Author + information
- Received January 29, 2014
- Revision received May 10, 2014
- Accepted May 22, 2014
- Published online December 1, 2014.
- Jackson J. Liang, DO∗,
- Terence T. Sio, MD, MS†,
- Joshua P. Slusser, BS‡,
- Ryan J. Lennon, MS‡,
- Robert C. Miller, MD†,
- Gurpreet Sandhu, MD§ and
- Abhiram Prasad, MD‖∗ ()
- ∗Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- †Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
- ‡Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
- §Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ‖Cardiovascular Sciences, St. George’s, University of London, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Abhiram Prasad, Cardiovascular Sciences Research Centre, St. George’s, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
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.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 29, 2014.
- Revision received May 10, 2014.
- Accepted May 22, 2014.
- American College of Cardiology Foundation