Baseline cardiovascular assessment and incidence of major adverse cardiovascular events during immune checkpoint inhibitor therapy in a hungarian population
Z Drobni, Z S Sandor, D Maraczi, L Jaekyung, A Metasebia, T Koleszar, P Hollo, V Muller, Z Pozsonyi, B MerkelyAbstract
Background
Immune checkpoint inhibitors (ICIs) are widely used oncological therapies that may be associated with cardiovascular adverse events. To date, no Hungarian data have been available regarding the risk of ICI-associated major adverse cardiovascular events (MACE) or the real-world practice of baseline cardiovascular assessment prior to therapy initiation.
Objectives
Our aim was to evaluate the implementation of baseline cardiovascular assessment in patients receiving ICI therapy and to analyze the incidence of MACE.
Methods
In this retrospective study, we analyzed data from patients who received at least one dose of ICI therapy at Semmelweis University in 2023, based on records from E-MedSolution and the Hungarian National eHealth Infrastructure (EESZT). Cardiovascular risk stratification was performed using the ESC risk score. Appropriate statistical tests were applied for group comparisons, and logistic regression was used to assess predictors of MACE (p < 0.05).
Results
A total of 589 patients were analyzed, the majority of whom were classified as high cardiovascular risk (ESC: 79.5%). Despite this, baseline assessment was largely incomplete (troponin: 2.7%, NT-proBNP: 0.5%, cardiology consultation: 14.1%). During a median follow-up of 748 days, 203 MACE occurred in 159 patients (27.0%), predominantly in the early phase of therapy. In multivariable models, age (OR 1.02), statin therapy (OR 1.58), and the presence of immune-related adverse events (irAEs) (OR 1.71) were independent predictors of MACE. The Charlson Comorbidity Index showed moderate discrimination; a score ≥8 was associated with significantly increased risk (OR 2.54). ESC-based risk classification was independently associated with MACE (OR 2.13).
Conclusions
Most patients receiving ICI therapy are at high cardiovascular risk; however, baseline cardiovascular assessment frequently falls short of guideline recommendations. MACE are common, particularly in the early phase of treatment, and are well predicted by comorbidity burden and high ESC risk status. Our findings support the need for guideline-based baseline cardiovascular evaluation and early monitoring in this population.