Are Cancer Patients at Higher Risk of Thrombotic and Ischemic Events After PCI?

Cancer patients have a higher risk of thrombotic and ischemic events as well as bleeding after undergoing PCI, according to a study published May 17 in JACC: Cardiovascular Interventions.

Wei Guo, MD, et al., sought to define the risk of stent thrombosis (ST) and myocardial infarction (MI) in cancer patients compared with noncancer patients after PCI. Researchers identified patients undergoing PCI at the Mayo Clinic Rochester between Jan. 1, 2003, and Dec. 31, 2013. Cancer patients were identified through cross-linking the institutional PCI and cancer databases and by propensity score matching to noncancer patients. The primary endpoints of the study were MI, all-cause mortality and revascularization rate at five years. The secondary endpoints looked at ST, cause of mortality, and Bleeding Academic Research Consortium 2+ bleeding.

Results showed that the primary endpoints were observed in 48.6% of the 416 cancer patients and 33% of the 768 noncancer patients. A competing risk analysis found that cancer patients had a higher rate of noncardiac death and a lower rate of cardiac death. Cancer patients had a higher rate of MI, repeat revascularization and bleeding. Researchers found that the first year after PCI was the most critical period for ST in cancer patients.

"A high [dual antiplatelet therapy (DAPT)] score identifies patients who are at a high ischemic and thrombotic risk and yet at a bleeding risk that is similar to those with a low DAPT score," write the authors. "These findings have important implications for anti-platelet therapy decisions."

In an accompanying editorial comment, Bonnie Ky, MD, MSCE, FACC, et al., note the limitations of the study, including the "exclusion of patients with cancer that could not be matched with patients without cancer" from the dataset and lack of "data on post-PCI medical therapy for patients with and without cancer." Despite these limitations, the authors write that "this study is an important step forward for precision medicine in cardio-oncology and interventional cardiology, solidifying cancer as a risk factor for both bleeding and ischemic events following PCI and demonstrating the applicability of the DAPT score to patients with cancer."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Platelet Aggregation Inhibitors, Percutaneous Coronary Intervention, Hemorrhage, Myocardial Infarction, Medical Oncology, Thrombosis, Neoplasms, Stents

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