TY - JOUR
T1 - Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis
T2 - Report from an international registry
AU - International ICI-myocarditis registry contributors
AU - Nowatzke, Joseph
AU - Guedeney, Paul
AU - Palaskas, Nicholas
AU - Lehmann, Lorenz
AU - Ederhy, Stephane
AU - Zhu, Han
AU - Cautela, Jennifer
AU - Francis, Sanjeev
AU - Courand, Pierre Yves
AU - Deswal, Anita
AU - Ewer, Steven M.
AU - Aras, Mandar
AU - Arangalage, Dimitri
AU - Ghafourian, Kambiz
AU - Fenioux, Charlotte
AU - Finke, Daniel
AU - Peretto, Giovanni
AU - Zaha, Vlad
AU - Itzhaki Ben Zadok, Osnat
AU - Tajiri, Kazuko
AU - Akhter, Nausheen
AU - Levenson, Joshua
AU - Baldassarre, Lauren
AU - Power, John
AU - Huang, Shi
AU - Collet, Jean Philippe
AU - Moslehi, Javid
AU - Salem, Joe Elie
AU - Aghel, Nazanin
AU - Alexandre, Joachim
AU - Aonuma, Kazutaka
AU - Asnani, Aarti H.
AU - Behling, Juliane
AU - Bilen, Mehmet
AU - Bottinor, Wendy
AU - Cariou, Eve
AU - Chahine, Johnny
AU - Chan, Weiting
AU - Chauhan, Aman
AU - Cohen, Max
AU - Crusz, Shanthini
AU - Fernando, Suran
AU - Florido, Roberta
AU - Frigeri, Mauro
AU - Fukushima, Satoshi
AU - Gaughan, Elizabeth
AU - Geisler, Benjamin P.
AU - Gilstrap, Lauren
AU - Grohe, Christian
AU - Perl, Michal
N1 - Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Acute coronary syndrome
KW - Coronary revascularization
KW - Immune checkpoint blockers
KW - Immune-related adverse events
KW - Myocarditis
UR - http://www.scopus.com/inward/record.url?scp=85142679024&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2022.07.018
DO - 10.1016/j.ejca.2022.07.018
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C2 - 36030143
AN - SCOPUS:85142679024
SN - 0959-8049
VL - 177
SP - 197
EP - 205
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -