Multicentre cohort study of the impact of percutaneous coronary intervention on patients with concurrent cancer and ischaemic heart disease

Tatsuya Nishikawa,Masashi Fujita,Toshihiro Kudo,Sumiyo Okawa,Takeshi Fujita,Taku Yasui,Wataru Shioyama,Yuki Fujii,Toshitaka Morishima,Isao Miyashiro,Takahiro Tabuchi,Risa Kamada,Tomoyuki Otsuka,Toru Oka

doi:10.1186/s12872-021-01968-w

Tatsuya Nishikawa, Masashi Fujita + Show 12 more

Open Access

https://doi.org/10.1186/s12872-021-01968-w

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Abstract

BackgroundThe incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear.MethodsFive-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention [PCI] or IHD diagnosis) were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n = 564, PCI + group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n = 3058, PCI-/IHD + group), and patients without IHD (n = 27,392, PCI-/IHD- group). Kaplan–Meier analysis was used for comparisons.ResultsAfter propensity score matching, the PCI + group had better prognosis (n = 489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51–0.81, P < 0.001) than the PCI-/IHD + group. PCI + patients (n = 282) had significantly higher mortality than those without IHD (n = 280 in each group, hazard ratio 2.88, 95% confidence interval 1.90–4.38, P < 0.001).ConclusionsPCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD. Since the present study has some limitations, further research will be needed on this important topic in cardio-oncology.

Highlights

The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; the longterm patient prognoses remain unclear
Long‐term prognosis of cancer patients according to percutaneous coronary intervention (PCI) In the primary analysis, the PCI + (n = 564; mean age 72 years) and PCI−/IHD+ (n = 3058; mean age 74 years) groups were compared
The PCI + group had a lower prevalence of metastatic cancer, but a higher prevalence of acute coronary syndrome (ACS) than the PCI-/IHD + group (33% vs. 15%)

Summary

Introduction

The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; the longterm patient prognoses remain unclear. Several studies have shown that cancer patients undergoing percutaneous coronary intervention (PCI) exhibit higher all-cause mortality, bleeding, and other adverse cardiovascular events when compared with patients who have no history of cancer [7,8,9,10,11,12,13]. This raises the question of whether PCI can improve long-term prognosis in patients with cancer and comorbid ischaemic heart disease (IHD)

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