Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry Journal Article
| Authors: | Nowatzke, J.; Guedeney, P.; Palaskas, N.; Lehmann, L.; Ederhy, S.; Zhu, H.; Cautela, J.; Francis, S.; Courand, P. Y.; Deswal, A.; Ewer, S. M.; 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, J. P.; Moslehi, J.; Salem, J. E.; International ICI-myocarditis registry contributors |
| Contributor: | Makker, V. |
| Article Title: | Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry |
| 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. © 2022 Elsevier Ltd |
| Keywords: | adult; controlled study; aged; retrospective studies; major clinical study; hypertension; comparative study; disease association; ipilimumab; cohort analysis; risk factors; steroid; diagnostic imaging; retrospective study; risk factor; coronary artery bypass graft; cause of death; heart palpitation; hospitalization; register; registries; acetylsalicylic acid; shock; insulin; hospital admission; creatine kinase; methylprednisolone; lidocaine; drug dose increase; atrial fibrillation; beta adrenergic receptor blocking agent; hydroxymethylglutaryl coenzyme a reductase inhibitor; metformin; kidney metastasis; coronary artery disease; adverse drug reaction; heart ventricle tachycardia; tachycardia; transthoracic echocardiography; hypertensive factor; percutaneous coronary intervention; coronary angiography; acute coronary syndrome; st segment elevation; troponin; mortality rate; endotracheal intubation; myocarditis; coronary artery obstruction; atrioventricular block; immune checkpoint inhibitor; hypokinesia; nivolumab; humans; prognosis; human; male; female; article; coronary revascularization; heart muscle revascularization; aldosterone antagonist; immune checkpoint inhibitors; immune-related adverse events; all cause mortality; meprednisone; continuous renal replacement therapy; immune-related gene; immune checkpoint blockers; statin (protein); hypoxemic respiratory failure |
| Journal Title: | European Journal of Cancer |
| Volume: | 177 |
| ISSN: | 0959-8049 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2022-12-01 |
| Start Page: | 197 |
| End Page: | 205 |
| Language: | English |
| DOI: | 10.1016/j.ejca.2022.07.018 |
| PUBMED: | 36030143 |
| PROVIDER: | scopus |
| PMCID: | PMC10165738 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 January 2023 -- Source: Scopus |
