Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE.
Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE.
Curr Probl Cardiol. 2022 Nov;47(11):101305. doi: 10.1016/j.cpcardiol.2022.101305. Epub 2022 Jul 4.
Chemotherapeutic regimens have cardiotoxic properties and thorax irradiation is associated with accelerated coronary artery disease (CAD). There is limited data regarding the influence of cancer on outcomes after percutaneous coronary intervention (PCI), as cancer patients were not routinely included in the PCI trials. We performed a systematic review and meta-analysis to compare the early outcomes of PCI between patients with active/historical cancer and patients without a cancer history. A systematic search was made in the PubMed, Medline, and Cochrane databases using the search terms "PCI" and "Cancer". The major outcomes were in-hospital mortality, in-hospital cardiovascular mortality, 30-day mortality, and peri-procedural complications. We used random effects model to aggregate data and calculate pooled incidence and risk ratios with 95% confidence intervals (CIs). A total of 7 studies were included, out of which 4 studies reported in-hospital mortality. Compared to patients without cancer, patients with active/historical cancer undergoing PCI had higher rates of in-hospital mortality (relative risk [RR] 1.89; 95% CI 1.33-2.70; P = 0.0004), in-hospital cardiovascular mortality (RR 2.21; 95% CI 1.19-4.08; P = 0.01), 30-day mortality (RR 2.01; 95% CI 1.24-3.27; P = 0.005), and peri-procedural blood transfusion (RR 1.73; 95% CI 1.02-2.95; P = 0.04). There were no significant differences in peri-procedural myocardial re-infarction, new-onset heart failure, shock, and stroke between the two cohorts. In conclusion, Among patients undergoing PCI, active/historical cancer was associated with worse early mortality compared to patients without a history of cancer. Management of cancer patients undergoing PCI should be individualized and involve multi-specialist team discussion to narrow the mortality gap.
化疗方案具有心脏毒性，胸部放疗与加速冠状动脉疾病（CAD）有关。由于癌症患者未常规纳入 PCI 试验，因此有关癌症对 PCI 后结局影响的数据有限。我们进行了系统评价和荟萃分析，以比较活跃/既往癌症患者与无癌症病史患者 PCI 的早期结局。在 PubMed、Medline 和 Cochrane 数据库中使用“PCI”和“Cancer”检索词进行系统搜索。主要结局是住院死亡率、住院心血管死亡率、30 天死亡率和围手术期并发症。我们使用随机效应模型汇总数据，并计算合并发生率和 95%置信区间（CI）的风险比。共纳入 7 项研究，其中 4 项研究报告了住院死亡率。与无癌症患者相比，接受 PCI 的活动性/既往癌症患者的住院死亡率更高（相对风险 [RR] 1.89；95%CI 1.33-2.70；P=0.0004），住院心血管死亡率更高（RR 2.21；95%CI 1.19-4.08；P=0.01），30 天死亡率更高（RR 2.01；95%CI 1.24-3.27；P=0.005），围手术期输血更多（RR 1.73；95%CI 1.02-2.95；P=0.04）。两组患者围手术期心肌再梗死、新发心力衰竭、休克和卒中等发生率无显著差异。结论：在接受 PCI 的患者中，与无癌症病史的患者相比，活动性/既往癌症与早期死亡率较高相关。接受 PCI 的癌症患者的管理应个体化，并涉及多学科团队讨论，以缩小死亡率差距。
