Abstract 10222: Impact of Bleeding Event for New Cancer Diagnosis in Patients With Antiplatelet Therapy After Percutaneous Coronary Intervention

Abstract

Background: It has been reported that the bleeding event represents unmasking of an occult cancer in anticoagulated patients with atrial fibrillation. However, the impact of bleeding event in patients with antiplatelet therapy after percutaneous coronary intervention (PCI) for new cancer diagnosis remains unclear. Methods and Results: Consecutive 1796 patients with coronary artery disease who underwent PCI and taking antiplatelet therapy were enrolled. Patients taking oral anticoagulants were excluded, and relationships between bleeding event and new cancer diagnosis were examined. Among 1565 patients, 189 (12.0%) experienced any bleeding events defined as Bleeding Academic Research Consortium (BARC) type-2/3/5 bleeding, 78 (4.9%) experienced minor bleeding events defined as BARC type-2 bleeding, and 116 (7.4%) were diagnosed with new cancer during a mean follow-up period of 1528 days. Patients with any bleeding were older (71.3 vs. 68.8 years, P = 0.005) and had higher prevalence of being at Academic Research Consortium criteria for high bleeding risk (62.4% vs. 43.8%, P < 0.001) than those without bleeding event. Of 189 patients with any bleeding and 78 patients with minor bleeding events, 31 (16.4%) and 16 (20.5%) were diagnosed with new cancer, respectively. In the univariate Cox proportional hazard analysis, the incidence of new cancer diagnosis was higher in patients with any bleeding and minor bleeding events than those without bleeding event (hazard ratio [HR] 3.19, P < 0.001 and HR 5.70, P < 0.001, respectively). In the multivariate analysis after adjusting for confounding factors, any bleeding and minor bleeding events were the independent predictors of new cancer diagnosis (HR 2.27, P = 0.003 and HR 3.93, P < 0.001, respectively). In addition, any gastrointestinal bleeding and minor bleeding events were associated with higher rates of new gastrointestinal cancer diagnosis (HR 4.46, P = 0.041 and HR 6.73, P = 0.009, respectively). Conclusion: In patients with antiplatelet therapy after PCI, any bleeding and minor bleeding events were associated with subsequent new cancer diagnosis. Even minor bleeding should be taken care as the first manifestation of underlying cancer during antiplatelet therapy.