Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction

Abstract

Background Antithrombotic agents to treat patients with acute myocardial infarction can cause bleeding, which may reveal undiagnosed cancer. However, the relationship between bleeding and new cancer diagnosis and the prognostic impact is still unclear. Methods and Results We analyzed the new cancer diagnosis, Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and all-cause death of 10 364 patients with acute myocardial infarction without a history of previous cancer in a multicenter acute myocardial infarction registry. During a median of 4.9 years, 1109 patients (10.7%) experienced Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and 338 patients (3.3%) were newly diagnosed with cancer. Bleeding Academic Research Consortium 2, 3, or 5 bleeding was associated with an increased risk of new cancer diagnosis (subdistribution hazard ratio [sHR] 3.29 [95% CI, 2.50-4.32]). In particular, there were robust associations between gastrointestinal bleeding and new gastrointestinal cancer diagnosis (sHR, 19.96 [95% CI, 11.30-29.94]) and between genitourinary bleeding and new genitourinary cancer diagnosis (sHR, 28.95 [95% CI, 14.69-57.07]). The risk of all-cause death was not lower in patients diagnosed with new gastrointestinal cancer after gastrointestinal bleeding (hazard ratio [HR], 4.05 [95% CI, 2.04-8.02]) and diagnosed with new genitourinary cancer after genitourinary bleeding (HR, 2.79 [95% CI, 0.81-9.56]) than in patients newly diagnosed with cancer without previous bleeding. Conclusions Clinically significant bleeding, especially gastrointestinal and genitourinary bleeding, in patients with AMI was associated with an increased risk of new cancer diagnoses. However, the bleeding preceding new cancer detection was not associated with better survival. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02385682 and NCT02806102.

Keywords: bleeding; cancer; gastrointestinal cancer; myocardial infarction; urogenital cancer.

Figures

Figure 1. Incidence and hazard ratio of new cancer diagnosis by multivariate competing risk analysis according to clinically relevant bleeding.

Values in the figure are HR (95% CI) according to subdistribution and cause‐specific hazard model. Bleeding confers the first occurrence of Bleeding Academic Research Consortium 2, 3, or 5 bleeding. GI indicates gastrointestinal; GU, genitourinary; and HR, hazard ratio.

Figure 2. Cumulative incidence of new cancer diagnosis after bleeding.

Values in the figure are percent (95% CI). GI indicates gastrointestinal; and GU, genitourinary.

Figure 3. Comparison of incidence of death according to previous clinically relevant bleeding.

Bleeding confers the first occurrence of Bleeding Academic Research Consortium 2, 3, or 5 bleeding. Bleeding before a new cancer diagnosis was associated with increases in all‐cause death, cardiovascular death, and noncardiovascular death. The incidence rate per 1000 person‐years of all‐cause death was highest in patients diagnosed with new cancer after clinically relevant bleeding. The increased rate of all‐cause mortality in patients diagnosed with new cancer after clinically relevant bleeding was driven by increased noncardiovascular death. CV indicates cardiovascular.