Assessment of coronary artery disease during hospitalization for cancer treatment

Clinical Research in Cardiology - 2021
Simone M. Mrotzek1, Alessia Lena2, Sara Hadzibegovic2, Ria Ludwig1, Fadi Al–Rashid1, Amir A. Mahabadi1, Raluca I. Mincu1, Lars Michel1, Laura Johannsen1, Lena Hinrichs1, Martin Schüler3, Ulrich Keller4, Stefan D. Anker2, Ulf Landmesser5, Tienush Rassaf1, Markus S. Anker5, Matthias Totzeck1
1Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
2Division of Cardiology and Metabolism, Department of Cardiology, Charité Campus Virchow Klinikum (CVK), Berlin, Germany
3Department of Medical Oncology, Medical Faculty, West German Cancer Center, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
4Department of Hematology, Oncology and Tumor Immunology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany
5Department of Cardiology, Charité Campus Benjamin Franklin (CBF), Berlin, Germany

Tóm tắt

Abstract Background With improvement of cancer-specific survival, comorbidities and treatment-related side effects, particularly cardiovascular toxicities, need close attention. The aim of the present study was to evaluate clinical characteristics and outcomes of cancer patients requiring coronary angiography during inpatient care. Methods We performed a retrospective analysis of patients hospitalized between 02/2011 and 02/2018 in our two university hospital cancer centers. From a cohort of 60,676 cancer patients, we identified 153 patients (65.7 ± 11.6 years, 73.2% male), who underwent coronary angiography and were eligible for analysis. These were compared to a control group of 153 non-cancer patients pair-matched with respect to age, sex, and indication for catheterization. Results Cancer patients presented in 66% with an acute coronary syndrome (ACS). The most prevalent cancer entities were lymphoma (19%) and lung cancer (18.3%). The rate of primary percutaneous coronary interventions (PCI) was significantly lower in the cancer cohort (40.5% vs. 53.6%, p = 0.029), although manifestation of coronary artery disease (CAD) and PCI results were comparable (SYNergy between PCI with TAXus and cardiac surgery (SYNTAX)-score, delta pre- and post-PCI − 9.8 vs. − 8.0, p = 0.2). Mortality was remarkably high in cancer patients (1-year mortality 46% vs. 8% in non-cancer patients, p < 0.001), particularly with troponin-positive ACS (5-year mortality 71%). Conclusion Strategies to effectively control cardiovascular risks in cancer patients are needed. Additionally, suspected CAD in cancer patients should not prevent prompt diagnostic clarification and optimal revascularization as PCI results in cancer patients are comparable to non-cancer patients and occurrence of troponin-positive ACS leads to a significantly increased risk of mortality. Graphic Abstract

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Iannaccone M, D’Ascenzo F, Vadala P, Wilton SB, Noussan P, Colombo F et al (2017) Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy. Eur Heart J Acute Cardiovasc Care. https://doi.org/10.1177/2048872617706501

Yeh ET, Chang HM (2016) Oncocardiology-past, present, and future: a review. JAMA Cardiol 1(9):1066–1072. https://doi.org/10.1001/jamacardio.2016.2132

Totzeck M, Schuler M, Stuschke M, Heusch G, Rassaf T (2019) Cardio-oncology—strategies for management of cancer-therapy related cardiovascular disease. Int J Cardiol 280:163–175. https://doi.org/10.1016/j.ijcard.2019.01.038

Al-Kindi SG, Oliveira GH (2016) Prevalence of preexisting cardiovascular disease in patients with different types of cancer: the unmet need for onco-cardiology. Mayo Clin Proc 91(1):81–83. https://doi.org/10.1016/j.mayocp.2015.09.009

Michel L, Rassaf T (2019) Cardio-oncology: need for novel structures. Eur J Med Res 24(1):1. https://doi.org/10.1186/s40001-018-0359-0

Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ et al (2014) 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 64(18):1929–1949. https://doi.org/10.1016/j.jacc.2014.07.017

Rassaf T, Totzeck M, Backs J, Bokemeyer C, Hallek M, Hilfiker-Kleiner D et al (2020) Onco-cardiology: consensus paper of the german cardiac society, the german society for pediatric cardiology and congenital heart defects and the german society for hematology and medical oncology. Clin Res Cardiol. https://doi.org/10.1007/s00392-020-01636-7

Michel L, Rassaf T, Totzeck M (2018) Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity. J Thorac Dis 10:S4282–S4295. https://doi.org/10.21037/jtd.2018.08.15

