Temporal trends in long-term outcomes after percutaneous coronary interventions among cancer patients.

Background:

Coronary artery disease and cancer often co-exist. While the mortality of acute coronary syndrome (ACS) is known to have steadily declined over the last decades, largely due to advances in revascularization and pharmacotherapy strategies, most trials have excluded oncology patients. Thus, information is lacking regarding this complex sub-population.

Methods:

In a single center observational study based on a large percutaneous coronary intervention (PCI) registry, we analyzed patients who had an active cancer diagnosis during PCI, or who were diagnosed with cancer during the ensuing year. Cox regression hazard models were implemented to compare major adverse cardiac events (MACE= death, MI or TVR) and overall mortality between two periods- 2006-2011 (period 1) and 2012-2017 (period 2).

Results:

A total of 3,286 patients were included, 1819 (55%) had undergone PCI at the first period, and 1467 (45%) at the second period. Patients in the second group were older (mean 72.0 years±10.8 vs. 70.5±10.1, p<.001), more had chronic renal failure (31% vs. 24%, p<.001), but less hypertension (85% vs. 89%, p=.001) and congestive heart failure (14% vs. 20%, p< .001).

MACE and overall mortality were significantly lower in patients who underwent PCI at the second compared with the first period (69% vs. 47%, p<.001 and 60% vs. 39%, p<.001, respectively). However, after correcting for confounding factors, the second period was still associated with reduced rates of overall mortality (HR-0.708, 95% confidence interval [CI] 0.53-0.93, P=.014), but not MACE (HR 0.83, 95% CI 0.75-1.42, P=.16).

Conclusion:

Oncology patients undergoing PCI during our most contemporary period had an improved overall survival, but no significant differences were observed in the composite cardiovascular end points, compared to an earlier PCI period. the management of coronary patients with cancer disease remains challenging.