Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention

被引:44
作者
Ueki, Yasushi [1 ]
Vogeli, Benjamin [1 ]
Karagiannis, Alexios [2 ]
Zanchin, Thomas [1 ]
Zanchin, Christian [1 ]
Rhyner, Daniel [1 ]
Otsuka, Tatsuhiko [1 ]
Praz, Fabien [1 ]
Siontis, George C. M. [1 ]
Moro, Christina [1 ]
Stortecky, Stefan [1 ]
Billinger, Michael [1 ]
Valgimigli, Marco [1 ]
Pilgrim, Thomas [1 ]
Windecker, Stephan [1 ]
Suter, Thomas [1 ]
Raber, Lorenz [1 ]
机构
[1] Univ Bern, Bern Univ Hosp, Dept Cardiol, CH-3010 Bern, Switzerland
[2] Univ Bern, Clin Trials Unit, Bern, Switzerland
关键词
bleeding; cancer; coronary artery disease; ischemia; percutaneous coronary intervention; DUAL-ANTIPLATELET THERAPY; RISK; VALIDATION; DISEASE; ESC; GUIDELINES; SURGERY; TRIALS; SCORE;
D O I
10.1016/j.jaccao.2019.11.001
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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. (C) 2019 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:145 / 155
页数:11
相关论文
共 29 条
[1]   Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents Risk Scores From PARIS [J].
Baber, Usman ;
Mehran, Roxana ;
Giustino, Gennaro ;
Cohen, David J. ;
Henry, Timothy D. ;
Sartori, Samantha ;
Ariti, Cono ;
Litherland, Claire ;
Dangas, George ;
Gibson, C. Michael ;
Krucoff, Mitchell W. ;
Moliterno, David J. ;
Kirtane, Ajay J. ;
Stone, Gregg W. ;
Colombo, Antonio ;
Chieffo, Alaide ;
Kini, Annapoorna S. ;
Witzenbichler, Bernhard ;
Weisz, Giora ;
Steg, Philippe Gabriel ;
Pocock, Stuart .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2016, 67 (19) :2224-2234
[2]   Risk of Arterial Thromboembolic Events With Sunitinib and Sorafenib: A Systematic Review and Meta-Analysis of Clinical Trials [J].
Choueiri, Toni K. ;
Schutz, Fabio A. B. ;
Je, Youjin ;
Rosenberg, Jonathan E. ;
Bellmunt, Joaquim .
JOURNAL OF CLINICAL ONCOLOGY, 2010, 28 (13) :2280-2285
[3]   Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials [J].
Costa, Francesco ;
van Klaveren, David ;
James, Stefan ;
Heg, Dik ;
Raber, Lorenz ;
Feres, Fausto ;
Pilgrim, Thomas ;
Hong, Myeong-Ki ;
Kim, Hyo-Soo ;
Colombo, Antonio ;
Steg, Philippe Gabriel ;
Zanchin, Thomas ;
Palmerini, Tullio ;
Wallentin, Lars ;
Bhatt, Deepak L. ;
Stone, Gregg W. ;
Windecker, Stephan ;
Steyerberg, Ewout W. ;
Valgimigli, Marco .
LANCET, 2017, 389 (10073) :1025-1034
[4]   Clinical end points in coronary stent trials - A case for standardized definitions [J].
Cutlip, Donald E. ;
Windecker, Stephan ;
Mehran, Roxana ;
Boam, Ashley ;
Cohen, David J. ;
van Es, Gerrit-Anne ;
Steg, P. Gabriel ;
Morel, Marie-angele ;
Mauri, Laura ;
Vranckx, Pascal ;
McFadden, Eugene ;
Lansky, Alexandra ;
Hamon, Martial ;
Krucoff, Mitchell W. ;
Serruys, Patrick W. .
CIRCULATION, 2007, 115 (17) :2344-2351
[5]   Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer [J].
Darby, Sarah C. ;
Ewertz, Marianne ;
McGale, Paul ;
Bennet, Anna M. ;
Blom-Goldman, Ulla ;
Bronnum, Dorthe ;
Correa, Candace ;
Cutter, David ;
Gagliardi, Giovanna ;
Gigante, Bruna ;
Jensen, Maj-Britt ;
Nisbet, Andrew ;
Peto, Richard ;
Rahimi, Kazem ;
Taylor, Carolyn ;
Hall, Per .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (11) :987-998
[6]   Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II [J].
Farooq, Vasim ;
van Klaveren, David ;
Steyerberg, Ewout W. ;
Meliga, Emanuele ;
Vergouwe, Yvonne ;
Chieffo, Alaide ;
Kappetein, Arie Pieter ;
Colombo, Antonio ;
Holmes, David R., Jr. ;
Mack, Michael ;
Feldman, Ted ;
Morice, Marie-Claude ;
Stahle, Elisabeth ;
Onuma, Yoshinobu ;
Morel, Marie-angele ;
Garcia-Garcia, Hector M. ;
van Es, Gerrit Anne ;
Dawkins, Keith D. ;
Mohr, Friedrich W. ;
Serruys, Patrick W. .
LANCET, 2013, 381 (9867) :639-650
[7]   A proportional hazards model for the subdistribution of a competing risk [J].
Fine, JP ;
Gray, RJ .
JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1999, 94 (446) :496-509
[8]   Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE) [J].
Fox, Keith A. A. ;
Dabbous, Omar H. ;
Goldberg, Robert J. ;
Pieper, Karen S. ;
Eagle, Kim A. ;
Van de Werf, Frans ;
Avezum, Alvaro ;
Goodman, Shaun G. ;
Flather, Marcus D. ;
Anderson, Frederick A., Jr. ;
Granger, Christopher B. .
BMJ-BRITISH MEDICAL JOURNAL, 2006, 333 (7578) :1091-1094
[9]   Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil [J].
Frickhofen, N ;
Beck, FJ ;
Jung, B ;
Fuhr, HG ;
Andrasch, H ;
Sigmund, M .
ANNALS OF ONCOLOGY, 2002, 13 (05) :797-801
[10]   Incidence, Predictors, and Impact of Post-Discharge Bleeding After Percutaneous Coronary Intervention [J].
Genereux, Philippe ;
Giustino, Gennaro ;
Witzenbichler, Bernhard ;
Weisz, Giora ;
Stuckey, Thomas D. ;
Rinaldi, Michael J. ;
Neumann, Franz-Josef ;
Metzger, D. Christopher ;
Henry, Timothy D. ;
Cox, David A. ;
Duffy, Peter L. ;
Mazzaferri, Ernest ;
Yadav, Mayank ;
Francese, Dominic P. ;
Palmerini, Tullio ;
Kirtane, Ajay J. ;
Litherland, Claire ;
Mehran, Roxana ;
Stone, Gregg W. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2015, 66 (09) :1036-1045