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Felix N, Nogueira A, Carvalho PEP, Costa TA, Tramujas L, Generoso G, Feldman S, Garot P, de Farias MDCAD. Outcomes of patients with active cancer after transcatheter aortic valve replacement: an updated meta-analysis. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:55. [PMID: 39252142 PMCID: PMC11386488 DOI: 10.1186/s40959-024-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 08/12/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Patients with active cancer and aortic stenosis may be under-referred for valve interventions due to concerns over a prohibitive risk. However, whether active cancer impacts outcomes after transcatheter aortic valve replacement (TAVR) remains unknown. METHODS We searched PubMed, Embase, and Cochrane Library in December 2023 for studies comparing the post-TAVR outcomes of patients with versus without active cancer. We pooled odds ratios (OR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI) applying a random-effects model. Statistical analyses were performed in R version 4.3.2. RESULTS We included nine observational studies analyzing 133,906 patients, of whom 9,792 (7.3%) had active cancer. Compared with patients without cancer, patients with active cancer had higher short- (OR 1.33; 95% CI 1.15-1.55; p < 0.001) and long-term mortality (OR 2.29; 95% CI 1.80-2.91; p < 0.001) rates, not driven by cardiovascular mortality (OR 1.30; 95% CI 0.70-2.40; p = 0.40), and higher major bleeding rates (OR 1.66; 95% CI 1.15-2.42; p = 0.008). The higher mortality rate was sustained in an adjusted analysis (aHR 1.77; 95% CI 1.34-2.35; p < 0.001). There was no significant difference in cardiac, renal, and cerebral complications at a follow-up ranging from 180 days to 10 years. CONCLUSION Patients with active cancer undergoing TAVR had higher non-cardiovascular mortality and bleeding rates, with comparable incidences of other complications. This highlights the need for a shared decision and appropriate patient selection considering cancer type, staging, bleeding risk, and optimal timing for intervention.
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Affiliation(s)
- Nicole Felix
- Division of Medicine, Federal University of Campina Grande, 795 Juvêncio Arruda Avenue, Campina Grande, Brazil.
| | - Alleh Nogueira
- Division of Medicine, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Pedro E P Carvalho
- Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, USA
| | | | | | | | - Stephanie Feldman
- Division of Cardiology, Department of Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
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Osawa T, Tajiri K, Hoshi T, Ieda M, Ishizu T. Impact of cancer in patients with aortic stenosis undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2024; 52:101410. [PMID: 38650615 PMCID: PMC11033174 DOI: 10.1016/j.ijcha.2024.101410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Background Owing to the minimally invasive nature of transcatheter aortic valve replacement (TAVR), TAVR seems to be preferred in patients with cancer; however, related research on the clinical efficacy and safety of TAVR in patients with cancer and severe aortic stenosis is limited, and conclusions are controversial. This study aimed to evaluate the clinical outcomes of patients with cancer who underwent TAVR. Method and results We conducted a systematic review and meta-analysis to investigate the clinical outcomes in patients with and without cancer who underwent TAVR. We systematically reviewed and analyzed 15 studies (195,658 patients) published in PubMed and Cochrane Library databases between January 2022 and January 2023. The primary outcomes were short-term (in-hospital or 30-day) and long-term (≥12 months) mortality. The prevalence of current or previous cancer in the patients undergoing TAVR was 19.8 % (38,695 patients). Patients with cancer had a lower risk of short-term mortality (odds ratio [OR] 0.69, 95 % confidence interval [CI] 0.61-0.77, P < 0.001) but a higher risk of long-term mortality (OR 1.54, 95 % CI 1.35-1.76, P < 0.001) than those without cancer. Patients with cancer had a lower incidence of postprocedural stroke and acute kidney injury but a higher incidence of pacemaker implantation than patients without cancer. Conclusions Patients with cancer undergoing TAVR have a good short-term prognosis and acceptable perioperative complications compared with patients without cancer. However, the long-term outcomes are contingent on cancer survival.
