1. Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry.
- Author
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Nowatzke, Joseph, Guedeney, Paul, Palaskas, Nicholas, Lehmann, Lorenz, Ederhy, Stephane, Zhu, Han, Cautela, Jennifer, Francis, Sanjeev, Courand, Pierre-Yves, Deswal, Anita, Ewer, Steven, 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, Salem, Joe-Elie, Huang, Shi, Collet, Jean-Philippe, Power, John, and Moslehi, Javid
- Subjects
Acute coronary syndrome ,Coronary revascularization ,Immune checkpoint blockers ,Immune-related adverse events ,Myocarditis ,Humans ,Coronary Artery Disease ,Immune Checkpoint Inhibitors ,Retrospective Studies ,Myocarditis ,Prognosis ,Registries ,Risk Factors - 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
- Published
- 2022