Acute Myocardial Infarction in Patients With MPN: What Happens Next?

By Dustin Samples - Last Updated: December 14, 2022

A recent study characterized the risk of major adverse cardiovascular events (MACE) and bleeding in patients with a history of myeloproliferative neoplasms (MPN) who experienced acute myocardial infarction (AMI).

The research team, led by Orly Leiva, MD, of the New York University Grossman School of Medicine, retrospectively reviewed a cohort of patients using data from the National Inpatient Sample. Adult patients who experienced AMI between September 2015 and December 2018 who had a history of MPN were included.

Patients were stratified by type of MPN: essential thrombocytopenia (ET), polycythemia vera (PV), or primary myelofibrosis (PMF). ET was used as the comparison group and contained the most patients (n=2359; PV, n=681; PMF, n=116).

The primary study outcomes were inpatient MACE, arterial thrombotic events (ATE) and venous thrombosis embolisms (VTE), nonfatal cardiac arrest, and mortality. Secondary outcomes included in-hospital bleeding events requiring blood transfusion, ATE, VTE, and in-hospital mortality.

To evaluate risk of MACE, ATE, VTE, and mortality, there were a number of covariables used for comparison: age, sex, race, hypertension, cancer, diabetes mellitus, coronary artery disease, prior percutaneous coronary intervention, prior VTE, history of renal failure, history of heart failure, obesity, private insurance status, Charlson comorbidity index, length of stay, ST-elevation myocardial infarction presentation, in-hospital cardiogenic shock, in-hospital ATE (mortality only), VTE (mortality only), and bleeding (mortality only).

The results of the analysis showed that the patients with ET and PV who experienced AMI had similar rates of MACE, mortality, and VTE; however, patients with PV had a higher risk of ATE (but lower risk of bleeding) than those with ET. Patients with PMF had a higher risk of MACE and mortality than those with ET, but they had a lower risk of ATE, VTE, and bleeding.

“More investigation is needed in order to identify risk factors for adverse cardiovascular outcomes in patients with MPNs and improved post-AMI outcomes,” Dr. Leiva and colleagues concluded.

Leiva O, Siddiqui E, Hobbs GS, Bangalore S. Risk factors for major adverse cardiac events and bleeding in patients with myeloproliferative neoplasms admitted for myocardial infarction. Abstract #4372. Presented at the 64th ASH Annual Meeting and Exposition; December 10-13, 2022; New Orleans, Louisiana.