Gitto Mauro, Sartori Samantha, Vogel Birgit, Leone Pier Pasquale, Smith Kenneth, Bay Benjamin, Krishnan Prakash, Sweeny Joseph, Oliva Angelo, Moreno Pedro, Gilhooley Sean, Di Muro Francesca Maria, Krishnamoorthy Parasuram Melarcode, Kini Annapoorna, Dangas George, Mehran Roxana, Sharma Samin
Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Can J Cardiol. 2025 Jul;41(7):1241-1250. doi: 10.1016/j.cjca.2025.02.035. Epub 2025 Mar 8.
Patients with cancer undergoing percutaneous coronary intervention (PCI) experience a higher risk of both ischemic and bleeding events. The aim of this study was to assess ischemic and bleeding risks after PCI in cancer patients treated with potent P2Y12 inhibitors (P2Y12i; prasugrel and ticagrelor) compared with clopidogrel.
Consecutive patients with cancer undergoing PCI at a tertiary center between 2012 and 2022 and discharged on P2Y12i were included in this study. Propensity score covariate adjustment was used to account for baseline differences between patients treated with potent P2Y12i and clopidogrel. Key clinical endpoints included major adverse cardiac and cerebrovascular events (MACCEs---composite of death, myocardial infarction, or stroke) and major bleeding.
Of the 1702 included patients, 373 (21.9%) were treated with potent P2Y12i and 1329 (78.1%) with clopidogrel. Factors associated with potent P2Y12i use were acute coronary syndrome presentation and lesion length, whereas clopidogrel use was associated with active cancer status, thrombocytopenia, older age, and femoral access. MACCEs at 1 year occurred in 3.5% of patients treated with potent P2Y12i vs 6.8% of those receiving clopidogrel (log-rank test, P = 0.035; adjusted hazard ratio [adj HR] 0.53, 95% confidence interval [CI] 0.26-1.10), but no differences in bleeding risk were detected (5.5% vs 7.0%, adj HR 0.92, 95% CI 0.53-1.60). The reduction in MACCEs was significant in patients with remission but not active cancer (P = 0.011).
Among cancer patients undergoing PCI, potent P2Y12i use was associated with similar bleeding risk and lower incidence of ischemic events compared with clopidogrel, but with no significant difference after propensity score adjustment.
接受经皮冠状动脉介入治疗（PCI）的癌症患者发生缺血性和出血性事件的风险更高。本研究的目的是评估与氯吡格雷相比，接受强效P2Y12抑制剂（P2Y12i；普拉格雷和替格瑞洛）治疗的癌症患者PCI术后的缺血和出血风险。
纳入2012年至2022年在一家三级中心接受PCI并出院时使用P2Y12i的连续癌症患者。采用倾向评分协变量调整来解释接受强效P2Y12i和氯吡格雷治疗患者之间的基线差异。主要临床终点包括主要不良心脑血管事件（MACCE，即死亡、心肌梗死或中风的复合事件）和大出血。
在纳入的1702例患者中，373例（21.9%）接受强效P2Y12i治疗，1329例（78.1%）接受氯吡格雷治疗。与使用强效P2Y12i相关的因素是急性冠状动脉综合征表现和病变长度，而使用氯吡格雷与活跃癌症状态、血小板减少、老年和股动脉入路相关。强效P2Y12i治疗的患者1年时MACCE发生率为3.5%，而接受氯吡格雷治疗的患者为6.8%（对数秩检验，P = 0.035；调整后风险比[adj HR]0.53，95%置信区间[CI]0.26 - 1.10），但未检测到出血风险的差异（5.5%对7.0%，adj HR 0.92，95% CI 0.53 - 1.60）。缓解期而非活跃期癌症患者的MACCE减少具有显著性（P = 0.011）。
在接受PCI的癌症患者中，与氯吡格雷相比，使用强效P2Y12i的出血风险相似，缺血事件发生率较低，但倾向评分调整后无显著差异。
