Author + information
- Yasushi Ueki, MDa,
- Benjamin Vögeli, BAa,
- Alexios Karagiannis, PhDb,
- Thomas Zanchin, MDa,
- Christian Zanchin, MDa,
- Daniel Rhyner, MDa,
- Tatsuhiko Otsuka, MDa,
- Fabien Praz, MDa,
- George C.M. Siontis, MD, PhDa,
- Christina Moro, RNa,
- Stefan Stortecky, MDa,
- Michael Billinger, MDa,
- Marco Valgimigli, MD, PhDa,
- Thomas Pilgrim, MDa,
- Stephan Windecker, MDa,
- Thomas Suter, MDa and
- Lorenz Räber, MD, PhDa,∗ (, )@RaberLorenz
- aDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- bClinical Trials Unit, University of Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Lorenz Räber, Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland.
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)
Dr. Pilgrim has received research grants to the institution from Biotronik, Symetis/Boston Scientific, and Edwards Lifesciences; and speaker fees from Biotronik and Boston Scientific. Dr. Valgimigli has received research grants to the institution from Abbott, Terumo, Medicure, and Astrazeneca; and personal fees from Abbott, Chiesi, Bayer, Daiichi Sankyo, Amgen, Terumo, Alvimedica, Astrazeneca, Biosensors, Idorsia, Coreflow, Vifor, and Bristol-Myers Squibb SA. Dr. Windecker has received research grants to the institution from Abbott, Amgen, Bayer, Bristol-Myers Squibb, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Sinomed, and Polares. Dr. Räber has received research grants to the institution from Abbott Vascular, Biotronik, Boston Scientific, HeartFlow, Sanofi, and Regeneron; and speaker fees from Abbott, Amgen, AstraZeneca, Bayer, CSL Behring, Occlutech, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 7, 2019.
- Revision received October 31, 2019.
- Accepted November 2, 2019.
- 2019 The Authors