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. 2022 Feb 14:8:793877.
doi: 10.3389/fcvm.2021.793877. eCollection 2021.

Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Nicole Thomason  1 , Dominique J Monlezun  2   3 , Awad Javaid  4 , Alexandru Filipescu  1 , Efstratios Koutroumpakis  2 , Fisayomi Shobayo  1 , Peter Kim  2 , Juan Lopez-Mattei  2 , Mehmet Cilingiroglu  4 , Gloria Iliescu  5 , Kostas Marmagkiolis  6 , Pedro T Ramirez  7 , Cezar Iliescu  2
Affiliations

Percutaneous Coronary Intervention in Patients With Gynecological Cancer: Machine Learning-Augmented Propensity Score Mortality and Cost Analysis for 383,760 Patients

Nicole Thomason et al. Front Cardiovasc Med. .

Abstract

Background: Despite the growing number of patients with both coronary artery disease and gynecological cancer, there are no nationally representative studies of mortality and cost effectiveness for percutaneous coronary interventions (PCI) and this cancer type.

Methods: Backward propagation neural network machine learning supported and propensity score adjusted multivariable regression was conducted for the above outcomes in this case-control study of the 2016 National Inpatient Sample (NIS), the United States' largest all-payer hospitalized dataset. Regression models were fully adjusted for age, race, income, geographic region, cancer metastases, mortality risk, and the likelihood of undergoing PCI (and also with length of stay [LOS] for cost). Analyses were also adjusted for the complex survey design to produce nationally representative estimates. Centers for Disease Control and Prevention (CDC)-based cost effectiveness ratio (CER) analysis was performed.

Results: Of the 30,195,722 hospitalized patients meeting criteria, 1.27% had gynecological cancer of whom 0.02% underwent PCI including 0.04% with metastases. In propensity score adjusted regression among all patients, the interaction of PCI and gynecological cancer (vs. not having PCI) significantly reduced mortality (OR 0.53, 95%CI 0.36-0.77; p = 0.001) while increasing LOS (Beta 1.16 days, 95%CI 0.57-1.75; p < 0.001) and total cost (Beta $31,035.46, 95%CI 26758.86-35312.06; p < 0.001). Among gynecological cancer patients, mortality was significantly reduced by PCI (OR 0.58, 95%CI 0.39-0.85; p = 0.006) and being in East North Central, West North Central, South Atlantic, and Mountain regions (all p < 0.03) compared to New England. PCI reduced mortality but not significantly for metastatic patients (OR 0.74, 95%CI 0.32-1.71; p = 0.481). Eighteen extra gynecological cancer patients' lives were saved with PCI for a net national cost of $3.18 billion and a CER of $176.50 million per averted death.

Conclusion: This large propensity score analysis suggests that PCI may cost inefficiently reduce mortality for gynecological cancer patients, amid income and geographic disparities in outcomes.

Keywords: PCI; cardio oncology; gynecologic malignancies; gynecological tumors; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Machine learning–augmented propensity score adjusted multivariable regression of inpatient mortality among gynecological malignancy patients (N = 383,760 admissions). Multivariable regression fully adjusted for age, race, income, metastases, and mortality risk by Diagnosis Related Group; NSTEMI/UA, non-ST elevation myocardial infarction/unstable angina; STEMI, ST-elevation myocardial infarction; *p < 0.05.
Figure 2
Figure 2
Multivariable regression of mortality by gynecological oncology status vs. no cancer (N = 383,760 admissions). Fully adjusted for age, race, income, region, PCI, PCI likelihood, and NIS-calculated mortality risk by DRG.
See this image and copyright information in PMC

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