PCI Safe, Becoming More Common in Patients with Active Cancer

Dominique Monlezun, MD, PhD, MPH

New research presented at the Society for Cardiovascular Angiography and Interventions (SCAI) 2022 Scientific Sessions is providing clinicians with insight into contemporary trends in percutaneous coronary intervention (PCI) among patients with cancer.

Using machine learning augmentation and data from the National Inpatient Sample, investigators found the rate of PCI among patients with thrombocytopenia had nearly doubled from 2016 to 2018 and detail the safety of PCI among patients with active, suggesting active cancer was not associated with an increased risk of mortality among patients undergoing PCI in multivariable adjusted analyses.

“Our study aimed to leverage the power of big data and artificial intelligence to provide robust, reliable and relevant results to guide appropriately tailored interventions for cardio-oncology patients,” said senior investigator Dominique J Monlezun, MD, PhD, MPH, adjunct assistant professor at the University of Texas MD Anderson Cancer Center in Houston, Texas, in a statement. “Our hope is to decrease undertreatment among this patient population by ensuring clinicians have reassuring evidence on the safety and efficacy of revascularizations techniques for this specific patient population.”

With the recent advent of cardio-oncology, research into the intersection of cardiovascular disease and cancer has grown in stride with the field itself. Designed with an interest in assessing mortality among patients with thrombocytopenia receiving PCI, the current study is the first nationally representative multi-year cardio-oncology mortality study of thrombocytopenia and coronary intervention and first such study using machine learning augmentation and propensity score.

Check out this article on a recent study examining trends in CV-specific mortality among cancer patients in the US from 1999-2018.

Using data from the 2016-2018 National Inpatient Sample survey cycles, investigators obtained data from 101,521,656 hospitalized adult patients for inclusion in their analyses. This cohort included 6,456,777 patients who had active cancer, which included 396,446 patients with thrombocytopenia. For the purpose of analysis, investigators used propensity scores and multivariable regression modeling to assess differences between patient subgroups.

Upon analysis, results indicated patients with thrombocytopenia and active cancer were significantly less likely to receive left heart catheterization (1.88% vs 5.41%) and PCI (0.48% vs 1.35%) than their counterparts with thrombocytopenia and without active cancer. Further analysis suggested patients with cancer with thrombocytopenia were more likely to have an acute myocardial infarction and to receive intravascular ultrasound but had comparable rates of practical flow reserve and optical coherence tomography than their counterparts with cancer but without thrombocytopenia. In multivariable-adjusted models assessing patients who underwent PCI, investigators found there were no associations observed between active cancer (OR, 0.89 [95% CI, 0.45-1.75]; P=.738) or any of the other 32 primary malignancies with increased mortality.

"This nationally representative longitudinal study suggests inpatient PCI is relatively safe and is increasing among patients with active cancer regardless of their primary malignancy,” wrote investigators.

This study, “PCI is Safe and Increasing Among Cancer Patients: Nationally Representative Propensity Score Adjusted and Machine Learning Augmented Study of 100 Million Hospitalizations,” was presented at SCAI 2022.