Lipid goal attainment and treatment intensification in oncological versus non-oncological patients undergoing percutaneous coronary intervention
E Pogran, P P Peterz, T H Hildebrandt, D Z Zweiker, K H Huber, B J JaegerAbstract
Background
Patients with malignancy frequently have concurrent cardiovascular risk factors and undergo percutaneous coronary intervention (PCI). European registries have documented substantial treatment gaps in lipid management, but data specifically addressing oncological patients after PCI are lacking (1,2).
Aim
To compare lipid profiles, LLT strategies, treatment intensification during hospitalization, and LDL-cholesterol (LDL-C) goal attainment between oncological and non-oncological patients undergoing PCI, stratified by a history of high-risk atherosclerotic cardiovascular disease (prior ASCVD).
Methods
In this single-centre retrospective study, consecutive patients undergoing PCI with stent implantation (2022-2023) were stratified by oncological history (active malignancy or history of oncologic diagnosis) and prior ASCVD. LDL-C target was defined as <55 mg/dL per 2019 ESC/EAS guidelines. In the prior ASCVD subgroup, equivalence of lipid target non-achievement was assessed using risk difference (RD) with Newcombe 90% confidence intervals (CI) and a predefined margin of +/-10 percentage points. Baseline LLT was compared within each stratum. As all post-PCI patients qualify as very high-risk ASCVD, LLT intensification and combination therapy at discharge were analysed in the entire cohort. Group comparisons used Fisher’s exact test. Exploratory logistic regression adjusted for age and high-intensity statin therapy.
Results
Among 1314 consecutive patients, 647 had prior ASCVD. In the ASCVD subgroup with available LDL-C (n=465), lipid target non-achievement did not differ significantly between oncological (19/56, 33.9%) and non-oncological patients (118/409, 28.9%; RD +5.1 percentage points, Newcombe 90% CI −5.1 to +16.6, p=0.811 after adjustment). Oncological patients with prior ASCVD were less frequently treated with high-intensity statins at baseline (9/53, 17.0% vs 128/359, 35.7%; p=0.007). Among patients without prior ASCVD, oncological patients had significantly lower baseline LDL-C (64.2±44.4 vs 104.6±31.6 mg/dL, p<0.001). In the entire post-PCI cohort, LLT intensification during hospitalization was comparable between oncological and non-oncological patients (105/128, 82.0% vs 779/1024, 76.1%; p=0.149). However, oncological patients were discharged with significantly less combination therapy (31/150, 20.7% vs 404/1145, 35.3%; p<0.001) and showed a trend toward lower high-intensity statin use at discharge (90/142, 63.4% vs 796/1121, 71.0%; p=0.065).
Conclusion(s)
Despite comparable rates of LLT intensification during hospitalization, oncological patients undergoing PCI were discharged with significantly less combination lipid-lowering therapy (p<0.001). These findings suggest therapeutic inertia specifically regarding combination therapy at the cardio-oncology interface, highlighting an actionable treatment gap in secondary prevention.Table.LDL-c values, Lipid lowering therapy