title: Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study.
abstract: OBJECTIVE
  Our objective was to define the most appropriate treatment for acute coronary syndrome (ACS) in patients with malignancy.
  
  
  RESULTS
  The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36-1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23-0.61; p < 0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55-1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83-2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1-0.4; log-rank p < 0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01).
  
  
  CONCLUSIONS
  In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs. (Clinical trials identifier: NCT02466854).
authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy. mario.iannaccone@hotmail.it.
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authors.identifier: http://orcid.org/0000-0003-0571-3918
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authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
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authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
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authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
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authors.affiliation: University Clinical Hospital, Santiago de Compostela, Spain.
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authors.affiliation: University Clinical Hospital, Santiago de Compostela, Spain.
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authors.lastname: Nie
authors.affiliation: Tokai University School of Medicine, Tokyo, Japan.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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authors.lastname: Kawashiri
authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
authors.forename: José María
authors.initials: JM
authors.lastname: García-Acuña
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authors.affiliation: Institute of Heart, Lung and Blood Vessel Disease, Beijing, China.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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authors.affiliation: Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
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authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
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authors.lastname: Moretti
authors.affiliation: Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy.
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mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention / Q000639:trends*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors