ABC | Volume 114, Nº6, June 2020

Original Article Chemotherapy-Related Anatomical Coronary-Artery Disease in Lung Cancer Patients Evaluated by Coronary-Angiography SYNTAX Score Qian Yang, 1 Yundai Chen, 1 Hai Gao, 2 Jianzhong Zhang, 3 Juan Zhang, 4 Mingjie Zhang, 1 Jing Jing, 1 Pingjun Zhu, 1 Hao Zhou, 1 Shunying Hu 1 Chinese PLA General Hospital - Department of Cardiology, First Medical Center, 1 Beijing - China Beijing An Zhen Hospital - Department of Cardiology, Chaoyang-qu, 2 Beijing - China Unimed Scientific Inc., 3 Wuxi - China Chinese PLA General Hospital - Department of Oncology - First Medical Center, 4 Beijing – China Mailing Address: Shunying Hu • Department of Cardiology, Chinese PLA General Hospital - 28 Fuxing Road Beijing 100853 – China E-mail: hsylily@163.com Manuscript received February 07, 2019, revised manuscript June 03, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20190201 Abstract Background: Chemotherapy-related coronary artery disease (CAD) is becoming an emerging issue in clinic. However, the underlying mechanism of chemotherapy-related CAD remains unclear. Objective: The study investigated the association between chemotherapy and atherosclerotic anatomical abnormalities of coronary arteries among lung cancer patients. Methods: Patients undergoing coronary angiography (CAG) between 2010 and 2017, who previously had lung cancer, were examined. Risk factors associated with CAD and information about lung cancer were evaluated. We assessed coronary-artery abnormalities by SYNTAX score (SXscore) based on CAG. In logistic-regression analysis, we defined high SXscore (SXhigh) grade as positive if ≥22. Data were analyzed through descriptive statistics and regression analysis. Results: A total of 94 patients were included in the study. The SXscore was higher in the chemotherapy group than in the non-chemotherapy group (25.25, IQR [4.50–30.00] vs. 16.50, IQR [ 5.00–22.00], p = 0.0195). The SXhigh rate was greater in the chemotherapy group than in the non-chemotherapy group (58.33% vs. 25.86; p = 0.0016). Both univariate (OR:4.013; 95% CI:1.655–9.731) and multivariate (OR:5.868; 95% CI:1.778–19.367) logistic-regression analysis revealed that chemotherapy increased the risk of greater SXhigh rates. Multivariate stepwise logistic-regression analysis showed the risk of more severe anatomical CAD is increased by chemotherapy as a whole by 5.323 times (95% CI: 2.002–14.152), and by platinum-based regimens by 5.850 times (95% CI: 2.027–16.879). Conclusions: Chemotherapy is associated with anatomical complexity and severity of CAD, which might partly account for the higher risk of chemotherapy-related CAD among lung cancer patients. (Arq Bras Cardiol. 2020; 114(6):1004-1012) Keywords: Coronary Artery Disease/physiopathology; Lung Neoplasms/drug therapy; Lung Neoplasms/complications; Propensity Score; Score Syntax; Angioplasty/methods; Risk Factors. Introduction Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer. However, these gains can come at a cost. 1 Cardiovascular toxicity is a potential short- or long-term complication of various anticancer therapies and is becoming one of the most concerning side effects of anti-cancer therapy. 2 Heart conditions that may be induced by anticancer chemotherapeutic agents include cardiac dysfunction, cardiac ischemia, arrhythmia, stroke and pulmonary-artery hypertension. 1,3,4 Chemotherapy- related coronary artery disease (CAD) is becoming an emerging clinical problem difficult to manage due to various clinical manifestation and complicated pathophysiological mechanisms. 5-7 Chemotherapy-induced coronary-artery events that occurred shortly after administration of chemotherapeutic agents, possibly due to acute thrombosis or vasospasm, have been reported. 3,8 However, the pathogenesis of chronic chemotherapy-related CAD remains unclear. Lung cancer is the most common incident cancer and the leading cause of cancer death. 9 Chemotherapy is an important treatment for this disease. 10,11 Chemotherapeutic agents for lung cancer, including taxanes, cisplatin, carboplatin, bevacizumab, sorafenib and erlotinib 3,10,12 are known to cause acute myocardial infarction (AMI). It is important to investigate the long term effect of chemotherapy on anatomical changes of coronary artery among lung cancer patients. Complexity and lesion characteristics of the coronary artery are well-recognized predictors of periprocedural complications and long-termmortality. 13-15 The SYNTAX score (SXscore) was developed to prospectively characterize the 1004