1. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry
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Joseph Nowatzke, Paul Guedeney, Nicholas Palaskas, Lorenz Lehmann, Stephane Ederhy, Han Zhu, Jennifer Cautela, Sanjeev Francis, Pierre-Yves Courand, Anita Deswal, Steven M. Ewer, Mandar Aras, Dimitri Arangalage, Kambiz Ghafourian, Charlotte Fenioux, Daniel Finke, Giovanni Peretto, Vlad Zaha, Osnat Itzhaki Ben Zadok, Kazuko Tajiri, Nausheen Akhter, Joshua Levenson, Lauren Baldassarre, John Power, Shi Huang, Jean-Philippe Collet, Javid Moslehi, Joe-Elie Salem, Nazanin Aghel, Joachim Alexandre, Kazutaka Aonuma, Aarti H. Asnani, Juliane Behling, Mehmet Bilen, Wendy Bottinor, Eve Cariou, Johnny Chahine, Weiting Chan, Aman Chauhan, Max Cohen, Shanthini Crusz, Suran Fernando, Roberta Florido, Mauro Frigeri, Satoshi Fukushima, Elizabeth Gaughan, Benjamin P. Geisler, Lauren Gilstrap, Christian Grohe, Avirup Guha, Manhal Habib, Eva Haegler-Laube, Andrew Haydon, Salim Hayek, Andrew Hughes, Rysk Imai, Yumi Katsume, Hideki Kimura, Lily Koo Lin, Carrie Lenneman, Daryl Leong, Vicky Makker, Nicolas Martinez-Calle, Melissa Moey, Masahiro Mohri, Ryota Morimoto, Yoshinobu Moritoki, Anna Narezkina, Martin Nicol, Ajay Nooka, Olusola Orimoloye, Milan Patel, Michal Perl, Nicolas Piriou, Jayant K. Raikhelkar, Yasmin Raza, Anjali Rao, Sunil Reddy, Nobuhiko Seki, Karl Stangl, Andrew Stewart, Bryan Stringer, Balaji K. Tamarappoo, Yuichi Tamura, Frank Thuny, Sean Tierney, Romain Tresorier, Waqas Ullah, Jean-Jacques Von Hunolstein, Ellen Warner, Allison Weppler, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Universität Heidelberg [Heidelberg] = Heidelberg University, German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH), CHU Saint-Antoine [AP-HP], Groupe de REcherche en Cardio Oncologie (GRC 27 - GRECO), Sorbonne Université (SU), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Imagerie Ultrasonore, Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), The University of Texas Medical School at Houston, University of Wisconsin-Madison, University of California [San Francisco] (UC San Francisco), University of California (UC), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Heidelberg, Medical Faculty, Division of Endocrinology, Metabolism, and Diabetes, University of Utah, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases [IHU ICAN], Universität Heidelberg [Heidelberg], Service de Cardiologie [CHU Saint-Antoine], Groupe de REcherche en Cardio Oncologie [CHU Saint-Antoine] (GRC 27 GRECO), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Service de Pharmacologie médicale [CHU Pitié-Salpêtrière]
- Subjects
Cancer Research ,Coronary Artery Disease ,Prognosis ,Coronary revascularization ,Myocarditis ,Oncology ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Risk Factors ,Immune-related adverse events ,[INFO.INFO-IM]Computer Science [cs]/Medical Imaging ,Humans ,Registries ,Immune checkpoint blockers ,Acute coronary syndrome ,[PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph] ,Immune Checkpoint Inhibitors ,Retrospective Studies - Abstract
International audience; Purpose: Immune checkpoint blocker (ICB) associated myocarditis (ICB-myocar-ditis) may present similarly and/or overlap with other cardiac pathology including acute cor-onary 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 steno-sis >70% in patients undergoing coronary angiogram.Results: Among 261 patients with clinically suspected ICB-myocarditis who underwent a coro-nary 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 coro-nary 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 revas-cularization 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 margin-ally 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 diag-nosis and treatment or more severe presentation of ICB-myocarditis.
- Published
- 2022
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