Amsterdam EA, Wenger NK, Brindis RG, Casey DE Jr, Ganiats TG, Holmes DR Jr et al (2014) 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 130(25):2354–2394. https://doi.org/10.1161/CIR.0000000000000133

Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G et al (2004) Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation 109(22):2749–2754. https://doi.org/10.1161/01.CIR.0000130926.51766.CC

Myocardial infarction redefined–a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. (2000) Eur Heart J 21(18):1502-13. https://doi.org/10.1053/euhj.2000.2305

Cardinale D, Sandri MT, Martinoni A, Tricca A, Civelli M, Lamantia G et al (2000) Left ventricular dysfunction predicted by early troponin I release after high-dose chemotherapy. J Am Coll Cardiol 36(2):517–522

Cardinale D, Sandri MT, Martinoni A, Borghini E, Civelli M, Lamantia G et al (2002) Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy. Ann Oncol 13(5):710–715

Michel L, Mincu RI, Mrotzek SM, Korste S, Neudorf U, Rassaf T et al (2020) Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer-a meta-analysis. ESC Heart Fail 7(2):423–433. https://doi.org/10.1002/ehf2.12589

Michel L, Mincu RI, Mahabadi AA, Settelmeier S, Al-Rashid F, Rassaf T et al (2020) Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta-analysis. Eur J Heart Fail 22(2):350–361. https://doi.org/10.1002/ejhf.1631

Iannaccone M et al (2017) Optimal medical therapy in patients with malignancy undergoing percutaneous coronary intervention for acute coronary syndrome: a BleeMACS Sub-Study. Am J Cardiovasc Drugs 17(1):61–71. https://doi.org/10.1007/s40256-016-0196-x

Yusuf SW, Daraban N, Abbasi N, Lei X, Durand JB, Daher IN (2012) Treatment and outcomes of acute coronary syndrome in the cancer population. Clin Cardiol 35(7):443–450. https://doi.org/10.1002/clc.22007

Wang F, Gulati R, Lennon RJ, Lewis BR, Park J, Sandhu GS et al (2016) Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) mortality after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. Mayo Clin Proc 91(12):1680–1692. https://doi.org/10.1016/j.mayocp.2016.06.029

Iliescu C, Durand JB, Kroll M (2011) Cardiovascular interventions in thrombocytopenic cancer patients. Tex Heart Inst J 38(3):259–260

Mincu RI, Rassaf T, Totzeck M (2018) Red blood cell transfusion in patients with ST-elevation myocardial infarction-a meta-analysis of more than 21,000 patients. Neth Heart J 26(9):454–460. https://doi.org/10.1007/s12471-018-1137-x

Chang HM, Moudgil R, Scarabelli T, Okwuosa TM, Yeh ETH (2017) Cardiovascular complications of cancer therapy: best practices in diagnosis, prevention, and management: part 1. J Am Coll Cardiol 70(20):2536–2551. https://doi.org/10.1016/j.jacc.2017.09.1096

Rosenbaum PR, Rubin DB (1985) Constructing a Control-Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score. Am Stat 39(1):33–38. https://doi.org/10.2307/2683903

Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123(23):2736–2747. https://doi.org/10.1161/CIRCULATIONAHA.110.009449

Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ et al (2009) Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 360(10):961–972. https://doi.org/10.1056/NEJMoa0804626

Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K et al (2005) The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 1(2):219–227

Genereux P, Palmerini T, Caixeta A, Rosner G, Green P, Dressler O et al (2012) Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention: the residual SYNTAX (Synergy Between PCI with Taxus and Cardiac Surgery) score. J Am Coll Cardiol 59(24):2165–2174. https://doi.org/10.1016/j.jacc.2012.03.010

Henley SJ, Ward EM, Scott S, Ma J, Anderson RN, Firth AU et al (2020) Annual report to the nation on the status of cancer, part I: national cancer statistics. Cancer 126(10):2225–2249. https://doi.org/10.1002/cncr.32802

Totzeck M, Mincu RI, Rassaf T (2017) Cardiovascular adverse events in patients with cancer treated with bevacizumab: a meta-analysis of more than 20 000 patients. J Am Heart Assoc 6:8. https://doi.org/10.1161/jaha.117.006278

Landes U, Kornowski R, Bental T, Assali A, Vaknin-Assa H, Lev E et al (2017) Long-term outcomes after percutaneous coronary interventions in cancer survivors. Coron Artery Dis 28(1):5–10. https://doi.org/10.1097/MCA.0000000000000429

