Association between immune checkpoint inhibitors and adverse cardiovascular events in patients with coronary artery disease and malignant tumors: a retrospective cohort study.

Background and purpose: With the widespread application of immune checkpoint inhibitors (ICIs) in cancer treatment, the associated risk of developing atherosclerotic cardiovascular injury is increasing. However, the risk of cardiovascular disease after ICI treatment in patients with both coronary artery disease and malignancy remains unclear. This study aimed to investigate whether ICI treatment is associated with an increased risk of major adverse cardiovascular events (MACE) in these high-risk patients. Methods: This single-center, retrospective cohort study included 93 patients diagnosed with coronary heart disease and malignant tumors who received ICIs or non-ICIs therapy. The primary outcome was MACE, defined as a composite of cardiogenic death, heart failure, non-fatal acute coronary syndrome, and non-fatal ischemic stroke. The association between baseline clinical parameters, including ICI exposure, and the incidence of MACE was evaluated. Results: During a median follow-up of 14 months, MACE occurred in 32.50% of ICIs-treated patients, with a median time to event of 4 months (2.0-8.5 months), compared to 11.32% and 15.5 months (7.8-27.0 months) in non-ICIs patients. Additionally, all-cause mortality occurred in 12.50% of the ICIs-treated group and 13.21% of the non-ICIs group. Traditional cardiovascular risk factors were not associated with MACE in patients with or without ICI treatment. Multivariable regression analyses revealed an increased risk of developing MACE following ICIs therapy (hazard ration [HR]: 2.86, 95% confidence interval [95% CI]: 1.01-8.11; P = 0.048). Conclusions: Our findings show that ICIs therapy may be independently associated with an increased risk of MACE in patients with coronary heart disease and malignancy. Further larger-scale studies are needed to validate the potential cardiotoxic risk associated with ICIs.