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Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention.

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Date
2015-07-06
Authors
Hess, Connie N
Roe, Matthew T
Clare, Robert M
Chiswell, Karen
Kelly, Joseph
Tcheng, James E
Hagstrom, Emil
James, Stefan K
Khouri, Michel G
Hirsch, Bradford R
Kong, David F
Abernethy, Amy P
Krucoff, Mitchell W
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(13 total)
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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 article
Subject
cancer
cardiovascular 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
Permalink
https://hdl.handle.net/10161/15606
Published Version (Please cite this version)
10.1161/JAHA.115.001779
Publication 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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Scholars@Duke

Abernethy

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.
Chiswell

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
Khouri

Michel Georges Khouri

Associate Professor of Medicine
Kong

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
Krucoff

Mitchell Wolfe Krucoff

Professor of Medicine
Roe

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,
Tcheng

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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