Abstract 10954: Clinical and Angiographic Predictors of Adverse Outcomes After Percutaneous Coronary Intervention in Patients With Radiation Associated Coronary Artery Disease

Abstract

Background: The clinical and angiographic predictors of outcomes after percutaneous coronary intervention (PCI) in patients with cancer and radiation associated coronary artery disease (CAD) are not well established. Methods: In this retrospective cohort study, 157 patients with thoracic malignancy and external beam radiation therapy (XRT) prior to PCI were identified. The rates of major adverse cardiovascular and cerebrovascular events (MACCE; all-cause mortality, myocardial infarction, repeat revascularization, or stroke) were compared across patient characteristics. Results: During follow-up of 5.4±4.5 years, 91 (58%) patients had MACCE; 59 (38%) died, of which 23 (39%) were cardiac deaths, 23 (39%) due to cancer or other causes, and 13 (22%) unknown. By Kaplan-Meier analysis, MACCE were more frequent with coronary artery calcification (p=0.023), ostial stenosis (p=0.049), target vessel diameter ≥ 3.0 mm (p=0.018), a SYNTAX score ≥ the median of 11 (p=0.014), or bare metal stenting (BMS) compared to drug-eluting stenting (DES) (p=0.006) (Figure). Cardiac death was more frequent in patients with SYNTAX score ≥ 11 (p=0.028) or BMS (p=0.043). After multivariable adjustment, independent predictors of MACCE were chronic kidney disease (CKD) (p=0.006), New York Heart Association (NYHA) class ≥ 3 (p=0.024), and BMS (p=0.008) (Table). Conclusions: In patients with radiation associated CAD treated with PCI, MACCE is more frequent in those with target vessel calcification, ostial stenosis, large vessel diameter, or SYNTAX score ≥ 11. BMS placement is independently associated with greater MACCE than DES, and other risk factors for MACCE include CKD and NYHA class ≥ 3.