Key result
Prior thoracic radiation therapy was associated with a significantly higher risk of all-cause mortality (RR 1.29) compared to no prior radiation in patients undergoing percutaneous coronary intervention.
Why the study?
Thoracic radiation predisposes to accelerated CAD, but data on short- and long-term outcomes following revascularization in these patients are lacking.
Does a history of prior thoracic radiation increase all-cause mortality in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=13,941)
Does a history of prior thoracic radiation increase all-cause mortality in patients undergoing percutaneous coronary intervention?
Patients with a history of thoracic radiation undergoing PCI have a 29% higher risk of all-cause mortality compared to non-irradiated patients, though cardiac mortality and MI rates are similar.
May warrant closer post-PCI surveillance in patients with prior thoracic radiation; leaves open optimal strategies pending prospective trials.
Background: Thoracic radiation predisposes patients to accelerated coronary artery disease. There is a paucity of data in both short-term and long-term outcomes following revascularization in patients who have undergone thoracic radiation. Methods: We performed a search of the Medline, Cochrane, and Scopus databases for studies that compared outcomes in cancer patients who have undergone thoracic radiation and percutaneous coronary intervention (PCI). The primary outcome of our meta-analysis was all-cause mortality. Secondary outcomes included cardiac mortality, myocardial infarction (MI), and restenosis. Results: The analysis included four observational studies with a total of 13,941 patients for the primary outcome of all-cause mortality. There were a total of 1,322 patients analyzed for cardiac mortality, 13,103 for MI, and 10,530 for restenosis. The longest follow-up for the primary outcome was 16 years. There was statistically significant higher risk of all-cause mortality in patients who underwent thoracic radiation (risk ratio (RR): 1.29, 95% confidence interval (CI): 1.08 - 1.54, P = 0.004). There was no statistically significant difference in cardiac mortality (RR: 1.15, 95% CI: 0.83 - 1.61, P = 0.40), MI (RR: 1.01, 95% CI: 0.20 - 5.08, P = 0.99), and restenosis (RR: 1.92, 95% CI: 0.24 - 15.35, P = 0.54). Conclusion: In this meta-analysis, we found a higher risk of all-cause mortality in patients with a history of thoracic radiation undergoing PCI, likely from underlying malignancy itself.
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Thakker et al. (2022) conducted a meta-analysis in Coronary artery disease requiring percutaneous coronary intervention (n=13,941). Prior thoracic radiation therapy vs. No prior thoracic radiation therapy was evaluated on All-cause mortality (RR 1.29, 95% CI 1.08 - 1.54, p=0.004). Prior thoracic radiation therapy was associated with a significantly higher risk of all-cause mortality (RR 1.29) compared to no prior radiation in patients undergoing percutaneous coronary intervention.
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