Outcomes after percutaneous coronary intervention with stents in patients treated with thoracic external beam radiation for cancer

Jackson J. Liang, Terence T. Sio, Joshua P. Slusser, Ryan J. Lennon, Robert C. Miller, Gurpreet Sandhu, Abhiram Prasad

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives: The aim of this study was to assess outcomes after percutaneous coronary intervention (PCI) with stents in patients treated with thoracic external beam radiation therapy (EBRT). Background: Thoracic EBRT for cancer is associated with long-term cardiotoxic sequelae. The impact of EBRT on patients requiring coronary stents is unclear. Methods: We analyzed outcomes after PCI in cancer survivors treated with curative thoracic EBRT before and after stenting between 1998 and 2012. Reference groups were propensity-matched cohorts with stenting but no EBRT. Primary endpoint was target lesion revascularization (TLR), a clinical surrogate for restenosis. Secondary endpoints included myocardial infarction (MI) and cardiac and overall mortality. Results: We identified 115 patients treated with EBRT a median 3.6 years after stenting (group A) and 45 patients treated with EBRT a median 2.2 years before stenting (group B). Long-term mean TLR rates in group A (3.2 vs. 6.6%; hazard ratio: 0.6; 95% confidence interval: 0.2 to 1.6; p = 0.31) and group B (9.2 vs. 9.7%; hazard ratio: 1.2; 95% confidence interval: 0.4 to 3.4; p = 0.79) were similar to rates in corresponding control patients (group A: 1,390 control patients; group B: 439 control patients). Three years post-PCI, group A had higher overall mortality (48.6% vs. 13.9%; p < 0.001) but not MI (4.8% vs. 4.3%; p = 0.93) or cardiac mortality (2.3% vs. 3.6%; p = 0.66) rates versus control patients. There were no significant differences in MI, cardiac, or overall mortality rates in group B. Conclusions: Thoracic EBRT is not associated with increased stent failure rates when used before or after PCI. A history of PCI should not preclude the use of curative thoracic EBRT in cancer patients or vice versa. Optimal treatment of cancer should be the goal.

Original languageEnglish (US)
Pages (from-to)1412-1420
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume7
Issue number12
DOIs
StatePublished - 2014

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Percutaneous Coronary Intervention
Stents
Radiotherapy
Thorax
Radiation
Neoplasms
Mortality
Myocardial Infarction
Confidence Intervals
Survivors
Control Groups

Keywords

  • Cancer
  • Coronary artery stent
  • Malignancy
  • Radiation therapy
  • Restenosis
  • Survivorship

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes after percutaneous coronary intervention with stents in patients treated with thoracic external beam radiation for cancer. / Liang, Jackson J.; Sio, Terence T.; Slusser, Joshua P.; Lennon, Ryan J.; Miller, Robert C.; Sandhu, Gurpreet; Prasad, Abhiram.

In: JACC: Cardiovascular Interventions, Vol. 7, No. 12, 2014, p. 1412-1420.

Research output: Contribution to journalArticle

Liang, Jackson J. ; Sio, Terence T. ; Slusser, Joshua P. ; Lennon, Ryan J. ; Miller, Robert C. ; Sandhu, Gurpreet ; Prasad, Abhiram. / Outcomes after percutaneous coronary intervention with stents in patients treated with thoracic external beam radiation for cancer. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 12. pp. 1412-1420.
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abstract = "Objectives: The aim of this study was to assess outcomes after percutaneous coronary intervention (PCI) with stents in patients treated with thoracic external beam radiation therapy (EBRT). Background: Thoracic EBRT for cancer is associated with long-term cardiotoxic sequelae. The impact of EBRT on patients requiring coronary stents is unclear. Methods: We analyzed outcomes after PCI in cancer survivors treated with curative thoracic EBRT before and after stenting between 1998 and 2012. Reference groups were propensity-matched cohorts with stenting but no EBRT. Primary endpoint was target lesion revascularization (TLR), a clinical surrogate for restenosis. Secondary endpoints included myocardial infarction (MI) and cardiac and overall mortality. Results: We identified 115 patients treated with EBRT a median 3.6 years after stenting (group A) and 45 patients treated with EBRT a median 2.2 years before stenting (group B). Long-term mean TLR rates in group A (3.2 vs. 6.6{\%}; hazard ratio: 0.6; 95{\%} confidence interval: 0.2 to 1.6; p = 0.31) and group B (9.2 vs. 9.7{\%}; hazard ratio: 1.2; 95{\%} confidence interval: 0.4 to 3.4; p = 0.79) were similar to rates in corresponding control patients (group A: 1,390 control patients; group B: 439 control patients). Three years post-PCI, group A had higher overall mortality (48.6{\%} vs. 13.9{\%}; p < 0.001) but not MI (4.8{\%} vs. 4.3{\%}; p = 0.93) or cardiac mortality (2.3{\%} vs. 3.6{\%}; p = 0.66) rates versus control patients. There were no significant differences in MI, cardiac, or overall mortality rates in group B. Conclusions: Thoracic EBRT is not associated with increased stent failure rates when used before or after PCI. A history of PCI should not preclude the use of curative thoracic EBRT in cancer patients or vice versa. Optimal treatment of cancer should be the goal.",
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T1 - Outcomes after percutaneous coronary intervention with stents in patients treated with thoracic external beam radiation for cancer

AU - Liang, Jackson J.

