Cancer Activity and Clinical Outcomes After Percutaneous Coronary Intervention: A Systematic Review of Bleeding, Ischemic Events, and Evidence Gaps

Cancer activity may modify bleeding and ischemic risk after percutaneous coronary intervention (PCI), but available reports differ in cancer definitions, antiplatelet exposure and follow-up. We reassessed a PROSPERO-registered systematic review (CRD420261350515), originally comprising five observational studies, and undertook targeted verification of related primary literature. Five further potentially eligible reports were identified, providing ten source-verified reports for an expanded, non-exhaustive evidence audit. Active cancer, recent diagnosis or ongoing therapy were frequently associated with bleeding, although ischemic findings were less consistent. One large Veterans Affairs cohort examined observational associations between dual antiplatetet therapy (DAPT) discontinuation and longer-term outcomes by cancer activity; this was not a randomized strategy comparison. Definitions and follow-up precluded pooling of activity-specific bleeding risk ratios. The evidence does not establish a cancer-specific DAPT duration or preferred P2Y12 inhibitor. Prospective studies should integrate serial oncologic, hematologic, procedural and antiplatelet information.