Abstract 4146877: Percutaneous coronary intervention in cancer patients with chronic coronary artery disease is associated with lower major cardiovascular events

Background: The interaction between cancer and coronary artery disease (CAD) is well established, primarily due to shared risk factors, chronic inflammation, and complications related to cancer therapies. Prior studies regarding percutaneous coronary intervention (PCI) in patients with chronic CAD have never demonstrated consistent reduction in hard endpoints. Nevertheless, cancer patients are frequently excluded or underrepresented in major clinical trials that address this matter. Objectives: To evaluate whether PCI in patients with chronic CAD and cancer could impact outcomes. Methods: Observational, retrospective cohort study with data from the TriNetX platform, an international research network database, which provides access to electronic medical records across large health care organizations. Inclusion criteria were age ≥18 years, diagnosis of chronic CAD and a concurrent cancer diagnosis within one year. Patients with acute coronary syndrome (ACS) and hematologic cancers were excluded. Participants were divided into two groups: 1) those who underwent PCI within this first year after the diagnosis of cancer and 2) those who did not receive intervention. The primary outcome was major adverse cardiovascular events (MACE), defined by all-cause mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke over a five-year period. Propensity score matching was conducted using variables such as age, gender, types of cancer, hypertension, previous cerebrovascular disease, diabetes, dyslipidemia, tobacco use, left ventricular ejection fraction, and peripheral artery disease. Results: A total of 741,184 patients were included, 12,189 in group 1 and 728,995 in group 2. The mean age was 72±9 and 73±10 years, respectively. Most patients were men, and most common cancer sites were prostate, digestive system, urinary tract and lungs. The primary analysis showed a five-year incidence of MACE of 27.6% in group 1 vs 31.1% in group 2 [OR 0.86 (95% CI 0.81-0.88), p<0.0001]. After propensity score matching, the incidence of MACE was 27.6% vs 29.2% [OR 0.92 (95% CI 0.87-0.98), p=0.006]. Kaplan-Meier event-free survival curves before and after propensity matching are shown in the figure. Conclusion: PCI in patients with chronic CAD and cancer was associated with a lower incidence of MACE in 5 years in a large real-world international database. Randomized controlled trials including patients with cancer are urgently needed to further investigate these outcomes.