Prognostic Impact of Cancer Activity on Clinically Relevant Bleeding Events After Percutaneous Coronary Intervention: A Retrospective Study

Abstract

Background: Prevalence of cancer is a high risk factor for bleeding events related with antiplatelet therapy after percutaneous coronary intervention (PCI) in cancer patients. However, the long-term bleeding event rates have not been elucidated previously. Further risk stratification was not sufficiently assessed among cancer patients. This study aimed to evaluate the risk factors for clinically relevant bleeding events in cancer patients after PCI with stent implantation.Methods: Among 236 patients who received PCI between 2013 and 2018, 89 cancer patients with first PCI with stent implantation, without prior dual-antiplatelet therapy (DAPT), were analyzed. They were divided into the active cancer (n=44) and non-active cancer (n=45) groups. The active cancer group included non-operable patients currently on treatment or those with metastasis. The non-active cancer group included patients who had already undergone radical surgery or had planned radical surgery within 3 months after the index PCI. The primary endpoint was bleeding events, characterized as Bleeding Academic Research Consortium (BARC) types 2, 3, and 5. The secondary endpoint was 3-point major adverse cardiovascular events (3P-MACE) determined as the composite of cardiac death, nonfatal myocardial infarction, and nonfatal stroke.Results: During the median follow-up period of 2.2 years, there were 11 patients with bleeding events, with only 1 patient in the non-active cancer group. Of the other 10 patients, 5 experienced bleeding during the dual-antiplatelet therapy (DAPT) period, while the remaining 5 experienced bleeding during the single-antiplatelet therapy (SAPT) period. The Kaplan-Meier analysis showed that the active cancer group had a significantly greater number of bleeding events of BARC types 2, 3, and 5 (log-rank, P=0.010). Multivariate Cox regression hazards model analysis revealed that cancer activity was an independent significant risk factor (HR, 9.03; 95% CI, 1.33–176.69; P=0.023). During the 2.5-years [IQR: 0.7–3.0] follow-up period, there was no significant difference in the 3P-MACE between the active and non-active cancer patients.Conclusions: The non-active cancer group presented with significantly lower clinically relevant bleeding after PCI than the active cancer patients. However, the bleeding risk was high in the active cancer groups during both the DAPT and SAPT periods.