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Affiliation(s)
- Takumi Osawa
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
- Department of Cardiology, Tsukuba Medical Center Hospital, Japan
- Department of Cardiology, National Cancer Center Hospital East, Japan
| | - Kazuko Tajiri
- Department of Cardiology, National Cancer Center Hospital East, Japan
- Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba, Japan
| | - Tomoya Hoshi
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
| | - Masaki Ieda
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
- Department of Cardiology, Keio University School of Medicine, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Japan
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Ishii M, Marume K, Nakai M, Ogata S, Kaichi R, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K, Ogawa H, Iwanaga Y, Miyamoto Y, Yamamoto N, Tsujita K. Risk Prediction Score for Cancer Development in Patients With Acute Coronary Syndrome. Circ J 2024; 88:234-242. [PMID: 34078839 DOI: 10.1253/circj.cj-21-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer is a known prognostic factor in patients with acute coronary syndrome (ACS), but few risk assessments of cancer development after ACS have been established. METHODS AND RESULTS Of the 573 consecutive ACS admissions between January 2015 and March 2018 in Nobeoka City, Japan, 552 were analyzed. Prevalent cancer was defined as a treatment history of cancer, and incident cancer as post-discharge cancer incidence. The primary endpoint was post-discharge cancer incidence, and the secondary endpoint was all-cause death during follow-up. All-cause death occurred in 9 (23.1%) patients with prevalent cancer, and in 17 (3.5%) without cancer. In the multivariable analysis, prevalent cancer was associated with all-cause death. To develop the prediction model for cancer incidence, 21 patients with incident cancer and 492 without cancer were analyzed. We compared the performance of D-dimer with that of the prediction model, which added age (≥65 years), smoking history, and high red blood cell distribution width to albumin ratio (RAR) to D-dimer. The areas under the receiver-operating characteristics curves of D-dimer and the prediction model were 0.619 (95% confidence interval: 0.512-0.725) and 0.774 (0.676-0.873), respectively. Decision curve analysis showed superior net benefits of the prediction model. CONCLUSIONS By adding elderly, smoking, and high RAR to D-dimer to the prediction model it became clinically useful for predicting cancer incidence after ACS.
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Affiliation(s)
- Masanobu Ishii
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kyohei Marume
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | | | | | - Ryota Kaichi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Sou Ikebe
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Takayuki Mori
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Soichi Komaki
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Hiroaki Kusaka
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Reiko Toida
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kazumasa Kurogi
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | - Nobuyasu Yamamoto
- Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Kumamoto University Hospital
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Kalkan A, Metze C, Iliadis C, Körber MI, Baldus S, Pfister R. Prognostic impact of cancer history in patients undergoing transcatheter mitral valve repair. Clin Res Cardiol 2024; 113:94-106. [PMID: 37581720 PMCID: PMC10808190 DOI: 10.1007/s00392-023-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND History of cancer is common in patients undergoing transcatheter mitral valve repair (TMVR). OBJECTIVES Aim was to examine the impact of cancer history on outcomes after TMVR. METHODS In patients of a monocentric prospective registry of TMVR history of cancer was retrospectively assessed from records. Associations with 6-week functional outcomes and clinical outcomes during a median follow-up period of 594 days were examined. RESULTS Of 661 patients (mean age 79 years; age-range 37-101 years; 56.1% men), 21.6% had a history of cancer with active disease in 4.1%. Compared with non-cancer patients, cancer patients had a similar procedural success rate (reduction of mitral regurgitation to grade 2 or lower 91.6% vs. 88%; p = 0.517) and similar relevant improvement in 6-min walking distance, NYHA class, Minnesota Living with Heart Failure Questionnaire score and Short Form 36 scores. 1-year survival (83% vs. 82%; p = 0.813) and 1-year survival free of heart failure decompensation (75% vs. 76%; p = 0.871) were comparable between cancer and non-cancer patients. Patients with an active cancer disease showed significantly higher mortality compared with patients having a history of cancer (hazard ratio 2.05 [95% CI 1.11-3.82; p = 0.023]) but similar mortality at landmark analysis of 1 year. CONCLUSION TMVR can be performed with equal efficacy in patients with and without cancer and symptomatic mitral regurgitation. Cancer patients show comparable clinical outcome and short-term functional improvement as non-cancer patients. However, longterm mortality was increased in patients with active cancer underlining the importance of patient selection within the heart-team evaluation.
