Ahmed Talha, Pacha Homam Moussa, Addoumieh Antoine, Koutroumpakis Efstratios, Song Juhee, Charitakis Konstantinos, Boudoulas Konstantinos Dean, Cilingiroglu Mehmet, Marmagkiolis Konstantinos, Grines Cindy, Iliescu Cezar A
Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States.
Division of Cardiovascular Medicine, MD Anderson Cancer Center, University of Texas, Houston, TX, United States.
Front Cardiovasc Med. 2022 Oct 19;9:901431. doi: 10.3389/fcvm.2022.901431. eCollection 2022.
Management of coronary artery disease (CAD) is unique and challenging in cancer patients. However, little is known about the outcomes of using BMS or DES in these patients. This study aimed to compare the outcomes of percutaneous coronary intervention (PCI) in cancer patients who were treated with bare metal stents (BMS) vs. drug-eluting stents (DES).
We identified cancer patients who underwent PCI using BMS or DES between 2013 and 2020. Outcomes of interest were overall survival (OS) and the number of revascularizations. The Kaplan-Meier method was used to estimate the survival probability. Multivariate Cox regression models were utilized to compare OS between BMS and DES.
We included 346 cancer patients who underwent PCI with a median follow-up of 34.1 months (95% CI, 28.4-38.7). Among these, 42 patients were treated with BMS (12.1%) and 304 with DES (87.9%). Age and gender were similar between the BMS and DES groups ( = 0.09 and 0.93, respectively). DES use was more frequent in the white race, while black patients had more BMS ( = 0.03). The use of DES was more common in patients with NSTEMI ( = 0.03). The median survival was 46 months (95% CI, 34-66). There was no significant difference in the number of revascularizations between the BMS and DES groups ( = 0.43). There was no significant difference in OS between the BMS and DES groups in multivariate analysis ( = 0.26). In addition, independent predictors for worse survival included age > 65 years, BMI ≤ 25 g/m, hemoglobin level ≤ 12 g/dL, and initial presentation with NSTEMI.
In our study, several revascularizations and survival were similar between cancer patients with CAD treated with BMS and DES. This finding suggests that DES use is not associated with an increased risk for stent thrombosis, and as cancer survival improves, there may be a more significant role for DES.
冠状动脉疾病（CAD）在癌症患者中的管理具有独特性且颇具挑战性。然而，对于这些患者使用裸金属支架（BMS）或药物洗脱支架（DES）的结果知之甚少。本研究旨在比较接受裸金属支架（BMS）与药物洗脱支架（DES）治疗的癌症患者经皮冠状动脉介入治疗（PCI）的结果。
我们确定了2013年至2020年间接受BMS或DES PCI治疗的癌症患者。感兴趣的结果是总生存期（OS）和血运重建次数。采用Kaplan-Meier方法估计生存概率。利用多变量Cox回归模型比较BMS和DES之间的OS。
我们纳入了346例接受PCI治疗的癌症患者，中位随访时间为34.1个月（95%CI，28.4 - 38.7）。其中，42例患者接受BMS治疗（12.1%），304例接受DES治疗（87.9%）。BMS组和DES组的年龄和性别相似（分别为=0.09和0.93）。DES在白人种族中使用更频繁，而黑人患者使用BMS更多（=0.03）。DES在非ST段抬高型心肌梗死（NSTEMI）患者中使用更常见（=0.03）。中位生存期为46个月（95%CI，34 - 66）。BMS组和DES组之间的血运重建次数无显著差异（=0.43）。多变量分析中，BMS组和DES组之间的OS无显著差异（=0.26）。此外，生存较差的独立预测因素包括年龄>65岁、体重指数（BMI）≤25 g/m、血红蛋白水平≤12 g/dL以及以NSTEMI首发。
在我们的研究中，接受BMS和DES治疗的CAD癌症患者的多次血运重建和生存期相似。这一发现表明，使用DES与支架血栓形成风险增加无关，并且随着癌症生存期的改善，DES可能会发挥更重要的作用。
