Temporal trends, cardiovascular complications, and outcomes in patients receiving CAR T-cell therapy: a 6-year nationwide analysis

Chimeric antigen receptor (CAR) T-cell therapy has transformed the treatment of relapsed or refractory hematologic malignancies. However, real-world data describing cardiovascular complications with CAR T-cell therapy remain limited. Using the National Inpatient Sample, we identified hospitalizations involving CAR T-cell therapy from 2017 to 2022. Temporal trends, in-hospital mortality, cardiovascular complications, and other clinical outcomes were evaluated using survey-weighted regression models. Among 13,370 weighted hospitalizations, CAR T-cell use increased from 70 cases in 2017 to 4,335 in 2022. The overall in-hospital mortality rate was 3.4%. Cardiovascular complications were observed in a subset of patients, including arrhythmias in 20.2%, acute myocardial infarction in 0.5%, stroke in 1.0%, cardiogenic shock in 0.2%, and major adverse cardiovascular and cerebrovascular events in 4.5%. Atrial fibrillation was the most common arrhythmia (11.1%), followed by conduction abnormalities (3.9%). The prevalence of arrhythmias increased with advancing age, reaching 48.3% in patients older than 80 years. Acute kidney injury occurred in 14.4%, with 1.7% requiring renal replacement therapy. Cytokine release syndrome occurred in 61.0% in 2021 and 62.1% in 2022, while immune effector cell–associated neurotoxicity syndrome was observed in 24.2% in 2022. Mean length of stay was 18.3 days, and inflation-adjusted hospitalization costs increased from $83,939 in 2017 to $378,507 in 2022. CAR T-cell therapy utilization increased substantially in the United States over the study period, with relatively low in-hospital mortality but notable cardiovascular complications, particularly arrhythmias. These findings highlight the importance of cardiovascular risk assessment and monitoring in patients undergoing CAR T-cell therapy.