Association Between Time From Percutaneous Coronary Intervention to Cancer Surgery and Cardiovascular and Oncological Outcomes

초록

BACKGROUND: Patients who undergo noncardiac surgery shortly after percutaneous coronary intervention (PCI) experience higher rates of perioperative ischemic events, but delaying surgery may affect disease staging and influence cancer recurrence. We aimed to evaluate the association between time from PCI to cancer surgery and cardiovascular and oncologic outcomes in patients with early-stage cancer. METHODS AND RESULTS: We included patients with early-stage cancer with a history of PCI who underwent cancer surgery (N=3621). The patients were divided into 2 groups based on the time between the dates of PCI and cancer surgery (<12 and >= 12 months). We also grouped patients who underwent early surgery and late surgery, defined as patients who underwent surgery >= 1 and <1 month after cancer diagnosis. Outcomes included bleeding, spontaneous myocardial infarction, repeat revascularization, cancer recurrence, and death. The time from PCI to cancer surgery <12 months group had higher bleeding (hazard ratio [HR], 1.30 [95% CI, 1.18-1.32]), spontaneous myocardial infarction (HR,1.96 [95% CI, 1.32-2.92]), cancer recurrence (HR, 1.26 [95% CI, 1.01-1.56]), and mortality (HR, 1.23 [95% CI, 1.04-1.44]) compared with the >= 12 months group. Among the time from PCI to cancer surgery <12 months group, the early-surgery group had lower cancer recurrence risk than those who underwent late surgery (HR, 0.70 [95% CI, 0.49-0.99]) without differences in bleeding and cardiac outcome. CONCLUSIONS: Although patients who undergo surgery within 12 months of PCI have higher risks of bleeding and cardiovascular events, delaying surgery may increase the risk of cancer recurrence. Therefore, the timing of surgery should be a personalized decision, weighing the risks of cardiovascular complications against the potential oncologic outcomes.

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