Raymundo A Quintana1, Dominique J Monlezun2, Giovanni Davogustto3, Humberto R Saenz4, Francisco Lozano-Ruiz5, Daisuke Sueta6, Kenichi Tsujita6, Uri Landes7, Ali E Denktas8, Mahboob Alam8, David Paniagua8, Daniel Addison9, Hani Jneid8. 1. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: raquint@emory.edu. 2. Division of Cardiology, Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Division of Geriatrics, Department of Internal Medicine, University of California San Diego, San Diego, CA, USA. 5. Department of Radiation Oncology, Medica Sur Hospital, México City, Mexico. 6. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 7. Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Israel. 8. Division of Cardiology, Department of Medicine, Baylor College of Medicine and Michael E. DeBakey VA Medical Center, TX, USA. 9. Cardio-Oncology Program Division of Cardiology, Ohio State University Columbus, OH, USA.
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.
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-cancerpatients. 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-cancerpatients. 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-cancerpatients. Cancerpatients should be managed by a multi-specialist team, in an effort to close the mortality gap.
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