Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry
- Author(s)
- Nowatzke, J; Guedeney, P; Palaskas, N; Lehmann, L; Ederhy, S; Zhu, H; Cautela, J; Francis, S; Courand, PY; Deswal, A; Ewer, SM; Aras, M; Arangalage, D; Ghafourian, K; Fenioux, C; Finke, D; Peretto, G; Zaha, V; Itzhaki Ben Zadok, O; Tajiri, K; Akhter, N; Levenson, J; Baldassarre, L; Power, J; Huang, S; Collet, JP; Moslehi, J; Salem, JE; International ICI-myocarditis registry contributors;
- Journal Title
- European Journal of Cancer
- Publication Type
- Research article
- Abstract
- PURPOSE: Immune checkpoint blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis. METHODS: An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis >70% in patients undergoing coronary angiogram. RESULTS: Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 patients (22.6%). Coronary revascularization was performed during the index hospitalisation in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24 h of admission compared to the other groups (p = 0.029). Myocarditis-related 90-day mortality was 9/17 (52.7%) in the revascularised cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p = 0.001). Immune-related adverse event-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p = 0.007). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p = 0.10). After adjustment of age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (hazard ratio [HR] = 4.03, 95% confidence interval [CI] 1.84-8.84, p < 0.001) and was marginally associated with all-cause death (HR = 1.88, 95% CI, 0.98-3.61, p = 0.057). CONCLUSION: CAD may exist concomitantly with ICB-myocarditis and may portend a poorer outcome when revascularization is performed. This is potentially mediated through delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.
- Publisher
- Elsevier
- Keywords
- Humans; *Coronary Artery Disease/diagnostic imaging/therapy; Immune Checkpoint Inhibitors; Retrospective Studies; *Myocarditis/drug therapy; Prognosis; Registries; Risk Factors; Acute coronary syndrome; Coronary revascularization; Immune checkpoint blockers; Immune-related adverse events; Myocarditis
- Department(s)
- Medical Oncology
- PubMed ID
- 36030143
- Publisher's Version
- https://doi.org/10.1016/j.ejca.2022.07.018
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2025-02-13 06:18:08
Last Modified: 2025-02-13 06:18:45