AU - Sio, Terence T.

AU - Slusser, Joshua P.

AU - Lennon, Ryan J.

AU - Miller, Robert C.

AU - Sandhu, Gurpreet

AU - Prasad, Abhiram

PY - 2014

Y1 - 2014

N2 - Objectives: The aim of this study was to assess outcomes after percutaneous coronary intervention (PCI) with stents in patients treated with thoracic external beam radiation therapy (EBRT). Background: Thoracic EBRT for cancer is associated with long-term cardiotoxic sequelae. The impact of EBRT on patients requiring coronary stents is unclear. Methods: We analyzed outcomes after PCI in cancer survivors treated with curative thoracic EBRT before and after stenting between 1998 and 2012. Reference groups were propensity-matched cohorts with stenting but no EBRT. Primary endpoint was target lesion revascularization (TLR), a clinical surrogate for restenosis. Secondary endpoints included myocardial infarction (MI) and cardiac and overall mortality. Results: We identified 115 patients treated with EBRT a median 3.6 years after stenting (group A) and 45 patients treated with EBRT a median 2.2 years before stenting (group B). Long-term mean TLR rates in group A (3.2 vs. 6.6%; hazard ratio: 0.6; 95% confidence interval: 0.2 to 1.6; p = 0.31) and group B (9.2 vs. 9.7%; hazard ratio: 1.2; 95% confidence interval: 0.4 to 3.4; p = 0.79) were similar to rates in corresponding control patients (group A: 1,390 control patients; group B: 439 control patients). Three years post-PCI, group A had higher overall mortality (48.6% vs. 13.9%; p < 0.001) but not MI (4.8% vs. 4.3%; p = 0.93) or cardiac mortality (2.3% vs. 3.6%; p = 0.66) rates versus control patients. There were no significant differences in MI, cardiac, or overall mortality rates in group B. Conclusions: Thoracic EBRT is not associated with increased stent failure rates when used before or after PCI. A history of PCI should not preclude the use of curative thoracic EBRT in cancer patients or vice versa. Optimal treatment of cancer should be the goal.

AB - Objectives: The aim of this study was to assess outcomes after percutaneous coronary intervention (PCI) with stents in patients treated with thoracic external beam radiation therapy (EBRT). Background: Thoracic EBRT for cancer is associated with long-term cardiotoxic sequelae. The impact of EBRT on patients requiring coronary stents is unclear. Methods: We analyzed outcomes after PCI in cancer survivors treated with curative thoracic EBRT before and after stenting between 1998 and 2012. Reference groups were propensity-matched cohorts with stenting but no EBRT. Primary endpoint was target lesion revascularization (TLR), a clinical surrogate for restenosis. Secondary endpoints included myocardial infarction (MI) and cardiac and overall mortality. Results: We identified 115 patients treated with EBRT a median 3.6 years after stenting (group A) and 45 patients treated with EBRT a median 2.2 years before stenting (group B). Long-term mean TLR rates in group A (3.2 vs. 6.6%; hazard ratio: 0.6; 95% confidence interval: 0.2 to 1.6; p = 0.31) and group B (9.2 vs. 9.7%; hazard ratio: 1.2; 95% confidence interval: 0.4 to 3.4; p = 0.79) were similar to rates in corresponding control patients (group A: 1,390 control patients; group B: 439 control patients). Three years post-PCI, group A had higher overall mortality (48.6% vs. 13.9%; p < 0.001) but not MI (4.8% vs. 4.3%; p = 0.93) or cardiac mortality (2.3% vs. 3.6%; p = 0.66) rates versus control patients. There were no significant differences in MI, cardiac, or overall mortality rates in group B. Conclusions: Thoracic EBRT is not associated with increased stent failure rates when used before or after PCI. A history of PCI should not preclude the use of curative thoracic EBRT in cancer patients or vice versa. Optimal treatment of cancer should be the goal.

KW - Cancer

KW - Coronary artery stent

KW - Malignancy

KW - Radiation therapy

KW - Restenosis

KW - Survivorship

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