Temporal trends in short and long-term outcomes after percutaneous coronary interventions among cancer patients

• Published in: Heart and vessels Vol. 36; no. 9; pp. 1283 - 1289
• Main Authors: Nardi Agmon, Inbar, Perl, Leor, Bental, Tamir, Itzhaki Ben Zadok, Osnat, Vaknin-Assa, Hana, Codner, Pablo, Greenberg, Gabriel, Kornowski, Ran
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-09-2021; Springer Nature B.V
• Subjects: Acute coronary syndromes; Biomedical Engineering and Bioengineering; Blood vessels; Cancer; Cardiac Surgery; Cardiology; Cardiovascular disease; Confidence intervals; Coronary artery; Coronary artery disease; Coronary Artery Disease - complications; Coronary Artery Disease - surgery; Heart diseases; Humans; Malignancy; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Myocardial Infarction; Neoplasms - complications; Original Article; Percutaneous Coronary Intervention - adverse effects; Regression analysis; Statistical analysis; Treatment Outcome; Vascular Surgery; Cardio-oncology; Acute coronary syndrome; Percutaneous intervention
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-01817-y

While mortality of acute coronary syndrome (ACS) is known to have steadily decline over the last decades, data are lacking regarding the complex sub-population of patients with both coronary artery disease and cancer. A large single-center percutaneous coronary intervention (PCI) registry was used to retrieve patients who had a known diagnosis of malignancy during PCI. Patients were divided into two groups according to the period in which PCI was performed (period 1: 2006–2011, period 2: 2012–2017). Cox regression hazard models were implemented to compare primary endpoint, defined as the composite outcomes of major adverse cardiac events (MACE) (which include cardiovascular death, myocardial infarction or target vessel revascularization) and secondary endpoint of all-cause mortality, between the two time periods. A total of 3286 patients were included, 1819 (55%) had undergone PCI in period 1, and 1467 (45%) in period 2. Both short- and long-term MACE and overall mortality were significantly lower in patients who underwent PCI at the latter period (2.3% vs. 4.3%,
p
 < 0.001 and 1.1% vs. 3.2%,
p
 < 0.001 after 30 days and 24% vs. 30%,
p
 < 0.001 and 12% vs. 22%,
p
 < 0.001 after 2 years, respectively). However, in a multivariate analysis, going through PCI in the latter period was still associated with lower rates of overall mortality (HR 0.708, 95% confidence interval [CI] 0.53–0.93,
p
 = 0.014) but there was no significant difference in MACE (HR 0.83, 95% CI 0.75–1.42,
p
 = 0.16). Patients with cancer undergoing PCI during our most contemporary period had an improved overall survival, but no significant differences were observed in the composite cardiovascular endpoints, compared to an earlier PCI period. The management of coronary patients with cancer disease remains challenging.