Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis: Report from an international registry

• DOI: 10.1016/j.ejca.2022.07.018
• Publication Date: 2022-08-24T12:12:46Z
• Authors: Joseph Nowatzke; Paul Guedeney; Nicholas Palaskas; Lorenz Lehmann; Stephane Ederhy; Han Zhu; Jennifer Cautela; Sanjeev Francis; Pierre-Yves Courand; Anita Deswal; Steven M. Ewer; Mandar Aras; Dimitri Arangalage; Kambiz Ghafourian; Charlotte Fenioux; Daniel Finke; Giovanni Peretto; Vlad Zaha; Osnat Itzhaki Ben...; Kazuko Tajiri; Nausheen Akhter; Joshua Levenson; Lauren Baldassarre; John Power; Shi Huang; Jean-Philippe Collet; Javid Moslehi; Joe-Elie Salem; Nazanin Aghel; Joachim Alexandre; Kazutaka Aonuma; Aarti H. Asnani; Juliane Behling; Mehmet Bilen; Wendy Bottinor; Eve Cariou; Johnny Chahine; Weiting Chan; Aman Chauhan; Max Cohen; Shanthini Crusz; Suran Fernando; Roberta Florido; Mauro Frigeri; Satoshi Fukushima; Elizabeth Gaughan; Benjamin P. Geisler; Lauren Gilstrap; Christian Grohe; Avirup Guha; Manhal Habib; Eva Haegler-Laube; Andrew Haydon; Salim Hayek; Andrew Hughes; Rysk Imai; Yumi Katsume; Hideki Kimura; Lily Koo Lin; Carrie Lenneman; Daryl Leong; Vicky Makker; Nicolas Martinez-...; Melissa Moey; Masahiro Mohri; Ryota Morimoto; Yoshinobu Moritoki; Anna Narezkina; Martin Nicol; Ajay Nooka; Olusola Orimoloye; Milan Patel; Michal Perl; Nicolas Piriou; Jayant K. Raikhelkar; Yasmin Raza; Anjali Rao; Sunil Reddy; Nobuhiko Seki; Karl Stangl; Andrew Stewart; Bryan Stringer; Balaji K. Tamarappoo; Yuichi Tamura; Frank Thuny; Sean Tierney; Romain Tresorier; Waqas Ullah; Jean-Jacques Von ...; Ellen Warner; Allison Weppler
• Keywords: [SDV]Life Sciences [q-bio]; [INFO.INFO-IM] Computer Science [cs]/Medical Imaging; 610; Coronary Artery Disease; Coronary revascularization; 03 medical and health sciences; 0302 clinical medicine; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; Immune-related adverse events; Risk Factors; 616; [INFO.INFO-IM]Computer Science [cs]/Medical Imaging; Humans; Registries; [PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph]; Immune Checkpoint Inhibitors; Retrospective Studies; [PHYS.MECA.BIOM] Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph]; 600; Prognosis; [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; 3. Good health; Myocarditis; Immune checkpoint blockers; Acute coronary syndrome

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.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.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).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.