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Affiliation(s)
- Alev Kalkan
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Clemens Metze
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Maria I Körber
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
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Leedy D, Elison DM, Farias F, Cheng R, McCabe JM. Transcatheter aortic valve intervention in patients with cancer. Heart 2023; 109:1508-1515. [PMID: 37147132 DOI: 10.1136/heartjnl-2022-321396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023] Open
Abstract
The prevalence of concurrent cancer and severe aortic stenosis (AS) is increasing due to an ageing population. In addition to shared traditional risk factors for AS and cancer, patients with cancer may be at increased risk for AS due to off-target effects of cancer-related therapy, such as mediastinal radiation therapy (XRT), as well as shared non-traditional pathophysiological mechanisms. Compared with surgical aortic valve replacement, major adverse events are generally lower in patients with cancer undergoing transcatheter aortic valve intervention (TAVI), especially in those with history of mediastinal XRT. Similar procedural and short-to-intermediate TAVI outcomes have been observed in patients with cancer as compared with no cancer, whereas long-term outcomes are dependent on cancer survival. Considerable heterogeneity exists between cancer subtypes and stage, with worse outcomes observed in those with active and advanced-stage disease as well as specific cancer subtypes. Procedural management in patients with cancer poses unique challenges and thus requires periprocedural expertise and close collaboration with the referring oncology team. The decision to ultimately pursue TAVI involves a multidisciplinary and holistic approach in assessing the appropriateness of intervention. Further clinical trial and registry studies are needed to better appreciate outcomes in this population.
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Affiliation(s)
- Douglas Leedy
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - David M Elison
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Francisco Farias
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Richard Cheng
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - James M McCabe
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Kojima Y, Higuchi R, Hagiya K, Saji M, Takamisawa I, Iguchi N, Takanashi S, Doi S, Okazaki S, Sato K, Tamura H, Takayama M, Ikeda T, Isobe M. Prognosis of patients with active cancer undergoing transcatheter aortic valve implantation: An insight from Japanese multicenter registry. IJC HEART & VASCULATURE 2022; 40:101045. [PMID: 35514877 PMCID: PMC9066355 DOI: 10.1016/j.ijcha.2022.101045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Abstract
Background Malignancy is common in older adults undergoing transcatheter aortic valve implantation (TAVI), and may affect prognosis. The present study aimed to examine whether active cancer affects all-cause mortality rates among patients undergoing TAVI. Methods This retrospective study examined data from 1,114 consecutive patients treated between April 2010 and June 2019. Patients with life expectancy of <1 year due to non-cardiac causes were excluded. Results Active cancer was defined as cancer under treatment or cured within 1 year, and was recognized in 62 patients (5.6%) with (n = 17) and without (n = 45) metastases. In multivariate analysis, being female (hazard ratio [HR] 0.55, 95% confidence interval [CI] 0.39–0.77, p < 0.001), body mass index (BMI) (HR = 0.92 per 1 kg/m2 increase, 95% CI 0.87–0.97, p = 0.001), New York Heart Association (NYHA) class III/IV (HR = 1.53, 95% CI 1.06–2.20, p = 0.022), atrial fibrillation (HR = 2.40, 95% CI 1.70–3.38, p < 0.001), albumin levels (HR = 0.41 per 1-g/dl, 95% CI 0.30–0.57, p < 0.001), and cancer metastasis (HR = 5.28, 95% CI 1.86–14.9, p = 0.001) were associated with all-cause mortality after TAVI. Conclusion In patients undergoing TAVI, being female, high BMI, NYHA class III/IV, atrial fibrillation, albumin levels, and cancer metastasis were factors associated with mortality. Meanwhile, active cancer without metastasis was not associated with increased mortality rates. These findings would help clinical decision-making by patients and physicians. Clinical trial registration: UMIN000031133.
