title: Relationship Between Cancer and Cardiovascular Outcomes Following Percutaneous Coronary Intervention.
abstract: BACKGROUND
  Cardiovascular disease and cancer increasingly coexist, yet relationships between cancer and long-term cardiovascular outcomes post-percutaneous coronary intervention (PCI) are not well studied.
  
  
  RESULTS
  We examined stented PCI patients at Duke (1996-2010) using linked data from the Duke Information Systems for Cardiovascular Care and the Duke Tumor Registry (a cancer treatment registry). Our primary outcome was cardiovascular mortality. Secondary outcomes included composite cardiovascular mortality, myocardial infarction, or repeat revascularization and all-cause mortality. We used adjusted cause-specific hazard models to examine outcomes among cancer patients (cancer treatment pre-PCI) versus controls (no cancer treatment pre-PCI). Cardiovascular mortality was explored in a cancer subgroup with recent (within 1 year pre-PCI) cancer and in post-PCI cancer patients using post-PCI cancer as a time-dependent variable. Among 15 008 patients, 3.3% (n=496) were cancer patients. Observed rates of 14-year cardiovascular mortality (31.4% versus 27.7%, P=0.31) and composite cardiovascular death, myocardial infarction, or revascularization (51.1% versus 55.8%, P=0.37) were similar for cancer versus control groups; all-cause mortality rates were higher (79.7% versus 49.3%, P<0.01). Adjusted risk of cardiovascular mortality was similar for cancer patients versus controls (hazard ratio 0.95; 95% CI 0.76 to 1.20) and for patients with versus without recent cancer (hazard ratio 1.46; 95% CI 0.92 to 2.33). Post-PCI cancer, present in 4.3% (n=647) of patients, was associated with cardiovascular mortality (adjusted hazard ratio 1.51; 95% CI 1.11 to 2.03).
  
  
  CONCLUSIONS
  Cancer history was present in a minority of PCI patients but was not associated with worse long-term cardiovascular outcomes. Further investigation into PCI outcomes in this population is warranted.
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.) Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: Connie N
authors.initials: CN
authors.lastname: Hess
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.) Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: Robert M
authors.initials: RM
authors.lastname: Clare
authors.affiliation: Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: Karen
authors.initials: K
authors.lastname: Chiswell
authors.affiliation: Center for Learning Healthcare, Duke Clinical Research Institute, Durham, NC (J.K., A.P.A.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.) Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.affiliation: Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Sweden (E.H., S.K.J.).
authors.forename: Emil
authors.initials: E
authors.lastname: Hagstrom
authors.affiliation: Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Sweden (E.H., S.K.J.).
authors.forename: Stefan K
authors.initials: SK
authors.lastname: James
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.).
authors.forename: Michel G
authors.initials: MG
authors.lastname: Khouri
authors.affiliation: Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.) Duke Cancer Institute, Durham, NC (B.R.H., A.P.A.).
authors.forename: Bradford R
authors.initials: BR
authors.lastname: Hirsch
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.) Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: David F
authors.initials: DF
authors.lastname: Kong
authors.affiliation: Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC (A.P.A.) Center for Learning Healthcare, Duke Clinical Research Institute, Durham, NC (J.K., A.P.A.) Duke Cancer Institute, Durham, NC (B.R.H., A.P.A.).
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (C.N.H., M.T.R., J.E.T., M.G.K., D.F.K., M.W.K.) Duke Clinical Research Institute, Durham, NC (C.N.H., M.T.R., R.M.C., K.C., J.E.T., B.R.H., D.F.K., M.W.K.).
authors.forename: Mitchell W
authors.initials: MW
authors.lastname: Krucoff
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality*; D009657:North Carolina / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: cancer; cardiovascular outcomes; percutaneous coronary intervention