Key result
ICI-related cardiac events like myocarditis are linked to ~26% worse 1-year overall survival.
Why the study?
Immune checkpoint inhibitor induced cardiac immune related adverse events are challenging to study and large database analyses may provide needed insights.
Does the development of cardiac immune-related adverse events reduce one-year overall survival in adult patients receiving immune checkpoint inhibitor therapy for neoplasm?
Cohort (n=88,928)
Yes
Does the development of cardiac immune-related adverse events reduce one-year overall survival in adult patients receiving immune checkpoint inhibitor therapy for neoplasm?
Hazard Ratio: 1.26 (95% CI 1.04–1.54)
p-value: p=0.02
Cardiac inflammatory immune-related adverse events following immune checkpoint inhibitor therapy are rare but significantly reduce one-year overall survival.
Cardiac irAEs after ICI therapy linked to higher 1-year mortality; supports monitoring but leaves optimal strategies open for prospective trials.
INTRODUCTION: Immune checkpoint inhibitor(ICI) induced cardiac immune related adverse events are challenging to study; Leveraging large data bases like TriNetX global health network may provide needed insights. METHODS: We performed a retrospective cohort study including patients diagnosed neoplasm and 18 and older when receiving ICI therapy from 1/1/2011 to 12/31/2022. Queried ICD 9/10 codes identified patients experiencing myocarditis, pericarditis, pericardial effusion, and cardiac tamponade within 1 year of ICI initiation. Survival analyses compared one-year overall survival (OS) of patients experiencing cardiac irAEs against propensity score matched populations not experiencing them. RESULTS: In 88,928 identified ICI patients, the incidence of myocarditis(0.48%), pericarditis(0.22%), and cardiac tamponade(0.47%) were less than 1% while pericardial effusion occurred in 4.71% of patients. Hazard ratios (HRs) were significantly higher in all cardiac irAE groups: myocarditis (HR:1.26, 95% CI:1.04-1.54, p = 0.02), pericarditis (HR:1.36, 95% CI:1.02-1.82, p = 0.04), pericardial effusion (HR:1.49, 95% CI:1.39-1.59, p < 0.0001), cardiac tamponade (HR:2.15, 95% CI:1.79-2.57, p < 0.0001), and overall pericardial disease (HR:1.46, 95% CI:1.37-1.56, p < 0.0001). There was no significant difference in OS between myocarditis and pericarditis or overall pericardial diseases. DISCUSSION/CONCLUSION: Utilizing a uniquely large cohort of ICI patients, this study further shows the rarity of cardiac inflammatory irAEs and highlights their significant impact on patient survival.
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Ozaki et al. (2025) conducted a cohort in Neoplasm receiving immune checkpoint inhibitor therapy (n=88,928). Cardiac immune-related adverse events (myocarditis, pericarditis, pericardial effusion, cardiac tamponade) vs. Propensity score matched patients not experiencing cardiac immune-related adverse events was evaluated on One-year overall survival (OS) (HR 1.26, 95% CI 1.04-1.54, p=0.02). In patients receiving immune checkpoint inhibitors, cardiac adverse events like myocarditis (HR 1.26; 95% CI 1.04-1.54; p=0.02) and pericardial disease significantly worsened 1-year overall survival.
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