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Song Y, Wang Y, Wang Z, Xu C, Dou J, Jiang T. Comparing Clinical Outcomes on Oncology Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 9:890082. [PMID: 35711365 PMCID: PMC9193798 DOI: 10.3389/fcvm.2022.890082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the clinical outcomes of cancer and non-cancer patients with severe aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI). Methods A computer-based search in PubMed, EMbase, The Cochrane Library, CBM, CNKI, and Wanfang databases from their date of inception to October 2021, together with reference screening, was performed to identify eligible clinical trials. Two reviewers independently screened the articles, extracted data, and evaluated their quality. Review Manger 5.3 and Stata 12.0 software were used for meta-analysis. Results The selected 11 cohort studies contained 182,645 patients, including 36,283 patients with cancer and 146,362 patients without cancer. The results of the meta-analysis showed that the 30-day mortality [OR = 0.68, 95%CI (0.63,0.74), I 2= 0, P < 0.00001] of patients with cancer in the AS group was lower than those in the non-cancer group; 1-year mortality [OR = 1.49, 95%CI(1.19,1.88), I 2= 58%, P = 0.0006] and late mortality [OR = 1.52, 95%CI(1.26,1.84), I 2= 55%, P < 0.0001] of patients with cancer in the AS group was higher than those in the non-cancer group. The results of the meta-analysis showed that the stroke [OR = 0.77, 95%CI (0.72, 0.82), I 2= 0, P < 0.00001] and the acute kidney injury [OR = 0.78, 95%CI (0.68, 0.90), I 2= 77%, P = 0.0005] of patients with cancer in the AS group was lower than those in the non-cancer group. The results of the meta-analysis showed no statistical difference in cardiovascular mortality, bleeding events, myocardial infarction, vascular complication, and device success rate. Conclusion It is more effective and safer in patients with cancer with severe AS who were undergoing TAVI. However, compared with patients with no cancer, this is still high in terms of long-term mortality, and further study of the role of TAVI in patients with cancer with AS is necessary. Systematic Review Registration Identifier [INPLASY CRD: 202220009].
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Affiliation(s)
- Yumeng Song
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Yutong Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Zuoxiang Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Chang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Jingshen Dou
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Medicine, Soochow University, Suzhou, China
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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8
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Siddiqui MU, Yacob O, Junarta J, Pasha AK, Mookadam F, Mamas MA, Fischman DL. Mortality after transcatheter aortic valve replacement for aortic stenosis among patients with malignancy: a systematic review and meta-analysis. BMC Cardiovasc Disord 2022; 22:210. [PMID: 35538411 PMCID: PMC9088110 DOI: 10.1186/s12872-022-02651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With advancements in cancer treatment, the life expectancy of oncology patients has improved. Thus, transcatheter aortic valve replacement (TAVR) may be considered as a feasible option for oncology patients with severe symptomatic aortic stenosis (AS). We aim to evaluate the difference in short- and long-term all-cause mortality in cancer and non-cancer patients treated with TAVR for severe AS. METHODS Medline, PubMed, and Cochrane Central Register of Controlled Trials were searched for relevant studies. Patients with cancer who underwent treatment with TAVR for severe AS were included and compared to an identical population without cancer. The primary endpoints were short- and long-term all-cause mortality. RESULTS Of 899 studies included, 8 met inclusion criteria. Cancer patients had significantly higher long-term all-cause mortality after TAVR when compared to patients without cancer (risk ratio [RR] 1.43; 95% confidence interval (CI) 1.26-1.62; P < 0.01). Four studies evaluated short-term mortality after TAVR and demonstrated no difference in it in patients with and without cancer (RR 0.72; 95% CI 0.47-1.08; P = 0.11). CONCLUSION Patients with cancer and severe AS have higher long-term all-cause mortality after TAVR. However, we found no difference in short-term all-cause mortality when comparing patients with and without cancer. The decision to perform TAVR in cancer patients should be individualized based on life expectancy and existing co-morbidities.
