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

Agmon, Inbar Nardi; Perl, Leor; Bental, Tamir; Zadok, Osnat Itzhaki Ben; Vaknin‐Assa, Hana; Codner, Pablo; Greenberg, Gabriel; Kornowski, Ran

doi:10.1007/s00380-021-01817-y

Cited by 6 publications

(2 citation statements)

References 24 publications

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“…Another concern for DES use in cancer patients is stent thrombosis, given the need for a shorter course of antiplatelet therapy in selected cases ( 16 ). In our study, the number of revascularizations was similar between the DES and BMS groups.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

Ahmed

Pacha²,

Addoumieh³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundManagement of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).MethodsWe identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan–Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.ResultsWe included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4–38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups (p = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS (p = 0.03). The use of DES was more common in patients with NSTEMI (p = 0.03). The median survival was 46 months (95% CI, 34–66). There was no significant difference in the number of revascularizations between the BMS and DES groups (p = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis (p = 0.26). In addition, independent predictors for worse survival included age > 65 years, BMI ≤ 25 g/m2, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.ConclusionsIn our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.

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Section: Discussionmentioning

confidence: 99%

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

Ahmed

Pacha²,

Addoumieh³

et al. 2022

Front. Cardiovasc. Med.

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“…Another registry study from Japan involving 3,499 patients with acute MI treated with PCI showed increased all-cause death in patients with cancer (adjusted HR: 2.43; 95% CI: 1.73-3.42) but no increased incidences of cardiovascular events including acute MI (adjusted HR: 0.71; 95% CI: 0.35-1.42) and stroke (adjusted HR: 1.41; 95% CI: 0.67-2.97) ( 195 ). Despite the increased thrombotic risk in patients with cancer, PCI has still shown the benefit of decreased major adverse cardiovascular events in patients with cancer who had acute coronary syndrome if performed within 72 hours of admission and may be underused in this patient population ( 196 , 197 , 198 ). Patients with malignancy are less likely to undergo stenting, receive drug-eluting stents, receive newer generation P2Y 12 inhibitors (ticagrelor or prasugrel), and receive standard of care medications (beta-blockers, statins, or angiotensin-converting enzyme inhibitors) compared with those without cancer ( 193 , 194 ).…”

Section: Thrombotic and Bleeding Risk In Patients With Cancermentioning

confidence: 99%

Common Pathophysiology in Cancer, Atrial Fibrillation, Atherosclerosis, and Thrombosis

Leiva

AbdelHameid

Connors

et al. 2021

JACC: CardioOncology

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Cardiovascular disease and cancer are the 2 leading causes of death worldwide. Emerging evidence suggests common mechanisms between cancer and cardiovascular disease, including atrial fibrillation and atherosclerosis. With advances in cancer therapies, screening, and diagnostics, cancer-specific survival and outcomes have improved. This increase in survival has led to the coincidence of cardiovascular disease, including atrial fibrillation and atherosclerosis, as patients with cancer live longer. Additionally, cancer and cardiovascular disease share several risk factors and underlying pathophysiologic mechanisms, including inflammation, cancer-related factors including treatment effects, and alterations in platelet function. Patients with cancer are at increased risk for bleeding and thrombosis compared with the general population. Although optimal antithrombotic therapy, including agent choice and duration, has been extensively studied in the general population, this area remains understudied in patients with cancer despite their altered thrombotic and bleeding risk. Future investigation, including incorporation of cancer-specific characteristics to traditional thrombotic and bleeding risk scores, clinical trials in the cancer population, and the development of novel antithrombotic and anti-inflammatory strategies on the basis of shared pathophysiologic mechanisms, is warranted to improve outcomes in this patient population.

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Comparing pharmacotherapy in MINOCA versus medically managed obstructive acute coronary syndrome

Adams

Sawhney²,

Singh

2021

Heart Vessels

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

Cited by 6 publications

References 24 publications

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

Percutaneous coronary intervention in patients with cancer using bare metal stents compared to drug-eluting stents

Common Pathophysiology in Cancer, Atrial Fibrillation, Atherosclerosis, and Thrombosis

Comparing pharmacotherapy in MINOCA versus medically managed obstructive acute coronary syndrome

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