Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention.
Abstract
BACKGROUND: Cardiovascular disease and cancer increasingly coexist, yet relationships
between cancer and long-term cardiovascular outcomes post-percutaneous coronary intervention
(PCI) are not well studied. METHODS AND RESULTS: We examined stented PCI patients
at Duke (1996-2010) using linked data from the Duke Information Systems for Cardiovascular
Care and the Duke Tumor Registry (a cancer treatment registry). Our primary outcome
was cardiovascular mortality. Secondary outcomes included composite cardiovascular
mortality, myocardial infarction, or repeat revascularization and all-cause mortality.
We used adjusted cause-specific hazard models to examine outcomes among cancer patients
(cancer treatment pre-PCI) versus controls (no cancer treatment pre-PCI). Cardiovascular
mortality was explored in a cancer subgroup with recent (within 1 year pre-PCI) cancer
and in post-PCI cancer patients using post-PCI cancer as a time-dependent variable.
Among 15 008 patients, 3.3% (n=496) were cancer patients. Observed rates of 14-year
cardiovascular mortality (31.4% versus 27.7%, P=0.31) and composite cardiovascular
death, myocardial infarction, or revascularization (51.1% versus 55.8%, P=0.37) were
similar for cancer versus control groups; all-cause mortality rates were higher (79.7%
versus 49.3%, P<0.01). Adjusted risk of cardiovascular mortality was similar for cancer
patients versus controls (hazard ratio 0.95; 95% CI 0.76 to 1.20) and for patients
with versus without recent cancer (hazard ratio 1.46; 95% CI 0.92 to 2.33). Post-PCI
cancer, present in 4.3% (n=647) of patients, was associated with cardiovascular mortality
(adjusted hazard ratio 1.51; 95% CI 1.11 to 2.03). CONCLUSIONS: Cancer history was
present in a minority of PCI patients but was not associated with worse long-term
cardiovascular outcomes. Further investigation into PCI outcomes in this population
is warranted.
Type
Journal articleSubject
cancercardiovascular outcomes
percutaneous coronary intervention
Aged
Case-Control Studies
Cause of Death
Comorbidity
Coronary Artery Disease
Female
Humans
Male
Middle Aged
Neoplasms
North Carolina
Percutaneous Coronary Intervention
Registries
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome
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https://hdl.handle.net/10161/15606Published Version (Please cite this version)
10.1161/JAHA.115.001779Publication Info
Hess, Connie N; Roe, Matthew T; Clare, Robert M; Chiswell, Karen; Kelly, Joseph; Tcheng,
James E; ... Krucoff, Mitchell W (2015). Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary
Intervention. J Am Heart Assoc, 4(7). 10.1161/JAHA.115.001779. Retrieved from https://hdl.handle.net/10161/15606.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Amy Pickar Abernethy
Adjunct Professor in the Department of Medicine
Amy P. Abernethy, MD PhDDirector, Center for Learning Health Care Director, Duke Cancer
Care Research Program Professor of Medicine, Department of Medicine, Division of Medical
Oncology, Duke University School of Medicine Associate Professor of Nursing, Duke
University School of NursingDr. Abernethy, a hematologist/oncologist and palliative
care physician, is Professor of Medicine in the Duke University School of Medicine,
Director of the Duke Center for Learn
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Karen Chiswell
Statistical Scientist
Ph.D., North Carolina State University - 2007I work closely with clinical and quantitative
colleagues to provide statistical leadership, guidance and mentoring on the design, execution,
and analysis of clinical research studies. My work includes design and analysis of
observational studies (including large cardiovascular registries, and clinical care
databases linke
Michel Georges Khouri
Associate Professor of Medicine
David Franklin Kong
Associate Professor of Medicine
David F. Kong, M.D., A.M., D.M.T., F.A.C.C., F.S.C.A.I. is an Associate Professor
of Medicine at Duke University Medical Center and Co-Director of the Cardiovascular
Late Phase 3 and Devices Unit at the Duke Clinical Research Institute. An interventional
cardiologist at Duke Hospital and a faculty member in the Duke Center for Healthcare
Informatics, Dr. Kong specializes in cardiovascular informatics research and integration
of evidence from cardiovascular clinical trials. Dr
Mitchell Wolfe Krucoff
Professor of Medicine
Matthew Todd Roe
Adjunct Professor in the Department of Medicine
My clinical activities focus upon general, preventive, and acute care cardiology.
I round regularly on the inpatient general cardiology and coronary care unit (CCU)
services and i have a particular interest in the treatment and management of patients
with acute myocardial infarction and cardiogenic shock. In my outpatient clinic,
I care for patients with a variety of cardiovascular conditions include chronic coronary
artery disease, hypertension, hyperlipidemia, atrial fibrillation,
James Enlou Tcheng
Professor of Medicine
In addition to my clinical responsibilities as an interventional cardiologist, my
research interests include the study of antithrombotic therapies in cardiovascular
disease and biomedical informatics and information technologies. My research is
applied (clinical research), primarily focusing on the evaluation of technologies
in the clinical arena. I have participated in numerous clinical trials and have also
conducted several multicenter studies, including the EPIC, P
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