Data_Sheet_1_Coronary Stent Healing in Cancer Patients—An Optical Coherence Tomography Perspective.DOCX

Objective: This study assessed stent healing patterns and cardiovascular outcomes by optical coherence tomography (OCT) in cancer patients after drug-eluting stent (DES) placement.Background: Cancer treatment, owing to its cytotoxic and antiproliferative effects, could delay stent healing and increase stent thrombosis risk, especially when dual antiplatelet therapy (DAPT) is discontinued early for oncological treatment. OCT can assess stent endothelialization and other healing parameters, which may provide clinical guidance in these challenging scenarios.Methods: This single-center retrospective study enrolled all cancer patients who underwent OCT for assessment of vascular healing patterns after prior DES placement from November 2009 to November 2018. Primary study endpoints were stent healing parameters, including stent coverage, apposition, degree of expansion, neointimal hyperplasia heterogeneity, in-stent restenosis, stent thrombosis, and overall survival (OS).Results: A total of 67 patients were included in this study. Mean time between DES placement and OCT evaluation was 154 ± 82 days. Stent healing matched published values for DES in non-cancer patients (P ≥ 0.063). At 1 year, the OS was 86% (95% confidence interval [CI]: 78–96%) with 0% incidence of acute coronary syndrome. Advanced cancers and active chemotherapies were associated with inferior OS (P = 0.024, hazard ratio [HR]: 3.50, 95% CI: 1.18–10.42 and P = 0.026, HR: 2.65, 95% CI: 1.13–6.22, respectively), while stent healing parameters were unassociated with OS. Forty-one patients (61%) had DAPT duration ≤6 months.Conclusions: Stent healing of contemporary DES appears similar in cancer and non-cancer patients. Cardiovascular risk of cancer patients after DES placement can be managed to facilitate timely cancer therapies, as the underlying malignancy and active chemotherapy ultimately determine survival.

研究目的：本研究旨在通过光学相干断层扫描（OCT）评估癌症患者在药物洗脱支架（DES）植入后支架愈合模式和心血管结局。研究背景：由于癌症治疗具有细胞毒性和抗增殖作用，可能会延迟支架愈合并增加支架血栓形成的风险，尤其是在为肿瘤治疗而提前终止双联抗血小板治疗（DAPT）的情况下。OCT能够评估支架内皮化及其他愈合参数，这些参数可能为这些复杂场景提供临床指导。研究方法：这是一项单中心回顾性研究，纳入了2009年11月至2018年11月期间所有因评估DES植入后血管愈合模式而接受OCT检查的癌症患者。主要研究终点包括支架愈合参数，如支架覆盖、贴附度、扩张程度、新生内膜增生异质性、支架内再狭窄、支架血栓形成以及总生存期（OS）。研究结果：共有67名患者纳入本研究。DES植入与OCT评估之间的平均时间为154 ± 82天。支架愈合与DES在非癌症患者中的已发表值相匹配（P ≥ 0.063）。1年后，总生存期为86%（95%置信区间[CI]：78–96%），急性冠脉综合征的发病率均为0%。晚期癌症和活跃的化疗与较差的总生存期相关（P = 0.024，风险比[HR]：3.50，95% CI：1.18–10.42；P = 0.026，HR：2.65，95% CI：1.13–6.22），而支架愈合参数与总生存期无关。41名患者（61%）的DAPT持续时间≤6个月。研究结论：当代DES的支架愈合在癌症患者和非癌症患者中表现相似。癌症患者在DES植入后的心血管风险可通过管理以促进及时进行癌症治疗，因为潜在的恶性肿瘤和活跃的化疗最终决定了生存。