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Affiliation(s)
- Muhammad Umer Siddiqui
- Department of Internal Medicine, Thomas Jefferson University Hospitals, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA.
| | - Omar Yacob
- Cardiovascular Medicine, MercyOne North Iowa Heart Center, Mason City, IA, USA
| | - Joey Junarta
- Department of Internal Medicine, Thomas Jefferson University Hospitals, 833 Chestnut Street, Suite 701, Philadelphia, PA, 19107, USA
| | - Ahmed K Pasha
- Cardiovascular Medicine, UHS Wilson Medical Center, Johnson City, NY, USA
| | - Farouk Mookadam
- Cardiovascular Medicine, Mayo Clinic Health System, Phoenix, AZ, USA
| | - Mamas A Mamas
- Cardiovascular Research Group, Center for Prognosis Research, Keele University, Keele, UK
| | - David L Fischman
- Cardiovascular Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Diaz-Arocutipa C, Torres-Valencia J, Zavaleta-Camacho G, Vicent L. Association Between Previous or Active Cancer and Clinical Outcomes in TAVR Patients: A Systematic Review and Meta-Analysis of 255,840 Patients. Front Cardiovasc Med 2021; 8:763557. [PMID: 34796218 PMCID: PMC8593236 DOI: 10.3389/fcvm.2021.763557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It has been proposed that transcatheter aortic valve replacement (TAVR) may be an option for patients with cancer and severe aortic stenosis. We assessed the association between previous or active cancer and clinical outcomes in TAVR patients. Methods: We searched four electronic databases from inception to March 05, 2021. The primary outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, myocardial infarction, stroke, acute kidney injury, pacemaker implantation, major bleeding, and vascular complications. All meta-analyses were performed using a random-effects model. Relative risks (RRs) and adjusted hazard ratios (aHRs) with their 95% confidence interval (95% CI) were pooled. Results: Thirteen cohort studies involving 255,840 patients were included. The time period for mortality ranged from inpatient to 10 years. Patients with active cancer had a higher risk of all-cause mortality using both crude (RR, 1.46; 95% CI, 1.13-1.88) and adjusted (aHR, 1.79; 95% CI, 1.43-2.25) estimates compared to non-cancer group. In contrast, the risk of cardiovascular mortality (RR, 1.26; 95% CI, 0.58-2.73), myocardial infarction (RR, 0.94; 95% CI, 0.34-2.57), stroke (RR, 0.90; 95% CI, 0.75-1.09), pacemaker implantation (RR, 0.87; 95% CI, 0.50-1.53), acute kidney injury (RR, 0.88; 95% CI, 0.74-1.04), major bleeding (RR, 1.15; 95% CI, 0.80-1.66), and vascular complications (RR, 0.96; 95% CI, 0.79-1.18) was similar between patients with or without cancer. Conclusion: Our review shows that TAVR patients with active cancer had an increased risk of all-cause mortality. No significant association with secondary outcomes was found.
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Affiliation(s)
- Carlos Diaz-Arocutipa
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.,Programa de Atención Domiciliaria - EsSalud, Lima, Peru
| | - Javier Torres-Valencia
- Departamento de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gabriela Zavaleta-Camacho
- Departamento de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.,Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lourdes Vicent
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
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10
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Clinical outcomes after transcatheter aortic valve implantation in active cancer patients and cancer survivors. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:45-51. [PMID: 33768980 PMCID: PMC7970091 DOI: 10.5606/tgkdc.dergisi.2021.20622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/23/2020] [Indexed: 12/03/2022]
Abstract
Background
In this study, we aimed to evaluate the clinical characteristics, perioperative, and mid-term outcomes of patients with severe symptomatic aortic stenosis and active cancer disease and cancer survivors undergoing transcatheter aortic valve implantation.
