In-hospital outcomes of elective percutaneous coronary intervention in patients with metastatic cancer

Metastasis is a key hallmark of cancer progression and significantly affects the management of other comorbidities, including coronary artery disease (CAD). Perioperative outcomes of elective percutaneous coronary intervention (PCI) for patients with metastatic cancer have not been thoroughly investigated. This study aimed to provide a comprehensive, population-based analysis of in-hospital outcomes of elective PCI among patients with metastatic cancer using a national database.

Adult patients who underwent elective PCI were identified by ICD-10-PCS codes in National Inpatient Sample from Q4 2015-2021. Patients who had concomitant procedures were excluded. A 1:3 propensity-score matching was used to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and transfer status between patients with and without metastatic cancer. In-hospital outcomes were examined.

Among 44,654 patients who underwent elective PCI, 233 (0.50 %) had metastatic cancer. After propensity-score matching, all patients with metastatic cancer were matched to 671 controls. Metastatic cancer patients had higher mortality (7.17 % vs 2.09 %, p < 0.01), cardiogenic shock (11.21 % vs 5.66 %, p = 0.01), mechanical ventilation (14.35 % vs 4.02 %, p < 0.01), acute kidney injury (AKI; 24.66 % vs 17.59 %, p = 0.02), hemorrhage/hematoma (25.11 % vs 9.84 %, p < 0.01), infection (8.07 % vs 1.79 %, p < 0.01), and transfer out (17.49 % vs 9.24 %, p < 0.01). In addition, metastatic cancer patients had longer length of stay (p < 0.01) and higher total hospital charges (p < 0.01). Significant morbidities associated with in-hospital mortality metastatic cancer patients included pericardial complications (aOR 75.91, p < 0.01), mechanical ventilation (aOR 28.09, p < 0.01), and AKI (aOR 12.53, p < 0.01).

Considering their elevated risks of in-hospital mortality and morbidities, elective PCI should be carefully considered in metastatic cancer patients. These findings could help guide preprocedural counseling, clinical decision-making, and goals of care discussion for these patients. Early identification and management of morbidities, particularly pericardial complications, may help reduce early mortality in these patients.