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Patients with vs without cancer were found to be at an increased risk for cardiac mortality and bleeding after undergoing a percutaneous coronary intervention, according to a study published in JACC: Cardiooncology.
All patients included in this study were prospectively enrolled in the Bern Percutaneous Coronary Intervention Registry (Clinicaltrials.gov identifier: NCT02241291), starting in January 2009. Demographic data as well as information on procedure characteristics, in-hospital and 1-year outcomes, were prospectively collected. The primary ischemic outcome was the device-oriented composite endpoint (ie, cardiac death, target vessel myocardial infarction, and target lesion revascularization), and the primary bleeding outcome was defined according to the Bleeding Academic Research Consortium (BARC) composite type 2 to 5 criteria.
Of the 13,647 patients included in this study, 1368 participants (10.0%) had a cancer diagnosis; 14.8% of patients were diagnosed with cancer in the year preceding the percutaneous coronary intervention. The most common types of cancer in this cohort were prostate (21.5%), gastrointestinal tract (13.7%), hematopoietic (12.9%), breast (12.6%), bladder (8.7%), skin (7.7%), lung (5.6%), and head/neck (5.5%) cancers.,.
Patients with vs without cancer had higher scores on the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) 0 to 100 scale (26.4 vs 19.6, respectively; P <.001). At discharge, patients with vs without cancer were administered dual antiplatelet therapy (93.9% vs 95.3%, respectively; P =.024) and P2Y12 inhibitors (30.6% vs 41.6%, respectively; P <.001) less frequently, and were prescribed anticoagulation therapy (11.4% vs 7.9%, respectively; P <.001) and triple therapy (12.3% vs 8.2%, respectively; P <.001) more frequently. The device-oriented composite endpoint was comparable in patients with vs without cancer. Patients with vs without cancer had an increased risk for cardiac death (hazard ratio [HR], 1.64; 95% CI, 1.17-2.31; P =.004), and comparable risks for target vessel myocardial infarction and target lesion revascularization. Patients with vs without cancer were more likely to meet the Bleeding Academic Research Consortium composite type 2 to 5 criteria (HR, 1.55; 95% CI, 1.14-2.11; P =.005). Patients with a recent cancer diagnosis (ie, ≤1 year) had a higher risk for cardiac death, all-cause death, and BARC 2 to 5 bleeding compared with patients diagnosed with cancer >1 year before percutaneous coronary intervention.
A recent cancer diagnosis was found to be an independent predictor of cardiac death (adjusted HR, 1.92; 95% CI, 1.10-3.36; P =.022) and of BARC 2 to 5 bleeding (adjusted HR, 1.75; 95% CI, 1.03-2.98; P =.04) in regression analyses.
Study limitations include a cohort from a single center which may limit generalizability, the possibility that other confounding factors were not included as variables, the heterogeneous nature of the cancer population, and the absence of data on platelet count, which can be affected by cancer or cancer treatment.
“[P]atients with cancer had an increased risk [for] cardiac death and bleeding, but not ischemic events. Specifically, a recent cancer diagnosis (≤1 year) was an independent predictor for cardiac death and bleeding.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Reference
Ueki Y, Vögeli B, Karagiannis A, et al. Ischemia and bleeding in cancer patients undergoing percutaneous coronary intervention. JACC: CardioOncology. 2019;1(2):145-155.
