Patients treated with immune checkpoint inhibitors (ICIs) have an increased risk of cardiovascular (CV) events, but the International Classification of Diseases (ICD) code creates a complete picture of the incidence of associated cardiovascular events We do not always collect all the information necessary to do so. ICI therapy.
Colorado researchers collaborated to learn more about the incidence of cardiovascular events in these patients and to assess diagnostic accuracy. Their findings were JACC: Cardiovascular Oncology.
Researchers used data from a cohort of 1813 patients who underwent ICI treatment in the University of Colorado Health System between January 2011 and April 2019. Two cardiologists reviewed the records and used established definitions to determine the diagnosis. We compared the results of the two methods.
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Among patient real-world datasets, venous thromboembolic events (VTE), myocardial infarction (MI), heart failure, and stroke occur much more frequently among patients treated with ICI than myocarditis Did. However, VTE, myocardial infarction, heart failure, and stroke occurred both before and after ICI treatment, whereas myocarditis was mainly detected after treatment.
“Our observation that myocarditis was observed in one patient before ICI and in six patients after ICI is consistent with reports of ICI-associated inflammation,” the researchers said. I’m here.
“The relative rarity of myocarditis compared with other cardiovascular events makes the proper evaluation and management of patients with cardiac symptoms important, especially as ICI therapy evolves into earlier and more widespread use. It emphasizes sexuality,” they added.
VTE was the most common CV event in this patient population, occurring in 11.4% of patients before ICI therapy and 11.3% of patients after ICI therapy. Furthermore, coding and adjudication correlated well in VTE and MI, but not in myocarditis and heart failure.
“This study shows that ICD codes can be used to determine the incidence of MI and VTE. However, this method lacks the fidelity required to accurately identify other cardiovascular events.” ,” the researchers wrote, adding that a standardized definition would help us better understand the incidence of cardiovascular events in these patients.
Future studies should identify predictors of cardiovascular events in patients undergoing ICI therapy so that effective strategies to reduce risk can be developed, the researchers suggest.
Regarding limitations, institutions are attracting patients who only interact with the health system during cancer treatment, so determining whether patients are responding to ICI therapy and correlating it with CV events is a challenging data set. could not run. “Because EMR reflects an incomplete health record, we are cautious about inferring CV rates within cohorts,” the researchers wrote.
Additionally, this study did not include a time-to-event analysis and the dataset did not include cardiac biomarker data. ICD data also relied on entering a billing code.
Disclosure: Some authors have declared affiliations with biotechnology, pharmaceutical, and/or device companies. See the original reference for the full list of disclosures.
reference
Kondapalli L, Hsia J, Miller R, Flaig TW, Bonaca MP. Cardiovascular burden in patients treated with immune checkpoint inhibitors: reconciliation of adjudicated and coded outcomes. JACC cardio on call. 2022;4(5):649-656.doi:10.1016/j.jaccao.2022.09.003
