Outcomes following percutaneous coronary intervention in patients with cancer

• Authors: Raymundo A Quintana, Emory University; Dominique J Monlezun, The University of Texas MD Anderson Cancer Center, Houston; Giovanni Davogustto, Vanderbilt University; Humberto R Saenz, University of California San Diego; Francisco Lozano-Ruiz, Medica Sur Hospital; Daisuke Sueta, Kumamoto University; Kenichi Tsujita, Kumamoto University; Uri Landes, Tel-Aviv University; Ali E Denktas, Baylor College of Medicine and Michael E. DeBakey VA Medical Center; Mahboob Alam, Baylor College of Medicine and Michael E. DeBakey VA Medical Center; David Paniagua, Baylor College of Medicine and Michael E. DeBakey VA Medical Center; Daneil Addison, Ohio State University; Hani Jneid, Baylor College of Medicine and Michael E. DeBakey VA Medical Center
• Journal Title: INTERNATIONAL JOURNAL OF CARDIOLOGY
• Volume: Volume 300
• Publisher: Elsevier | 2020-02-01, Pages 106-112
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ijcard.2019.09.016
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Cancer; Percutaneous coronary intervention; Mortality; Outcomes; Drug eluding stent; Meta-analysis

Abstract

Background: Randomized clinical trials demonstrated the benefits of percutaneous coronary interventions (PCI) in diverse clinical settings. Patients with cancer were not routinely included in these studies. Methods/results: Literature search of PubMed, Cochrane, Medline, SCOPUS, EMBASE, and ClinicalTrials was conducted to identify studies that assessed one-year all-cause, cardiovascular and non-cardiovascular mortality in patients with historical or active cancer. Using the random effects model, we computed risk ratios (RRs) and standardized mean differences and their 95% confidence intervals for the dichotomous and continuous measures and outcomes, respectively. Of 171 articles evaluated in total, 5 eligible studies were included in this meta-analysis. In total, 33,175 patients receiving PCI were analyzed, of whom 3323 patients had cancer and 29,852 no cancer history. Patients in the cancer group had greater all-cause mortality [RR 2.22 (1.51–3.26; p < 0.001)], including cardiovascular mortality [RR 1.34 (1.1–1.65; p = 0.005)] and non-cardiovascular mortality [RR 3.42 (1.74–6.74; p ≤ 0.001], at one-year compared to non-cancer patients. Patients in the cancer group had greater one-month all-cause mortality [RR 2.01 (1.24–3.27; p = 0.005)] and greater non-cardiovascular mortality [RR 6.87 (3.10–15.21; p ≤0.001)], but no difference in one-month cardiovascular mortality compared to non-cancer patients. Meta-regression analyses showed that the difference in one-year all-cause and cardiovascular mortality between both groups was not attributable to differences in baseline characteristics, index PCI characteristics, or medications prescribed at discharge. Conclusions: Patients with cancer undergoing PCI have worse mid-term outcomes compared to non-cancer patients. Cancer patients should be managed by a multi-specialist team, in an effort to close the mortality gap.