Abstract 14693: Outcomes Following Percutaneous Coronary Intervention in Cancer Survivors Previously Treated With Thoracic Radiation Therapy
Background: Radiation therapy (RT) improves survival in some cancers, although it is associated with long-term cardiotoxic sequelae. There is limited information available on outcomes following PCI in RT treated patients. We aimed to determine whether prior RT is associated with stent failure in cancer survivors who require PCI for symptomatic coronary artery disease.
Methods: We retrospectively analyzed outcomes following PCI in cancer survivors who had a prior history of thoracic RT at Mayo Clinic, Rochester, from 1998 to 2012 compared with a cohort of propensity-matched PCI controls without prior RT. Primary endpoint was target lesion revascularization (TLR), a clinical surrogate for restenosis. Secondary endpoints included myocardial infarction (MI), cardiac mortality and all-cause mortality.
Results: A total of 45 cases treated with coronary artery stents (median time after RT 2.2 years) were compared with 439 controls. Over a median follow-up of 3.1 years, there were no significant differences in rates of TLR (RT 9.2%, controls 9.7%; p=0.79; Fig. A), MI (4.6% vs 9.3%; p=0.66; Fig. B), cardiac mortality (6.8% vs 3.4%; p=0.30; Fig. C) or overall mortality (27.4% vs 22.0%; p=0.35; Fig. D) between groups. Most TLR events occurred between day 30-180 after PCI in the RT cohort. There was an early trend towards increased TLR (9.2% vs 5.7%, p=0.72) and cardiac death (4.4% vs 1.2%, p=0.84) in the RT group six months after stenting.
Conclusions: PCI in patients with prior thoracic RT for cancer is associated with favorable outcomes with rates of TLR, MI and cardiac death that are similar to controls. Larger studies are necessary to assess whether there is an early hazard of stent failure.
- © 2013 by American Heart Association, Inc.