Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention

Yasushi Ueki, MD; Benjamin Vögeli, BA; Alexios Karagiannis, PhD; Thomas Zanchin, MD; Christian Zanchin, MD; Daniel Rhyner, MD; Tatsuhiko Otsuka, MD; Fabien Praz, MD; George C.M. Siontis, MD, PhD; Christina Moro, RN; Stefan Stortecky, MD; Michael Billinger, MD; Marco Valgimigli, MD, PhD; Thomas Pilgrim, MD; Stephan Windecker, MD; Thomas Suter, MD; Lorenz Räber, MD, PhD

JACC. CardioOncology (Dec 2019)

Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention

Yasushi Ueki, MD,
Benjamin Vögeli, BA,
Alexios Karagiannis, PhD,
Thomas Zanchin, MD,
Christian Zanchin, MD,
Daniel Rhyner, MD,
Tatsuhiko Otsuka, MD,
Fabien Praz, MD,
George C.M. Siontis, MD, PhD,
Christina Moro, RN,
Stefan Stortecky, MD,
Michael Billinger, MD,
Marco Valgimigli, MD, PhD,
Thomas Pilgrim, MD,
Stephan Windecker, MD,
Thomas Suter, MD,
Lorenz Räber, MD, PhD

Affiliations

Yasushi Ueki, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Benjamin Vögeli, BA: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Alexios Karagiannis, PhD: Clinical Trials Unit, University of Bern, Bern, Switzerland
Thomas Zanchin, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Christian Zanchin, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Daniel Rhyner, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Tatsuhiko Otsuka, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Fabien Praz, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
George C.M. Siontis, MD, PhD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Christina Moro, RN: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Stefan Stortecky, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Michael Billinger, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Marco Valgimigli, MD, PhD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Thomas Pilgrim, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Stephan Windecker, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Thomas Suter, MD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
Lorenz Räber, MD, PhD: Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland; Address for correspondence: Dr. Lorenz Räber, Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland.

Journal volume & issue: Vol. 1, no. 2
pp. 145 – 155

Abstract

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Objectives: The purpose of this study was to evaluate ischemic and bleeding outcomes of unselected cancer patients undergoing percutaneous coronary intervention (PCI). Background: The number of cancer patients undergoing PCI is increasing despite concerns regarding ischemic and bleeding risks. Methods: Between 2009 and 2017, consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Cancer-specific data including type, date of initial diagnosis, and health status at index PCI were collected. We performed propensity score matching to adjust for baseline differences between patients with and without cancer. The primary ischemic endpoint was the device-oriented composite endpoint (cardiac death, target vessel myocardial infarction, target lesion revascularization) at 1 year, and the primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) 2 to 5 at 1 year. Results: Among 13,647 patients, 1,368 (10.0%) had an established diagnosis of cancer. The 3 leading cancer types were prostate (n = 294), gastrointestinal tract (n = 188), and hematopoietic (n = 177). At index PCI, 179 (13.1%) patients were receiving active cancer treatment. In matched analysis, there was no significant difference in device-oriented composite endpoint (11.5% vs. 10.2%; p = 0.251), whereas cardiac death and BARC 2 to 5 bleeding occurred more frequently among patients with cancer compared with those without cancer (6.8% vs. 4.5%; p = 0.010 and 8.0% vs. 6.0%; p = 0.026, respectively). Cancer diagnosis within 1 year before PCI emerged as an independent predictor for cardiac death and BARC 2 to 5 bleeding at 1 year. Conclusions: Cancer patients carry an increased risk of cardiac mortality that was not associated with stent-related ischemic events among patients undergoing PCI in routine clinical practice. Higher risk of bleeding in cancer patients undergoing PCI deserves particular attention. (CARDIOBASE Bern PCI Registry; NCT02241291)

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

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