Cardio-Oncology Research Unit, Cardiovascular Analytics Group, Hong Kong, China-United Kingdom Collaboration.
School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China.
Curr Probl Cardiol. 2023 Jan;48(1):101380. doi: 10.1016/j.cpcardiol.2022.101380. Epub 2022 Aug 27.
Immune checkpoint inhibitors (ICI) have known associations with cardiotoxicity. However, a representative quantification of the adverse cardiovascular events and cardiovascular attendances amongst Asian users of ICI has been lacking. This retrospective cohort study identified all ICI users in Hong Kong, China, between 2013 and 2021. All patients were followed up until the end of 2021 for the primary outcome of major adverse cardiovascular event (MACE; a composite of cardiovascular mortality, myocardial infarction, heart failure, and stroke). Patients with prior diagnosis of any component of MACE were excluded from all MACE analyses. In total, 4324 patients were analyzed (2905 (67.2%) males; median age 63.5 years old (interquartile range 55.4-70.7 years old); median follow-up 1.0 year (interquartile range 0.4-2.3 years)), of whom 153 were excluded from MACE analyses due to prior events. MACE occurred in 116 (2.8%) with an incidence rate (IR) of 1.7 [95% confidence interval: 1.4, 2.0] events per 100 patient-years; IR was higher within the first year of follow-up (2.9 [2.3, 3.5] events per 100 patient-years). Cardiovascular hospitalization(s) occurred in 188 (4.4%) with 254 episodes (0.5% of all episodes) and 1555 days of hospitalization (1.3% of all hospitalized days), for whom the IR of cardiovascular hospitalization was 5.6 [4.6, 6.9] episodes per 100 person-years with 52.9 [39.8, 70.3] days' stay per 100 person-years. Amongst Asian users of ICI, MACE was uncommon, and a small proportion of hospitalizations were cardiovascular in nature. Most MACE and cardiovascular hospitalizations occurred during the first year after initiating ICI.
免疫检查点抑制剂 (ICI) 已知与心脏毒性相关。然而，亚洲 ICI 用户的不良心血管事件和心血管就诊情况缺乏代表性的量化评估。本回顾性队列研究在 2013 年至 2021 年间确定了所有在中国香港使用 ICI 的患者。所有患者均随访至 2021 年底，以评估主要不良心血管事件 (MACE；心血管死亡、心肌梗死、心力衰竭和中风的综合指标) 的主要终点。所有 MACE 分析均排除了先前诊断为 MACE 任何组成部分的患者。共分析了 4324 例患者（2905 例 [67.2%] 为男性；中位年龄 63.5 岁 [四分位距 55.4-70.7 岁]；中位随访时间 1.0 年 [四分位距 0.4-2.3 年]），其中 153 例由于先前发生事件而被排除在 MACE 分析之外。116 例发生 MACE（2.8%），发生率（IR）为每 100 患者年 1.7 [95%置信区间：1.4，2.0] 例事件；在随访的第一年中，IR 更高（每 100 患者年 2.9 [2.3，3.5] 例事件）。心血管住院（CVH）发生 188 例（4.4%），共 254 例（所有住院的 0.5%）和 1555 天（所有住院天数的 1.3%），CVH 的 IR 为每 100 人年 5.6 [4.6，6.9] 例，每 100 人年住院 52.9 [39.8，70.3] 天。在亚洲 ICI 用户中，MACE 较为罕见，且住院治疗中心血管性质的比例较小。大多数 MACE 和心血管住院发生在开始使用 ICI 后的第一年。
