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36 An analysis of the virtual cardio-oncology research initiative (VICORI) resource: bleeding risk among acute coronary syndrome patients with cancer

Heart (British Cardiac Society), 2023-06, Vol.109 (Suppl 3), p.A40-A41 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. ;2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2023-BCS.36

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  • Title:
    36 An analysis of the virtual cardio-oncology research initiative (VICORI) resource: bleeding risk among acute coronary syndrome patients with cancer
  • Author: Ow, Kok Weng ; Van den Berg, Freek ; de Belder, Mark ; Deanfield, John ; Rutherford, Mark ; Peake, Michael ; Paley, Lizz ; Adlam, David ; Lambert, Paul ; Tyrer, Freya ; Lai, Jennifer
  • Subjects: Acute coronary syndrome ; Acute coronary syndromes ; Acute coronary syndromes & Interventional Cardiology ; Bleeding ; Cancer ; Cardio-oncology ; Cardiovascular disease ; Hospitalization
  • Is Part Of: Heart (British Cardiac Society), 2023-06, Vol.109 (Suppl 3), p.A40-A41
  • Description: IntroductionCardiovascular disease and cancer are common causes of morbidity and mortality. Significant advancements in treatment strategies for both disease entities have resulted in a growing population who live with both conditions. Myocardial infarction (MI) represents approximately 20% of all cardiovascular disease admissions in cancer patients and 10% of patients who present with an acute MI has cancer. Bleeding is a major concern in patients with cancer and an acute coronary syndrome (ACS). While dual antiplatelet therapy (DAPT) increases a patient’s bleeding risk, cancer patients are at a further increased risk. Cancer is a recognised risk factor associated with an increased bleeding risk after percutaneous coronary intervention (PCI), but blood dyscrasias, liver disease and multiple long-term conditions – all common to cancer patients – further exacerbate this risk. Prescribing DAPT post-ACS and post-PCI remains a challenge when balancing ischaemic and bleeding risks in this population. The VICORI database is the world’s first whole-country cardio-oncology research platform, linking data from the National Cancer Registration and Analysis Service, National Institute for Cardiovascular Outcomes Research and Hospital Episode Statistics. We aim to investigate the risk of hospitalisation for bleeding among ACS patients stratified by presence or absence of cancer.MethodsThis is an observational cohort study using linked data from the VICORI database. We investigated the risk of hospitalisation for bleeding following an ACS, in patients with and without cancer, identified between 2006–2019. Patients were followed up for one year from the date of their ACS. We used inverse probability weighting based on propensity scores to produce a balanced cohort of patients with and without cancer. Subgroup analyses were performed on patients with ST and non-ST-elevation MI alongside coronary stenting.ResultsOf 608,771 patients presenting with ACS, 9861 (1.6%) had cancer while 598,910 (98.4%) did not. Prostate (n=1753, 17.8%), colorectal (n=1548, 15.7%), lung (n=1543, 15.7%) and breast (n=607, 6.2%) cancers were among the most common types of cancers. Relating to PCI, cancer patients received stents in only 35.4% (n=3,489) of cases, while non-cancer patients received stents in 55.5% (n=332,566) of cases. Bleeding events were more prevalent in cancer patients compared to non-cancer patients (n=779, 7.9% vs n=28,016, 4.7%). The rate (hazard) of hospitalisation for bleeding in the first year following ACS was higher in patients with cancer than those without (HR:1.46, 95%CI 1.36 to 1.57).ConclusionIn this large real-world observational study, cancer patients had an increased risk of hospitalisation for bleeding after ACS compared to those without. Further work is needed to identify people with cancer who are at a high-risk of bleeding, optimal therapies, and the risk:benefit ratio of bleeding versus subsequent cardiovascular events.Abstract 36 Figure 1Incidence rate of bleeding in Male & Female PatientsAbstract 36 Figure 2Forest plot of Hazard Ratios for Hospitalisation for Bleeding in Cancer Patients after Inverse Probability WeightingConflict of InterestNone
  • Publisher: London: BMJ Publishing Group Ltd and British Cardiovascular Society
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2023-BCS.36
  • Source: AUTh Library subscriptions: ProQuest Central
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