.

Hollander JE, Chang AM, Shofer FS, McCusker CM, Baxt WG, Litt HI (2009) Coronary computed tomographic angiography for rapid discharge of low-risk patients with potential acute coronary syndromes. Ann Emerg Med 53(3):295–304. doi:10.1016/j.annemergmed.2008.09.025 PubMedCrossRef

11.

Limkakeng A, Gibler WB, Pollack C, Hoekstra JW, Sites F, Shofer FS, Tiffany B, Hollander JE (2001) Combination of Goldman risk and initial cardiac troponin I for emergency department chest pain patient risk stratification. Acad Emerg Med 8(7):696–702. doi:10.1111/j.1553-2712.2001.tb00187.x PubMedCrossRef

12.

Lee TH, Goldman L (2000) Primary care: evaluation of the patient with acute chest pain. N Engl J Med 342(16):1187–1195. doi:10.1056/Nejm200004203421607 PubMedCrossRef

13.

Goldman L, Cook EF, Brand DA, Lee TH, Rouan GW, Weisberg MC, Acampora D, Stasiulewicz C, Walshon J, Terranova G, Gottlieb L, Kobernick M, Goldsteinwayne B, Copen D, Daley K, Brandt AA, Jones D, Mellors J, Jakubowski R (1988) A computer protocol to predict myocardial-infarction in emergency department patients with chest pain. N Engl J Med 318(13):797–803. doi:10.1056/Nejm198803313181301 PubMedCrossRef

14.

Hedges JR, Young GP, Henkel GF, Brian Gibler W, Green TR, Robert Swanson J (1992) Serial ECGs are less accurate than serial CK-MB results for emergency department diagnosis of myocardial infarction. Ann Emerg Med 21(12):1445–1450PubMedCrossRef

15.

Roberts RR, Zalenski RJ, Mensah EK, Rydman RJ, Ciavarella G, Gussow L, Das K, Kampe LM, Dickover B, McDermott MF, Hart A, Straus HE, Murphy DG, Rao R (1997) Costs of an emergency department-based accelerated diagnostic protocol vs hospitalization in patients with chest pain—a randomized controlled trial. JAMA J Am Med Assoc 278(20):1670–1676. doi:10.1001/jama.278.20.1670 CrossRef

16.

Tosteson ANA, Goldman L, Udvarhelyi IS, Lee TH (1996) Cost-effectiveness of a coronary care unit versus an intermediate care unit for emergency department patients with chest pain. Circulation 94(2):143–150PubMedCrossRef

17.

Pollack CV, Sites FD, Shofer FS, Sease KL, Hollander JE (2006) Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med 13(1):13–18. doi:10.1197/j.aem.2005.06.031 PubMedCrossRef

18.

Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E (2000) The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA 284(7):835–842PubMedCrossRef

19.

Kirk JD, Turnipseed S, Lewis WR, Amsterdam EA (1998) Evaluation of chest pain in low-risk patients presenting to the emergency department: the role of immediate exercise testing. Ann Emerg Med 32(1):1–7PubMedCrossRef

20.

Lewis WR, Amsterdam EA, Turnipseed S, Kirk JD (1999) Immediate exercise testing of low risk patients with known coronary artery disease presenting to the emergency department with chest pain. J Am Coll Cardiol 33(7):1843–1847PubMedCrossRef

21.

Pope JH, Ruthazer R, Beshansky JR, Griffith JL, Selker HP (1998) Clinical features of emergency department patients presenting with symptoms suggestive of acute cardiac ischemia: a multicenter study. J Thromb Thrombolysis 6(1):63–74. doi:10.1023/A:1008876322599 PubMedCrossRef

22.

Goldstein JA, Chinnaiyan KM, Abidov A, Achenbach S, Berman DS, Hayes SW, Hoffmann U, Lesser JR, Mikati IA, O’Neil BJ, Shaw LJ, Shen MY, Valeti US, Raff GL, Investigators C-S (2011) The CT-STAT (coronary computed tomographic angiography for systematic triage of acute chest pain patients to treatment) trial. J Am Coll Cardiol 58(14):1414–1422. doi:10.1016/j.jacc.2011.03.068 PubMedCrossRef

23.

Goldstein JA, Gallagher MJ, O’Neill WW, Ross MA, O’Neil BJ, Raff GL (2007) A randomized controlled trial of multi-slice coronary computed tomography for evalation of acute chest pain. J Am Coll Cardiol 49(8):863–871. doi:10.1016/j.jacc.2006.05.064 PubMedCrossRef

Title: Is there coronary artery disease in the cancer patient who manifests with chest pain, shortness of breath and/or tachycardia? A retrospective observational cohort
Authors: Adam H. Miller
Maria Teresa Cruz Carreras
Stephan A. Miller
Hannah E. Miller
Valda D. Page
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 2/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-014-2396-8

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2015

Unanticipated frequency and consequences of regimen-related diarrhea in patients being treated with radiation or chemoradiation regimens for cancers of the head and neck or lung

Erratum to: Adolescents and young adult cancer survivors: exercise habits, quality of life and physical activity preferences

Efficacy, effectiveness and safety of long-acting granulocyte colony-stimulating factors for prophylaxis of chemotherapy-induced neutropenia in patients with cancer: a systematic review

Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit

The relationship between nutritional status, inflammatory markers and survival in patients with advanced cancer: a prospective cohort study

Acknowledgment of Reviewers 2014

Keynote webinar | Spotlight on antibody–drug conjugates in cancer