Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry. (December 2022)

• Record Type: Journal Article
• Authors: Nowatzke, Joseph; Guedeney, Paul; Palaskas, Nicholas; Lehmann, Lorenz; Ederhy, Stephane; Zhu, Han; Cautela, Jennifer; Francis, Sanjeev; Courand, Pierre-Yves; Deswal, Anita; Ewer, Steven M.; Aras, Mandar; Arangalage, Dimitri; Ghafourian, Kambiz; Fenioux, Charlotte; Finke, Daniel; Peretto, Giovanni; Zaha, Vlad; Itzhaki Ben Zadok, Osnat; Tajiri, Kazuko; Akhter, Nausheen; Levenson, Joshua; Baldassarre, Lauren; Power, John; Huang, Shi; Collet, Jean-Philippe; Moslehi, Javid; Salem, Joe-Elie; Aghel, Nazanin; Alexandre, Joachim; Aonuma, Kazutaka; Asnani, Aarti H.; Behling, Juliane; Bilen, Mehmet; Bottinor, Wendy; Cariou, Eve; Chahine, Johnny; Chan, Weiting; Chauhan, Aman; Cohen, Max; Crusz, Shanthini; Fernando, Suran; Florido, Roberta; Frigeri, Mauro; Fukushima, Satoshi; Gaughan, Elizabeth; Geisler, Benjamin P.; Gilstrap, Lauren; Grohe, Christian; Guha, Avirup; Habib, Manhal; Haegler-Laube, Eva; Haydon, Andrew; Hayek, Salim; Hughes, Andrew; Imai, Rysk; Katsume, Yumi; Kimura, Hideki; Koo Lin, Lily; Lenneman, Carrie; Leong, Daryl; Makker, Vicky; Martinez-Calle, Nicolas; Moey, Melissa; Mohri, Masahiro; Morimoto, Ryota; Moritoki, Yoshinobu; Narezkina, Anna; Nicol, Martin; Nooka, Ajay; Orimoloye, Olusola; Patel, Milan; Perl, Michal; Piriou, Nicolas; Raikhelkar, Jayant K.; Raza, Yasmin; Rao, Anjali; Reddy, Sunil; Seki, Nobuhiko; Stangl, Karl; Stewart, Andrew; Stringer, Bryan; Tamarappoo, Balaji K.; Tamura, Yuichi; Thuny, Frank; Tierney, Sean; Tresorier, Romain; Ullah, Waqas; Von Hunolstein, Jean-Jacques; Warner, Ellen; Weppler, Allison;
• Is Part Of: European journal of cancer. Volume 177(2022)
• Page Start: 197
• Page End: 205
• Publication Date: 2022-12
• Subjects: Immune checkpoint blockers -- Immune-related adverse events -- Myocarditis -- Acute coronary syndrome -- Coronary revascularization; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.07.018
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Purpose: Immune checkpoint blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary 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 stenosis >70% in patients undergoing coronary angiogram. Results: Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary 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 coronary 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 revascularization 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 marginally 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 diagnosis and treatment or more severe presentation of ICB-myocarditis. Highlights: ICB-myocarditis can clinically present similarly to acute coronary syndrome. Diagnostic steps are similar; treatment of both entities is substantially different. Delay in appropriate treatments of severe ICB-myocarditis should be avoided.