Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention

Abstract

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).

Keywords: BARC, Bleeding Academic Research Consortium; CAD, coronary artery disease; CI, confidence interval; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; DOCE, device-oriented composite endpoint; HR, hazard ratio; IPTW, inverse probability of treatment weighting; MI, myocardial infarction; PCI, percutaneous coronary interventions; PS, propensity score; bleeding; cancer; coronary artery disease; ischemia; percutaneous coronary intervention.

Graphical abstract

Figure 1

Kaplan-Meier Curves (A) DOCE, (B) bleeding (BARC 2 to 5), (C) all-cause death, (D) cardiac death, (E) myocardial infarction, and (F) and revascularization in the propensity score matched-cohort. BARC = bleeding academic research consortium; DOCE = device oriented composite endpoint.

Figure 2

Event Rates According to Time Between Cancer Diagnosis and Index PCI Among Cancer Patients The p values were based on log-rank test. Abbreviations as in Figure 1.

Central Illustration

Event Rates at 1 Year and Risks According to Years Between Cancer Diagnosis and PCI (Upper panel) Population is the propensity score matched-cohort (cancer vs. no cancer). The p values were based on Cox models. (Lower panel) Population is the overall cohort. The p values were based on Cox models. Of the study patients, 83.1% (11,339 of 13,647) and 82.2% (11,220 of 13,647) were entered into the multivariable model for cardiac death and BARC 2 to 5 bleeding, respectively. BARC = bleeding academic research consortium; CI = confidence interval; HR = hazard ratio; NS = not significant; PCI = percutaneous coronary intervention.