Incidence of coronary stent thrombosis in patients with cancer undergoing percutaneous coronary intervention: protocol for a systematic review and meta-analysis

Background Cardiovascular disease is a major cause of morbidity and mortality among cancer survivors. Cancer survivors represent a substantial proportion of patients treated with percutaneous coronary intervention (PCI). Coronary stent thrombosis (ST) is a rare but catastrophic complication of PCI associated with high mortality. Despite growing use of PCI in oncology populations, the incidence of ST in cancer survivors remains uncertain. In this study, we aim to estimate the pooled incidence of ST in cancer survivors undergoing PCI. Methods This protocol has been developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A systematic search of MEDLINE (via Ovid), Embase, the Cochrane Library, Web of Science and ClinicalTrials.gov will be conducted from inception to 12 March 2026. Randomised controlled trials and observational studies including adults (≥18 years) with active or prior cancer undergoing PCI with stent implantation will be eligible. The primary outcome is the incidence of coronary ST defined using Academic Research Consortium criteria. Two reviewers will independently screen articles and a third reviewer will adjudicate any conflicts. Random-effects meta-analysis of proportions will be performed, with heterogeneity assessed using the I 2 statistic. Risk of bias will be evaluated using validated design-appropriate tools. Certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Discussion This systematic review and meta-analysis will synthesise available evidence to provide a pooled estimate of coronary ST incidence in adult cancer survivors undergoing PCI using standardised ARC definitions. We will also summarise all-cause mortality and bleeding events following ST. By exploring variation by cancer status (active vs prior), stent type and follow-up duration, and summarising reported predictors for ST, the findings may improve risk stratification and inform antithrombotic decision-making in this high-risk population. Anticipated limitations include heterogeneity in study populations, cancer characteristics and outcome definitions, and the predominance of observational data. Systematic review registration PROSPERO CRD 420261322043.