| Abstrakt: |
Introduction:The number of cancer patients undergoing percutaneous coronary intervention (PCI) increases annually. It is unclear as to what extent the benefits of PCI outweigh the increased risk in cancer patients. The aim of this study is to compare the procedural outcomes of PCI for coronary artery disease (CAD) in patients with and without cancer.Methods:Machine learning-augmented, propensity score adjusted multivariable regression was utilized in this multi-center case-control study to assess inpatient mortality using a nationally representative, all-payor dataset from 2016 (the National Inpatient Sample). Racial and income disparities were additionally assessed.Results:Among the 6,033,643 hospitalized patients meeting study criteria, the mean age was 57.51 (SD 20.33), 58.15% were female, 67.69% were Caucasian, 15.43% had malignancy, 3.84% underwent an inpatient PCI, and 2.19% died while inpatient. Among PCI patients, 11.07% had malignancy and 0.07% had metastatic disease. In fully adjusted analyses controlling for age, race, income, metastasis, and mortality risk by diagnosis-related group (DRG), PCI significantly reduced mortality for patients overall (OR 0.77, 95%CI 0.75-0.79; p<0.001) and specifically for cancer patients (OR 0.82, 95%CI 0.75-0.89; p<0.001). There were no significant income or racial disparities within PCI subjects by outcome. In propensity score analysis, PCI significantly reduced mortality for patients overall and particularly for malignancy patients (OR 0.82, 95%CI 0.75-0.89; p<0.001).Conclusions:This is the largest all-patient study to examine the effect of PCI in cancer patients with CAD. This study includes all hospitalizations (not only PCI patients) to allow for greater generalizability. There is a significant, unique inpatient mortality benefit for PCI in cancer patients with CAD. This is independent of the PCI benefit all patients can receive based on their population-averaged CAD burden and is fully adjusted for various common healthcare disparities. Cancer patients with concomitant CAD should not be excluded from revascularization at large. |
