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Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study

  • Original Research Article
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Abstract

Objective

Our objective was to define the most appropriate treatment for acute coronary syndrome (ACS) in patients with malignancy.

Methods and Results

The BleeMACS project is a worldwide multicenter observational prospective registry in 16 hospitals enrolling patients with ACS undergoing percutaneous coronary intervention. Primary endpoints were death, re-infarction, and major adverse cardiac events (MACE; composite of death and re-infarction) after 1 year of follow-up. The secondary endpoint was bleeding events during follow-up. We performed sub-study analyses according to whether β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, or proton pump inhibitors (PPIs) were prescribed at discharge. We also calculated the propensity score for optimal medical therapy (OMT; combination of BB, ACEI/ARB, and statins). The study included 926 patients. According to the multivariate analysis, ACEIs/ARBs (hazard ratio [HR] 0.58, 95 % confidence interval [CI] 0.36–1.94; p = 0.03) and statins (HR 0.37, 95 % CI 0.23–0.61; p < 0.01) reduced the risk of MACE, while the effects of BBs (HR 0.85, 95 % CI 0.55–1.32; p = 0.48) and PPIs (HR 1.33, 95 % CI 0.83–2.12; p = 0.23) were not significant. OMT was prescribed at discharge in 300 (32.4 %) patients; after propensity score analysis, OMT showed a significant reduction in death (3 % vs. 12.5 %, HR 0.21, 95 % CI 0.1–0.4; log-rank p < 0.001) and MACE (6.7 vs. 15.2 %, log-rank p = 0.01).

Conclusion

In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs. (Clinical trials identifier: NCT02466854).

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Authors and Affiliations

  1. Divisione di Cardiologia, Dipartimento di Scienze Mediche, Città della Salute e della Scienza, Turin, Italy

    Mario Iannaccone, Fabrizio D´Ascenzo, Ovidio De Filippo, Marco Gagliardi, José María García-Acuña, Claudio Moretti & Fiorenzo Gaita

  2. Libin Cardiovascular Institute of Alberta and Institute for Public Health, Calgary, AB, Canada

    Danielle A. Southern & Stephen B. Wilton

  3. University Clinical Hospital, Santiago de Compostela, Spain

    Sergio Raposeiras-Roubín, Emad Abu-Assi & José Ramón González-Juanatey

  4. University Academic Medical Center, Amsterdam, The Netherlands

    Jose Paulo Simao Henriques & Wouter J. Kikkert

  5. NorthShore University Hospital, Chicago, IL, USA

    Jorge Saucedo

  6. San Carlos Hospital, Madrid, Spain

    Iván Nuñez-Gil, Emilio Alfonso & Belén Terol

  7. Bellvitge Hospital, Barcelona, Spain

    Albert Ariza-Sole & Alberto Garay

  8. Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Xiantao Song, Dongfeng Zhang & Yalei Chen

  9. University Patras Hospital, Athens, Greece

    Dimitrios Alexopoulos & Ioanna Xanthopoulou

  10. Kerckhoff Heart and Thorax Center, Frankfurt, Germany

    Christoph Liebetrau, Neriman Osman & Helge Möllmann

  11. University Clinical Hospital, Kyoto, Japan

    Tetsuma Kawaji & Hiroki Shiomi

  12. University Clinical Hospital, Warsaw, Poland

    Zenon Huczek, Michal Kowara & Krzysztof Filipiak

  13. Institute of Heart, Lung and Blood Vessel Disease, Beijing, China

    Shao-Ping Nie, Xiao Wang, Yan Yan & Jing-Yao Fan

  14. Tokai University School of Medicine, Tokyo, Japan

    Toshiharu Fujii & Yuji Ikari

  15. Hospital Sao Rafael, Salvador, Brazil

    Luis Correia

  16. Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Masa-aki Kawashiri, Takuya Nakahashi, Kenji Sakata & Masakazu Yamagishi

  17. University Clinic of Cardiology, Skopje, Macedonia

    Oliver Kalpak & Sasko Kedev

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  1. Mario Iannaccone
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  2. Fabrizio D´Ascenzo
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  28. Dongfeng Zhang
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  37. Yan Yan
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  45. Oliver Kalpak
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  46. Sasko Kedev
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Corresponding author

Correspondence to Mario Iannaccone.

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Conflict of interest

Iannaccone Mario, Fabrizio D´Ascenzo, Ovidio De Filippo, Marco Gagliardi, Claudio Moretti, Sergio Raposeiras-Roubín, Emad Abu-Assi, Jose Paulo Simao Henriques, Jorge Saucedo, José Ramón González-Juanatey, Stephen B. Wilton, Wouter J. Kikkert, Iván Nuñez-Gil, Albert Ariza-Sole, Xiantao Song, Dimitrios Alexopoulos, Christoph Liebetrau, Tetsuma Kawaji, Zenon Huczek, Shao-Ping Nie, Toshiharu Fujii, Luis Correia, Masa-aki Kawashiri, José María García-Acuña, Danielle Southern, Emilio Alfonso, Belén Terol, Alberto Garay, Dongfeng Zhang, Yalei Chen, Ioanna Xanthopoulou, Neriman Osman, Helge Möllmann, Hiroki Shiomi, Michal Kowara, Krzysztof Filipiak, Xiao Wang, Yan Yan, Jing-Yao Fan, Yuji Ikari, Takuya Nakahayshi, Kenji Sakata, Masakazu Yamagishi, Fiorenzo Gaita, Oliver Kalpak, and Sasko Kedev have no conflicts of interest that might be relevant to the contents of this manuscript.

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Iannaccone, M., D´Ascenzo, F., De Filippo, O. et al. Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study. Am J Cardiovasc Drugs 17, 61–71 (2017). https://doi.org/10.1007/s40256-016-0196-x

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