Abstract 17075: Outcomes in Radiation Associated Cardiac Disease Patients that present with Coronary Artery Disease: Comparison between PCI and CABG
Background: Radiation associated cardiac disease (RACD) patients have a characteristic presentation, including aggressive coronary artery disease (CAD), observed years after index radiation for thoracic malignancy; & portends a worse prognosis, as compared to matched controls. In patients with prior thoracic radiation & obstructive CAD, we sought to compare outcomes between those undergoing percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG).
Methods: We studied 267 consecutive patients with prior thoracic malignancy (including 58% breast & 20% Hodgkin’s) & thoracic radiation (25 % to right breast, 30% to left breast, 45% to mediastinum) who presented for treatment of RACD manifesting as advanced CAD (138 for PCI & 129 for CABG) between 1994-2013 (excluding those with known CAD prior to radiation or concomitant valvular disease). Clinical, angiographic & echo data were recorded. Mortality was recorded (including due to recurrent malignancy).
Results: Clinical data of 2 groups are shown in the Table. At 9±5 years of follow-up, there were 58 (22%) deaths (17 due to recurrent malignancy). On stepwise multivariable Cox Proportional Hazard Analysis, Euroscore (Hazard ratio [HR] 1.28 [1.13-1.45], p<0.001 was the only significant predictor of cardiac deaths. There was no difference in cardiac deaths between PCI vs. CABG (HR 1.40 [0.73-2.70], p=0.3).A higher % of patients with known recurrent malignancy underwent PCI as opposed to CABG; & died during follow-up (11% vs 2%, p<0.001).Higher % of patients in the PCI group had a repeat PCI during follow-up, vs. CABG group (11% vs. 5% p<0.05).
Conclusion: Patients with prior thoracic radiation & suspected RACD, the majority of whom are females, have a varied presentation for CAD (including a high % with proximal disease). Long-term survival from cardiac death is similar in PCI vs. CABG groups. RACD patients that have recurrent malignancy tend to have more PCI than CABG for relief of symptomatic CAD.
- Coronary artery disease
- Coronary artery bypass grafting (CABG)
- Percutaneous coronary intervention (PCI)
Author Disclosures: A. Masri: None. R. Grant: None. S. Ellis: None. N.G. Smedira: None. B.W. Lytle: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2014 by American Heart Association, Inc.