Clinical Outcomes After Percutaneous Coronary Intervention in Patients With Cancer

Abstract

Background: The aim of this study is to evaluate clinical outcomes after percutaneous coronary intervention (PCI) in patients with cancer. Methods and Results: Cancer screening was recommended before PCI in consecutive 1,303 patients who underwent their first PCI. By using cancer screening, cancer was diagnosed in 29 patients (2.2%). In total, 185 patients had present or a history of cancer. Patients with cancer more often suffered from non-cardiac death than those without (4.4% vs. 1.5%, P=0.006), and patients with cancer requiring ongoing therapy (n=18) more often suffered from major bleeding compared with those with recently (≤12 months) diagnosed cancer who do not have ongoing therapy (n=59) (16.7% vs. 3.4%, P=0.049). During the 1-year follow up, 25 patients (2.0%) were diagnosed as having cancer, in which 48.0% of bleeding events led to a cancer diagnosis. Patients with high bleeding risk according to the Academic Research Consortium for high bleeding risk (ARC-HBR) were associated with a greater 1-year major bleeding risk than those without high bleeding risk in patients with (7.9% vs. 0.0%, P=0.02) and without cancer (7.1% vs. 2.5%, P<0.001), respectively. Conclusions: Cancer was diagnosed in 2.2% of 1,303 unselected patients before PCI by cancer screening and in 2.0% within 1-year after PCI. Cancer was associated with a greater risk of non-cardiac death, whereas ongoing active cancer was associated with greater risk of major bleeding. ARC-HBR criteria successfully identified high-bleeding risk patients, irrespective of the presence or absence of cancer.

Cancer and Coronary Heart Disease ― To Bleed or Not to Bleed, That Is the Question ―

“…lights a point of concern and a major limitation of the study of Kanenawa et al The procedures for cancer screening used by Kanenawa et al only focused on cancer in the upper and lower gastrointestinal tract: stool occult blood and upper and lower endoscopy. 9 Therefore, there is a significant bias in the higher incidence of gastrointestinal cancers; more precisely, the cancer incidence in that paper was specific for those gastrointestinal cancers in the elective PCI patient population.…”

“…9 During the 1-year follow-up period, 25 patients (2.0%) were diagnosed with cancer, 48.0% of whom experienced bleeding events that led to a cancer diagnosis. 9 Kanenawa et al aimed to predict the risk of bleeding complications using the criteria of the Academic Research Consortium for high bleeding risk (ARC-HBR 8 ) compared with other bleeding risk scores namely, Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT), 13 Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients (PARIS), 14 and Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto). 8 Interestingly, the ARC-HBR was found to be useful in predicting >1-year major bleeding risk than the other bleeding risk scores in both patients with (7.9% vs. 0.0%) and without (7.1% vs. 2.5%) cancer.…”

“…8 Interestingly, the ARC-HBR was found to be useful in predicting >1-year major bleeding risk than the other bleeding risk scores in both patients with (7.9% vs. 0.0%) and without (7.1% vs. 2.5%) cancer. 9 As mentioned by Kanenawa et al, 9 the ARC-HBR criteria 8 and CREDO-Kyoto score 15 include active cancer in their criteria, and patients with a high bleeding risk (HBR) were more prevalent among those with cancer, whereas active cancer is excluded as a risk factor in the PRECISE-DAPT 13 and PARIS bleeding scores. 14 Components of each score are summarized in Figure 1.…”

“…The study of Kanenawa et al 9 is the first to report on clinical outcomes after percutaneous coronary intervention (PCI) in Japanese patients with cancer. It is important to note that one of the unique characteristics of the Japanese cancer population is that, with the exception of sex-specific malignancies, the most frequent type of cancer is gastrointestinal cancer, 10 which is also a major cause of clinically relevant non-major bleeding (CRMN) in the cancer population.…”

“…1 More importantly, patients in the study of Kanenawa et al underwent cancer screening prior to the first PCI. 9 Surprisingly, following screening, 2.2% of 1,303 patients were positive for cancer; a possible reason for this is the overlap of risk factors between cancer and atherosclerotic disease, such as aging, smoking, and diabetes, 9 presumably associated with clonal hematopoiesis. 11 Cancer screening in PCI patients is a challenge in terms of reducing medical expenses and the tasks required for cardiology care; however, as cardiologists, we are supposed to provide well-rounded patient care to make the lives of our patients better, and we may tend to lose sight of this during our too-busy days as practicing cardiologists.…”