Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention.


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.





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Publication Info

Hess, Connie N, Matthew T Roe, Robert M Clare, Karen Chiswell, Joseph Kelly, James E Tcheng, Emil Hagstrom, Stefan K James, et al. (2015). Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention. J Am Heart Assoc, 4(7). 10.1161/JAHA.115.001779 Retrieved from

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Karen Chiswell

Statistical Scientist

Ph.D., North Carolina State University - 2007

I 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 linked with electronic health record data) and early-phase trials in pediatric populations. My statistical interests include study design, linear and non-linear mixed effects models, survival analysis, biology- and mechanism-based models, and statistical thinking and learning. 


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, clinical informatics, artificial intelligence, and information technology systems. 

I have conducted and participated in numerous clinical trials, including the EPIC, PROLOG, EPILOG, EPISTENT, IMPACT, IMPACT II, TOTAL, PRIDE, ESPRIT, MEND-1, ELECT, and SUPPORT Trials.

My areas of expertise are an outgrowth of my clinical research, and includes use of the new antiplatelet therapeutics in the treatment of coronary artery disease; treatment of unstable angina and acute myocardial infarction; quality assurance and quality improvement; application of informatics and information technology to the delivery of care; and the application of excimer laser coronary angioplasty in the treatment of coronary artery disease.

My current focus is in clinical informatics, including initiatives spanning professional societies, regulatory and other government agencies, industry, and non-governmental organizations to develop clinical data standards, interoperability solutions, and to integrate structured reporting into clinical workflows. This includes harmonizing the clinical definitions of cardiovascular concepts across academia, regulatory agencies, the life sciences industry, professional societies, and standards organizations, to improve the capture, communication, interoperability, and analysis of healthcare information.

Key words: angioplasty, excimer laser, platelet glycoproteins, computers, clinical trials, clinical informatics.


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. Kong graduated magna cum laude from HarvardUniversity, where he also received a master’s degree in Organismic and Evolutionary Biology. He received his medical degree from the Johns Hopkins University School of Medicine, and was a resident on the Osler Medical Service at the JohnsHopkinsHospital. He completed fellowships in Cardiovascular Disease and Interventional Cardiovascular Medicine at DukeUniversity before joining the Duke faculty.  Dr. Kong is board certified in internal medicine, cardiology, and interventional cardiology. He is a Certified Diver Medic, Master Diver, and Dive Medical Examiner, and has been elected Fellow of the American College of Cardiology and the Society for Cardiovascular Angiography and Interventions.


Mitchell Wolfe Krucoff

Professor of Medicine

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