Impact of Cancer History on Clinical Outcomes Among Patients Without Standard Modifiable Cardiovascular Risk Factors Who Received PCI

IF 2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2026-10-12 DOI:10.1155/ijcp/3095145

Min Wang, Qizhi Chen, Huasu Zeng, Lin Gao, Mingxing Wu, Junfeng Zhang, Zhengde Tang, Jun Gu, Changqian Wang

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引用次数: 0

Abstract

Background

Coronary artery disease (CAD) has traditionally been attributed to a cluster of standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking. Among SMuRF-less patients (those with none of the four SMuRFs), cancer emerges as an increasingly recognized nontraditional risk factor.

Objective

The purpose of this study was to evaluate the influence of coexisting cancer on the clinical outcomes among SMuRF-less patients who underwent percutaneous coronary intervention (PCI).

Methods

This single-center prospective cohort study enrolled 1416 SMuRF-less CAD patients from August 2016 to December 2024; 493 who received PCI with stents were included, and 468 were analyzed after exclusions (67 with cancer, 401 without). The primary outcome was the incidence of major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal myocardial infarction (MI), heart failure hospitalization, and nonfatal stroke. The secondary outcome was all-cause mortality.

Results

After a median follow-up of 46 months, the cancer group showed poorer prognosis than the noncancer group in terms of MACEs (25.37 vs. 10.97%; HR, 2.828; 95% CI, 1.614–4.957; p < 0.001) and all-cause mortality (13.43 vs. 3.49%; HR, 4.078; 95% CI, 1.764–9.427; p < 0.001). Moreover, proportional hazards analyses identified cancer history as an independent predictor for MACEs (HR 3.40, 95% CI 1.73–6.68, p < 0.001) and all-cause mortality (HR 5.44, 95% CI 2.14–13.84, p < 0.001) following coronary stent implantation. In addition, serum C-reactive protein (CRP) levels were significantly higher in the cancer group than in the noncancer group, and we determined the optimal cutoff value of CRP as 1.25 mg/L. Kaplan–Meier analysis showed that the high CRP group had lower MACE-free survival than that of the low CRP group (p = 0.030) in cancer subgroup analyses. Among the cancer group, patients who were presented as having current cancer had more MACE events than those who were presented as having past cancer at the time of PCI (HR 3.60, 95% CI 1.28–10.13, p = 0.015).

Conclusion

Cancer history was a potent, independent predictor of poorer prognosis in SMuRF-less CAD patients following PCI. Routine measurement of CRP may help identify cancer patients at highest risk.

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接受PCI治疗的无标准可改变心血管危险因素患者的癌症病史对临床结果的影响

传统上，冠状动脉疾病（CAD）归因于一系列标准可改变的心血管危险因素（smurf），包括高血压、糖尿病、血脂异常和吸烟。在smurf较少的患者（没有四种smurf的患者）中，癌症逐渐成为公认的非传统风险因素。目的评价smurf较少患者行经皮冠状动脉介入治疗（PCI）时并发肿瘤对其临床预后的影响。方法该单中心前瞻性队列研究于2016年8月至2024年12月招募了1416例SMuRF-less CAD患者；纳入了493名接受PCI支架的患者，并在排除后对468名患者进行了分析（67名患有癌症，401名没有）。主要结局是主要不良心血管事件（mace）的发生率，包括心血管死亡、非致死性心肌梗死（MI）、心力衰竭住院和非致死性卒中。次要终点是全因死亡率。结果中位随访46个月后，癌症组的预后比非癌症组差，mace（25.37比10.97%；HR, 2.828; 95% CI, 1.614-4.957; p < 0.001）和全因死亡率（13.43比3.49%；HR, 4.078; 95% CI, 1.764-9.427; p < 0.001）。此外，比例风险分析发现，癌症史是冠状动脉支架植入术后mace （HR 3.40, 95% CI 1.73-6.68, p < 0.001）和全因死亡率（HR 5.44, 95% CI 2.14-13.84, p < 0.001）的独立预测因子。此外，癌症组的血清c反应蛋白（CRP）水平明显高于非癌症组，我们确定CRP的最佳临界值为1.25 mg/L。Kaplan-Meier分析显示，在癌症亚组分析中，高CRP组的无mace生存率低于低CRP组（p = 0.030）。在癌症组中，在PCI时，目前患有癌症的患者比过去患有癌症的患者有更多的MACE事件（HR 3.60, 95% CI 1.28-10.13, p = 0.015）。结论癌症史是PCI术后smurf减少的CAD患者预后较差的有效独立预测因子。常规测量CRP可能有助于识别癌症高危患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.