Methods
Between December 2011 and March 2019, a total of 550 patients (248 males, 302 females; mean age: 77.6±7.9 years; range, 46 to 103 years) who underwent transcatheter aortic valve implantation for severe symptomatic aortic stenosis in our center were retrospectively analyzed. Baseline demographic characteristics, cancer type, laboratory data, procedural data, and outcome data of the patients were collected. The primary outcome measure was all-cause mortality at 30 days and every six months up to maximally available follow-up. Follow-up was performed at 30 days, six months, and 12 months after the procedure and annually thereafter.
Results
Of the patients, 36 had a cancer diagnosis-active (n=10) or cured (n=26). The most common types of cancer were colorectal (16.6%), prostate (13.8%), leukemia (11.1%), and bladder (11.1%) cancers. Post-procedural complication rates were similar between the two groups. No mortality was observed in the cancer group at one month of follow-up. During follow-up, seven patients died within one year due to non-cardiac reasons. Although mortality at one year was higher in cancer patients, it did not reach statistical significance (23.3% vs. 11.6%, respectively; p=0.061). The estimated cumulative survival rate was 71.0% in the non-cancer group and 58.3% in the cancer group. The multivariate Cox regression analysis revealed that cancer was independently associated with cumulative mortality after adjusting for age, sex, body mass index, and atrial fibrillation (p=0.008).
Conclusion
Our study results show that transcatheter aortic valve implantation is safe and feasible in active cancer patients and cancer survivors with similar short-term and mid-term mortality and procedure-related complication rates, compared to non-cancer patients.
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11
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Frattini S, Troise G, Fucci C, Pressman GS, Faggiano P. Aortic valve stenosis and cancer: a common and complex association. Expert Rev Cardiovasc Ther 2021; 19:289-299. [PMID: 33688784 DOI: 10.1080/14779072.2021.1902306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction. The prevalence of aortic valve stenosis (AS) and malignancy are both high, especially in elderly people and in developed countries. These two conditions frequently coexist and share the same risk factors as atherosclerotic disease.Area covered. The progression of calcified AS may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy. The standard treatment for symptomatic severe AS is surgical aortic valve replacement; however, in cancer patients, transcatheter implantation may be preferred as they are often at high-risk for cardiac surgery. In patients with AS and cancer, physicians may face difficult treatment decisions.To date, there is limited information on the impact of malignancy on outcomes in patients with severe AS; hence, there is no established treatment policy.Expert Opinion. Treating clinicians must integrate complex information about the severity of valve disease and expected cardiac outcomes with information regarding the cancer prognosis and the need for specific treatment, including surgery. Other comorbidities, age and frailty also contribute to decision-making about whether, when, and how to perform aortic valve replacement.
