Morbidity and Mortality of Major Adverse Cardiovascular Events in Hospitalized Acute Myeloid Leukemia Patients

Introduction: Patients with acute myeloid leukemia (AML) undergo different intensive chemotherapy regimens, with possible side effects including cardiovascular toxicity. This could be challenging when managing AML with its complex pathophysiology.

Methods: This is a retrospective analysis conducted using ICD-10 codes from the National Inpatient Sample (NIS) between 2016 and 2020 and analyzed with STATA BE software. Our aim is to identify major adverse cardiovascular events (MACE) in patients with AML. Descriptive analysis was used to illustrate baseline characteristics of hospitalized patients with AML. Logistic regression was further employed to examine the association between AML and MACE. Underlying comorbidities including hypertension, hyperlipidemia, diabetes, chronic kidney disease (CKD), smoking, and thrombophilia were adjusted for.

Results: This study consisted of 103,697 hospitalized AML patients with a mean age of 61 years, most of whom were of white race (69%) and male gender (55.6%). The most common underlying comorbid condition was hypertension (34%), followed by hyperlipidemia (30.5%), smoking (25%), congestive heart failure (17.3%), and chronic kidney disease (16.4%). Cardiovascular-related death accounted for 34%. AML patients not in remission (AMLniR) made up most of our cohort (73.6%) and were generally older than AML in remission (AMLiR) and AML with relapse (rAML) (mean age of 63 years vs 54.6 and 54.1 in other two groups, respectively). rAML had higher rates of death (11%) compared to AMLiR (2.8%) and AMLniR (8.2%). Hospitalized patients with relapse were more likely to undergo bone marrow transplant (23.6%).

The effect size of the association between AMLniR and AMLiR with MACE rounded to 1 (p=0.98 and p=0.043, respectively). This could be due to underlying cardiac risk factors rather than the presence of AML. Interestingly, AML with relapse were less likely to have major cardiovascular events (Odds ratio (OR) 0.9, 95% CI, 0.86-0.98; p value <0.01), possibly related to younger age observed in this group. Patients who underwent bone marrow transplant and received chemotherapy had less odds of developing major adverse cardiovascular events (OR 0.8, 95% CI, 0.7-0.95 and OR 0.6, 95% CI, 0.5-0.63). MACE in AML patients ((OR 2, 95% CI, 1.9-2.12,), AMLniR (OR 1.46, 95% CI, 1.2-1.9), and rAML (OR 2.5, 95% CI, 2-3.2) were associated with increased in-hospital deaths. However, AMLiR had lower likelihood of deaths (OR 0.6, 95% CI, 0.45-0.74).

Conclusion: Hospitalized AML patients with relapse had lower rates of major cardiovascular events, possibly due to the younger age of this group. Bone marrow transplant and chemotherapy were associated with less major cardiovascular events, while AMLniR and rAML were associated with increased in-hospital mortality. More research is needed to evaluate MACE in AML patients undergoing intensive chemotherapy.

No relevant conflicts of interest to declare.