Clinical Outcomes After Percutaneous Coronary Intervention in Patients With Cancer

Kenji Kanenawa; Kyohei Yamaji; Takashi Morinaga; Takashi Hiromasa; Masaomi Hayashi; Seiichi Hiramori; Yusuke Tomoi; Shoichi Kuramitsu; Takenori Domei; Makoto Hyodo; Yoshimitsu Soga; Shinichi Shirai; Kenji Andò

doi:10.1253/circj.cj-20-1119

February 25, 2021Circulation JournalOpen Access

Clinical Outcomes After Percutaneous Coronary Intervention in Patients With Cancer

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Why the study?

Clinical outcomes after percutaneous coronary intervention in patients with cancer needed to be evaluated.

Does the presence of cancer increase the risk of adverse clinical outcomes such as non-cardiac death and major bleeding in patients undergoing percutaneous coronary intervention?

Structured PICO

Does the presence of cancer increase the risk of adverse clinical outcomes such as non-cardiac death and major bleeding in patients undergoing percutaneous coronary intervention?

P

Population

1,303 consecutive patients who underwent their first percutaneous coronary intervention (PCI), including 185 patients with present or a history of cancer.

I

Intervention

Percutaneous coronary intervention (PCI) in patients with cancer

C

Comparator

Percutaneous coronary intervention (PCI) in patients without cancer

O

Outcome

Clinical outcomes including non-cardiac death and major bleeding at 1-year follow-uphard clinical

Patients with cancer undergoing PCI have a higher risk of non-cardiac death, and those on active therapy have an increased risk of major bleeding, which can be effectively risk-stratified using ARC-HBR criteria.

Implication

Cancer patients had higher non-cardiac death after PCI; leaves open benefit of routine pre-procedural screening.

Abstract

BACKGROUND: The aim of this study is to evaluate clinical outcomes after percutaneous coronary intervention (PCI) in patients with cancer. METHODS AND RESULTS: Cancer screening was recommended before PCI in consecutive 1,303 patients who underwent their first PCI. By using cancer screening, cancer was diagnosed in 29 patients (2.2%). In total, 185 patients had present or a history of cancer. Patients with cancer more often suffered from non-cardiac death than those without (4.4% vs. 1.5%, P=0.006), and patients with cancer requiring ongoing therapy (n=18) more often suffered from major bleeding compared with those with recently (≤12 months) diagnosed cancer who do not have ongoing therapy (n=59) (16.7% vs. 3.4%, P=0.049). During the 1-year follow up, 25 patients (2.0%) were diagnosed as having cancer, in which 48.0% of bleeding events led to a cancer diagnosis. Patients with high bleeding risk according to the Academic Research Consortium for high bleeding risk (ARC-HBR) were associated with a greater 1-year major bleeding risk than those without high bleeding risk in patients with (7.9% vs. 0.0%, P=0.02) and without cancer (7.1% vs. 2.5%, P<0.001), respectively. CONCLUSIONS: Cancer was diagnosed in 2.2% of 1,303 unselected patients before PCI by cancer screening and in 2.0% within 1-year after PCI. Cancer was associated with a greater risk of non-cardiac death, whereas ongoing active cancer was associated with greater risk of major bleeding. ARC-HBR criteria successfully identified high-bleeding risk patients, irrespective of the presence or absence of cancer.