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Affiliation(s)
| | - Giovanni Troise
- Cardiac Surgery Division, Fondazione Poliambulanza, Brescia, Italy
| | - Carlo Fucci
- Cardiac Surgery Division, Spedali Civili, Brescia, Italy
| | - Gregg S Pressman
- Einstein Medical Center, Heart and Vascular Institute, Philadelphia, Pennsylvania, US
| | - Pompilio Faggiano
- , University of Brescia and Fondazione Poliambulanza, Brescia, Italy
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Tabata N, Weber M, Sugiura A, Öztürk C, Tsujita K, Nickenig G, Sinning JM. Impact of cancer history on clinical outcome in patients undergoing transcatheter edge-to-edge mitral repair. Clin Res Cardiol 2020; 110:440-450. [PMID: 33169224 PMCID: PMC7907025 DOI: 10.1007/s00392-020-01770-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/26/2020] [Indexed: 01/20/2023]
Abstract
Background Little is known about the prevalence of a history of cancer and its impact on clinical outcome in mitral regurgitation (MR) patients undergoing transcatheter mitral valve repair (TMVR). Objectives The purpose of this study is to investigate the prevalence of cancer, baseline inflammatory parameters, and clinical outcome in MR patients undergoing TMVR. Methods Consecutive patients undergoing a MitraClip procedure were enrolled, and the patients were stratified into two groups: cancer and non-cancer. Baseline complete blood counts (CBC) with differential hemograms were collected prior to the procedure to calculate the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). All-cause death within a one-year was examined. Results In total, 82 out of 446 patients (18.4%) had a history of cancer. Cancer patients had a significantly higher baseline PLR [181.4 (121.1–263.9) vs. 155.4 (109.4–210.4); P = 0.012] and NLR [5.4 (3.5–8.3) vs. 4.0 (2.9–6.1); P = 0.002] than non-cancer patients. A Kaplan–Meier analysis revealed that cancer patients had a significantly worse prognosis than non-cancer (estimated 1-year mortality, 20.2 vs. 9.2%; log-rank P = 0.009), and multivariable analyses of three models showed that cancer history was an independent factor for 1-year mortality. Patients who died during follow-up had a significantly higher baseline PLR [214.2 (124.2–296.7) vs. 156.3 (110.2–212.1); P = 0.007] and NLR [6.4 (4.2–12.5) vs. 4.0 (2.9–6.2); P < 0.001] than survivors. Conclusions In MitraClip patients, a history of cancer was associated with higher inflammatory parameters and worse prognosis compared to non-cancer patients. Graphical Abstract Central Illustration. Clinical outcomes and baseline PLR and NLR values accord-ing to one-year mortality.
(Left) Patients who died within the follow-up period had a significantly higher baseline PLR (214.2 [124.2–296.7] vs 156.3 [110.2–212.1]; P = 0.007) and NLR (6.4 [4.2–12.5] vs 4.0 [2.9–6.2]; P < 0.001) than patients who survived.
PLR, platelet-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio
(Right) A Kaplan-Meier analysis revealed that cancer patients had a significantly worse prognosis than non-cancer patients (estimated one-year mortality, 20.2 vs 9.2%; log-rank P = 0.009).
![]() Electronic supplementary material The online version of this article (10.1007/s00392-020-01770-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Noriaki Tabata
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Machine learning-based risk prediction of intrahospital clinical outcomes in patients undergoing TAVI. Clin Res Cardiol 2020; 110:343-356. [PMID: 32583062 DOI: 10.1007/s00392-020-01691-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Currently, patient selection in TAVI is based upon a multidisciplinary heart team assessment of patient comorbidities and surgical risk stratification. In an era of increasing need for precision medicine and quickly expanding TAVI indications, machine learning has shown promise in making accurate predictions of clinical outcomes. This study aims to predict different intrahospital clinical outcomes in patients undergoing TAVI using a machine learning-based approach. The main clinical outcomes include all-cause mortality, stroke, major vascular complications, paravalvular leakage, and new pacemaker implantations. METHODS AND RESULTS The dataset consists of 451 consecutive patients undergoing elective TAVI between February 2014 and June 2016. The applied machine learning methods were neural networks, support vector machines, and random forests. Their performance was evaluated using five-fold nested cross-validation. Considering all 83 features, the performance of all machine learning models in predicting all-cause intrahospital mortality (AUC 0.94-0.97) was significantly higher than both the STS risk score (AUC 0.64), the STS/ACC TAVR score (AUC 0.65), and all machine learning models using baseline characteristics only (AUC 0.72-0.82). Using an extreme boosting gradient, baseline troponin T was found to be the most important feature among all input variables. Overall, after feature selection, there was a slightly inferior performance. Stroke, major vascular complications, paravalvular leakage, and new pacemaker implantations could not be accurately predicted. CONCLUSIONS Machine learning has the potential to improve patient selection and risk management of interventional cardiovascular procedures, as it is capable of making superior predictions compared to current logistic risk scores.
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