Banasiak W, Zymlinski R, Undas A (2018) Optimal management of cancer patients with acute coronary syndrome. Pol Arch Intern Med 128(4):244–253. https://doi.org/10.20452/pamw.4254

Potts JE, Iliescu CA, Lopez Mattei JC, Martinez SC, Holmvang L, Ludman P et al (2019) Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J 40(22):1790–1800. https://doi.org/10.1093/eurheartj/ehy769

Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al (2015) 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment Elevation. Rev Esp Cardiol (Engl Ed) 68(12):1125. https://doi.org/10.1016/j.rec.2015.10.009

Al-Kindi SG, Oliveira GH (2016) Onco-Cardiology: a Tale of Interplay Between 2 Families of Diseases. Mayo Clin Proc 91(12):1675–1677. https://doi.org/10.1016/j.mayocp.2016.10.015

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U et al (2019) 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 40(2):87–165. https://doi.org/10.1093/eurheartj/ehy394

Kastrati A, Dibra A, Spaulding C, Laarman GJ, Menichelli M, Valgimigli M et al (2007) Meta-analysis of randomized trials on drug-eluting stents vs bare-metal stents in patients with acute myocardial infarction. Eur Heart J 28(22):2706–2713. https://doi.org/10.1093/eurheartj/ehm402

Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA et al (2016) 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 134(10):e123–e155. https://doi.org/10.1161/CIR.0000000000000404

Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M et al (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349(2):146–153. https://doi.org/10.1056/NEJMoa025313

Schulman S, Kearon C, Kakkar AK, Mismetti P, Schellong S, Eriksson H et al (2009) Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 361(24):2342–2352. https://doi.org/10.1056/NEJMoa0906598

Investigators E, Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H et al (2010) Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med 363(26):2499–2510. https://doi.org/10.1056/NEJMoa1007903

Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M et al (2013) Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 369(9):799–808. https://doi.org/10.1056/NEJMoa1302507

Hokusai VTEI, Buller HR, Decousus H, Grosso MA, Mercuri M, Middeldorp S et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369(15):1406–1415. https://doi.org/10.1056/NEJMoa1306638

Totzeck M, Mincu RI, Mrotzek S, Schadendorf D, Rassaf T (2018) Cardiovascular diseases in patients receiving small molecules with anti-vascular endothelial growth factor activity: a meta-analysis of approximately 29,000 cancer patients. Eur J Prev Cardiol 25(5):482–494. https://doi.org/10.1177/2047487318755193

Rassaf T, Totzeck M (2018) Modern concepts in cardio-oncology. J Thorac Dis 10:S4386–S4390. https://doi.org/10.21037/jtd.2018.11.110

Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL et al (2016) American cancer society/american society of clinical oncology breast cancer survivorship care guideline. J Clin Oncol 34(6):611–635. https://doi.org/10.1200/JCO.2015.64.3809

Pfister DG, Rubin DM, Elkin EB, Neill US, Duck E, Radzyner M et al (2015) Risk adjusting survival outcomes in hospitals that treat patients with cancer without information on cancer stage. JAMA Oncol 1(9):1303–1310. https://doi.org/10.1001/jamaoncol.2015.3151

DeCaria K, Dudgeon D, Green E, Shaw Moxam R, Rahal R, Niu J et al (2017) Acute care hospitalization near the end of life for cancer patients who die in hospital in Canada. Curr Oncol 24(4):256–261. https://doi.org/10.3747/co.24.3704

Brown BW, Brauner C, Minnotte MC (1993) Noncancer deaths in white adult cancer patients. J Natl Cancer Inst 85(12):979–987. https://doi.org/10.1093/jnci/85.12.979

Inagaki J, Rodriguez V, Bodey GP (1974) Proceedings: causes of death in cancer patients. Cancer 33(2):568–573. https://doi.org/10.1002/1097-0142(197402)33:2%3c568:aid-cncr2820330236%3e3.0.co;2-2

Anker MS, Ebner N, Hildebrandt B, Springer J, Sinn M, Riess H et al (2016) Resting heart rate is an independent predictor of death in patients with colorectal, pancreatic, and non-small cell lung cancer: results of a prospective cardiovascular long-term study. Eur J Heart Fail 18(12):1524–1534. https://doi.org/10.1002/ejhf.670

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Clinical Research in Cardiology

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