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

• Published in: European journal of cancer (1990) Vol. 177; pp. 197 - 205
• Main Authors: Nowatzke, Joseph, Guedeney, Paul, Palaskas, Nicholas, Lehmann, Lorenz, Ederhy, Stephane, Zhu, Han, Cautela, Jennifer, Francis, Sanjeev, Courand, Pierre-Yves, Deswal, Anita, Ewer, Steven M., 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, Power, John, Huang, Shi, Collet, Jean-Philippe, Moslehi, Javid, Salem, Joe-Elie, Aghel, Nazanin, Alexandre, Joachim, Aonuma, Kazutaka, Asnani, Aarti H., Behling, Juliane, Bilen, Mehmet, Bottinor, Wendy, Cariou, Eve, Chahine, Johnny, Chan, Weiting, Chauhan, Aman, Cohen, Max, Crusz, Shanthini, Fernando, Suran, Florido, Roberta, Frigeri, Mauro, Fukushima, Satoshi, Gaughan, Elizabeth, Geisler, Benjamin P., Gilstrap, Lauren, Grohe, Christian, Guha, Avirup, Habib, Manhal, Haegler-Laube, Eva, Haydon, Andrew, Hayek, Salim, Hughes, Andrew, Imai, Rysk, Katsume, Yumi, Kimura, Hideki, Koo Lin, Lily, Lenneman, Carrie, Leong, Daryl, Makker, Vicky, Martinez-Calle, Nicolas, Moey, Melissa, Mohri, Masahiro, Morimoto, Ryota, Moritoki, Yoshinobu, Narezkina, Anna, Nicol, Martin, Nooka, Ajay, Orimoloye, Olusola, Patel, Milan, Perl, Michal, Piriou, Nicolas, Raikhelkar, Jayant K., Raza, Yasmin, Rao, Anjali, Reddy, Sunil, Seki, Nobuhiko, Stangl, Karl, Stewart, Andrew, Stringer, Bryan, Tamarappoo, Balaji K., Tamura, Yuichi, Thuny, Frank, Tierney, Sean, Tresorier, Romain, Ullah, Waqas, Von Hunolstein, Jean-Jacques, Warner, Ellen, Weppler, Allison
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2022; Elsevier Science Ltd; Elsevier
• Subjects: Acute coronary syndrome; Angiography; Biomechanics; Cardiology and cardiovascular system; Cardiovascular disease; Computer Science; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary revascularization; Coronary vessels; Death; Diagnosis; Human health and pathology; Humans; Immune checkpoint; Immune checkpoint blockers; Immune Checkpoint Inhibitors; Immune-related adverse events; Life Sciences; Mechanics; Medical Imaging; Mortality; Myocarditis; Myocarditis - drug therapy; Patients; Physics; Prognosis; Registries; Retrospective Studies; Risk Factors; Stenosis; Steroid hormones; Vein & artery diseases; Immune checkpoint blockers; Myocarditis; Coronary revascularization; Immune-related adverse events; Acute coronary syndrome
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2022.07.018

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. •ICB-myocarditis can clinically present similarly to acute coronary syndrome.•Diagnostic steps are similar; treatment of both entities is substantially different.•Delay in appropriate treatments of severe ICB-myocarditis should be avoided.