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PCI Outcomes in Cancer Patients
Study Questions:
What are the prognostic implications of a cancer diagnosis on in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI)?
Methods:
The authors reviewed data from the National Inpatient Sample (NIS) for hospital discharges in the United States, and identified all adults discharged after PCI between 2004-2014 using International Classification of Diseases, Ninth Revision (ICD-9) procedure codes. ICD-9 codes were also used to identify cancer diagnoses and in-hospital clinical outcomes including mortality, cardiac complications, postoperative stroke, and bleeding and vascular complications. They reported the prevalence of cancer diagnoses in patients undergoing PCI, and their association with the aforementioned outcomes in addition to length of stay and healthcare costs compared to patients without cancer.
Results:
Out of 6,571,034 PCIs between 2004-2014, 1.8% carried a current diagnosis of cancer and 5.8% had a previous history of malignancy, with prostate, breast, colon, and lung cancer being the most common. The authors noted an increase in the number of patients with a historical cancer diagnosis undergoing PCI from 4.8% in 2004 to 7.2% in 2014; the largest increase being in patients with lung cancer. In multivariable analyses, only comorbid lung cancer was associated with close to a threefold increase in in-hospital mortality. Colon and prostate cancer were associated with an increased risk of bleeding, but not mortality. Breast cancer was not independently associated with the aforementioned outcomes. In subgroup analyses, patients who received a drug-eluting stent fared better compared to those with a bare-metal stent. Last, comorbid cancer was associated with longer length of stay and costs of hospitalization.
Conclusions:
Patients with cancer are more frequently undergoing PCI. The impact of cancer on post-PCI outcomes is dependent on the type of cancer and the presence of metastasis.
Perspective:
This study represents a major contribution examining an understudied aspect of the impact of cancer on cardiovascular disease, with important clinical significance. For example, bleeding events were more common in patients with colon and prostate cancer, highlighting the need for strategies to minimize bleeding in these patient subgroups. Patients with breast cancer, however, fare as well as those without cancer post-PCI. While it appears that those with a drug-eluting stent fared better than bare-metal stent, that is likely due to selection bias. All with metastatic disease fare worse. Evidently, not all cancer has the same impact on outcomes and cardiovascular care, and this study highlights the need to individualize decision making and strategies in cardiovascular care.
Clinical Topics: Cardio-Oncology, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention
Keywords: Breast Neoplasms, Cardiotoxicity, Colonic Neoplasms, Comorbidity, Drug-Eluting Stents, Health Care Costs, Hemorrhage, Hospital Mortality, Inpatients, Lung Neoplasms, Neoplasms, Percutaneous Coronary Intervention, Prostatic Neoplasms, Secondary Prevention, Stroke, Vascular Diseases
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