In-hospital and short-term outcomes in patients with atrial fibrillation undergoing chimeric antigen receptor-T cell therapy

BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy is an innovative immunotherapy for hematologic malignancies. Cardiovascular complications associated with CAR-T therapy have also received increasing attention. However, the impact of atrial fibrillation (AF) on outcomes in patients undergoing CAR-T therapy remains poorly understood. METHODS: We conducted a retrospective study using the National Readmission Database (NRD) to identify adult patients who underwent CAR-T therapy between 2017 and 2020. We divided the patients into two groups based on the presence of AF to study in-hospital and 30-day outcomes. Propensity score matching was performed, and outcomes were analyzed using multivariable logistic regression and Cox proportional hazards models. The primary outcomes included in-hospital mortality, stroke, sepsis, and 30-day readmission. RESULTS: A total of 3,003 hospitalizations were identified, incluing 162 (5.39%) patients with AF. Patients in the AF group were older and more likely to be male. Compared with patients without AF, those with AF had higher rates of in-hospital mortality (7.4% vs 3.2%; P = 0.007), sepsis (18.5% vs 8.8%; P < 0.001), and stroke (8.0% vs 3.2%; P < 0.001). No significant differences were observed in neurotoxicity or acute kidney injury. In 30-day readmissions, there were no differences in all-cause readmission or in readmissions due to cancer- or treatment-related events, sepsis or infection, and neurologic events. CONCLUSION: Among patients undergoing CAR-T cell therapy, AF was associated with a higher risk of in-hospital mortality, stroke and sepsis. However, the 30-day all-cause readmission rate showed no difference between the AF group and the non-AF group.