Key result
PCI links to ~36% lower 5-year mortality vs no intervention in concurrent cancer and IHD.
Why the study?
The incidence of concurrent cancer and ischaemic heart disease is increasing, but long-term patient prognoses remain unclear.
Does percutaneous coronary intervention improve 5-year all-cause mortality in patients with concurrent cancer and ischemic heart disease?
Cohort (n=3,622)
Yes
Does percutaneous coronary intervention improve 5-year all-cause mortality in patients with concurrent cancer and ischemic heart disease?
Hazard Ratio: 0.64 (95% CI 0.51–0.81)
p-value: p=<0.001
In patients with concurrent cancer and ischemic heart disease, undergoing PCI is associated with improved long-term survival compared to medical management alone, though their overall prognosis remains worse than cancer patients without IHD.
Should not yet change practice in cancer patients with IHD; leaves open whether RCTs confirm survival benefit.
Background: The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear.Methods: Five-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention (PCI) or IHD diagnosis), were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n=564, PCI+ group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n=3058, PCI-/IHD+ group), and patients without IHD (n=27,392, PCI-/IHD- group). Kaplan-Meier analysis was used for comparisons. Results: After propensity score matching, the PCI+ group had better prognosis (n=489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51–0.81, P<0.001) than the PCI-/IHD+ group. PCI+ patients (n=282) had significantly higher mortality than those without IHD (n=280 in each group, hazard ratio 2.88, 95% confidence interval 1.90–4.38, P<0.001). Conclusions: PCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD.
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Nishikawa et al. (2020) conducted a cohort in Concurrent cancer (colorectal, lung, prostate, gastric) and ischaemic heart disease (n=3,622). Percutaneous coronary intervention (PCI) vs. No percutaneous coronary intervention was evaluated on 5-year all-cause mortality (HR 0.64, 95% CI 0.51-0.81, p=<0.001). Percutaneous coronary intervention was associated with a significantly lower risk of 5-year all-cause mortality compared to no intervention in patients with concurrent cancer and ischaemic heart disease (HR 0.64).
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