急性心肌梗死合并癌症患者出血风险的观察性研究价值
癌症患者占急性心肌梗死(AMI)病例的5%。由于恶性肿瘤是多数AMI随机对照试验的排除标准，关于合并癌症的AMI患者最佳治疗策略存在不确定性。观察性研究在循证医学框架下对这类患者的出血风险评估具有重要价值。
要点
- 癌症患者可占急性心肌梗死病例的5%
- 恶性肿瘤是多数AMI随机对照试验的排除标准
- 观察性研究对评估AMI合并癌症患者的出血风险具有重要意义
核心结论
- 急性心肌梗死合并癌症患者的最佳治疗策略存在不确定性
研究设计与样本
- 恶性肿瘤是多数评估AMI血运重建策略或抗栓治疗的随机对照试验的排除标准
主要发现
- 癌症患者可占急性心肌梗死病例的5%
- AMI与癌症共存可能与共同危险因素、致病途径、社会决定因素、生存率改善及肿瘤治疗相关心血管毒性有关
临床怎么用
- 观察性研究在循证医学框架下对AMI合并癌症患者的出血风险评估具有重要价值
局限性
- 缺乏纳入相当比例癌症患者的AMI随机对照试验
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
While extensive knowledge and experience about the whole spectrum of cancer treatment-related cardiovascular toxicity (CTR-CVT) is achieved by those who specialise in cardio-oncology, all cardiologists encounter individuals who have cancer in addition to cardiovascular disease. 1 A prime example in this respect is the patient with active cancer presenting with an acute myocardial infarction (AMI), which may account for up to 5% of AMI cases. The coexistence of AMI and cancer has several, non-mutually exclusive explanations, such as shared risk factors, pathogenic pathways and social determinants, improved survival from either condition and, thereby, higher likelihood of overlap, and CTR-CVT. 2 Yet, there is uncertainty about the optimal treatment of AMI in oncological patients. Malignancy was a criterion for exclusion from many randomised clinical trials (RCTs) evaluating revascularisation strategies or antithrombotic therapies for AMI. 2 Indeed, an RCT on AMI with a sizeable proportion of patients with...
引用
- Heart：Importance of observational studies in the evidence-based medicine framework: the case of bleeding risk in patients with acute myocardial infarction and cancer
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。