In PCI population, cancer confers mortality, bleeding risks
Click Here to Manage Email Alerts
Among patients who underwent PCI, those with cancer had elevated risks for cardiac mortality and bleeding, researchers reported in JACC: CardioOncology.
The elevated cardiac mortality risk in those with cancer was not related to stent-associated ischemic events, Yasushi Ueki, MD, from the department of cardiology at Bern University Hospital, Switzerland, and colleagues wrote.
The researchers analyzed 13,647 patients (mean age, 68 years; 26% women) from the Bern PCI registry who underwent PCI between January 2009 and January 2017. In the cohort, 10% of patients had cancer, and of those with cancer, 13.1% were receiving active cancer treatment at the time of PCI.
The most common types of cancer were prostate (21.5%), gastrointestinal tract (13.7%) and hematopoietic (12.9%), according to the researchers.
Using propensity matching, the researchers generated 1,343 pairs for the primary analysis. In the propensity-matched analysis, the primary ischemic endpoint of a device-oriented composite endpoint of cardiac death, target vessel MI or target lesion revascularization at 1 year did not differ between the groups (cancer, 11.5%; no cancer, 10.2%; HR = 1.18; 95% CI, 0.93-1.5).
Bleeding risk elevated
However, the primary bleeding endpoint of BARC 2 to 5 bleeding at 1 year was higher in those with cancer (8% vs. 6%; HR = 1.55; 95% CI, 1.14-2.11).
At 1 year, compared with the no-cancer group, cardiac death was higher in the cancer group (HR = 1.64; 95% CI, 1.17-2.31), as was CV death (HR = 1.64; 95% CI, 1.18-2.27), all-cause death (HR = 2.03; 95% CI, 1.55-2.65) and non-CV death (HR = 3.1; 95% CI, 1.89-5.06), according to the researchers.
Cancer diagnosis less than 1 year before PCI was an independent predictor of cardiac death (HR = 3.43; 95% CI, 2.23-5.26) and BARC 2 to 5 bleeding (HR = 2.31; 95% CI, 1.53-3.5) at 1 year, as was cancer diagnosis 5 years or more before PCI (HR for cardiac death = 1.71; 95% CI, 1.26-2.31; HR for BARC 2 to 5 bleeding = 1.41; 95% CI, 1.07-1.85), Ueki and colleagues wrote.
The researchers noted the cardiac death risk in patients with cancer existed despite no elevated risk for MI, stroke, stent thrombosis or revascularization.
“Explanations for an increased risk of cardiac death without increased hazards for other ischemic endpoints are likely multifactorial,” they wrote. “First, several adverse effects of cancer treatment might increase the risk of cardiac death. This hypothesis is supported by our finding that patients diagnosed with cancer within 1 year before PCI had an increased risk of cardiac death. because cancer treatments usually start immediately after cancer diagnosis, and the risk was attenuated over time. Second, a higher incidence of bleeding in patients with cancer may also contribute to an increased risk of cardiac death. Post-PCI bleeding (periprocedural and postdischarge) is known to be associated with increased mortality, to a greater degree than post-discharge MI. Third, patients with cancer had a higher risk of unclear death compared with those without. According to universal definition of cardiac death, unclear death belongs to the category of cardiac death, although by far not every unclear death is of cardiac origin.”
Safe, viable option
In a related editorial, Cardiology Today Next Gen Innovator Jay Giri, MD, MPH, FAHA, director of peripheral intervention at the Hospital of the University of Pennsylvania and assistant professor of medicine at the Perelman School of Medicine at the University of Pennsylvania, and Ashwin S. Nathan, MD, MSHP, fellow in cardiovascular medicine at Penn, wrote that due to the lack of elevated risk for stent-related complications, the results “support the contention that PCI is a safe and viable option among cancer patients to treat unstable coronary syndromes and can also be considered as an option to relieve angina and improve quality of life in select circumstances.”
However, they wrote, “it becomes paramount to identify strategies to modify bleeding risk in this high-risk population. One such strategy may be to reduce the use of potent P2Y12 inhibitors ... in favor of clopidogrel.” – by Erik Swain
Disclosures: Ueki and Nathan report no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures. Giri reports he has served on advisory boards for AstraZeneca and Philips and has received institutional research grants from Recor Medical and St. Jude Medical.
Click Here to Manage Email Alerts