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Background <p>Immune checkpoint inhibitors (ICIs) have become the standard for treating various cancers. Nevertheless, their use may lead to significant cardiovascular immune-related adverse events (CV irAEs).</p> Objectives <p>We aimed to assess whether pre-treatment coronary artery calcium (CAC) deposition predicts CV irAEs in patients treated with ICIs.</p> Methods <p>A retrospective single-center cohort of patients treated with ICIs who performed pre-treatment chest computed tomography. A visual CAC assessment was categorized into Positive or Negative calcium deposits. Patients with pre-existing ischemic heart disease were excluded. The primary endpoint was the composite CV irAEs, including myocarditis, acute coronary syndrome, heart failure, and arrhythmias, and the secondary endpoint was all-cause mortality.</p> Results <p>The cohort included 240 patients with a median age of 67 (IQR 59–73) years and 47% female. The most prevalent type of cancer was lung cancer (36%), and the prominent ICIs was pembrolizumab (54%). Patients with Positive CAC (38%) were predominantly male, with higher rates of cardiovascular comorbidities. The primary outcome occurred in 36 cases (15%) at a median of 94 (IQR 48–338) days from the first ICIs dose. The Positive CAC group observed a non-significant trend toward a higher hazard for CV irAEs (HR 1.66, 95% CI 0.86–3.21, <i>p</i> = 0.13), with no significant difference in all-cause mortality (HR 1.15, 95% CI 0.88–1.51, <i>p</i> = 0.30).</p> Conclusion <p>Pre-treatment CAC deposition did not demonstrate an independent predictive role in assessing the risk of CV irAEs and all-cause mortality in patients treated with ICIs.</p>

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The predictive value of coronary artery calcium deposit for cardiovascular events in patients treated with immune checkpoint inhibitors

  • 期刊论文

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  • 发表日期：

    2025年9月30日

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  • Moaad Slieman,
  • Ophir Freund,
  • Galit Aviram,
  • Haim Shmilovich,
  • Zach Rozenbaum,
  • Moran Gvili Perelman,
  • Lior Zornitzki,
  • Dana Viskin,
  • Anna Rozenfeld Hemed,
  • Shafik Khoury,
  • Ofer Havakuk,
  • Yan Topilsky,
  • Shmuel Banai,
  • Joseph Carver,
  • Michal Laufer-Perl

摘要

Background

Immune checkpoint inhibitors (ICIs) have become the standard for treating various cancers. Nevertheless, their use may lead to significant cardiovascular immune-related adverse events (CV irAEs).

Objectives

We aimed to assess whether pre-treatment coronary artery calcium (CAC) deposition predicts CV irAEs in patients treated with ICIs.

Methods

A retrospective single-center cohort of patients treated with ICIs who performed pre-treatment chest computed tomography. A visual CAC assessment was categorized into Positive or Negative calcium deposits. Patients with pre-existing ischemic heart disease were excluded. The primary endpoint was the composite CV irAEs, including myocarditis, acute coronary syndrome, heart failure, and arrhythmias, and the secondary endpoint was all-cause mortality.

Results

The cohort included 240 patients with a median age of 67 (IQR 59–73) years and 47% female. The most prevalent type of cancer was lung cancer (36%), and the prominent ICIs was pembrolizumab (54%). Patients with Positive CAC (38%) were predominantly male, with higher rates of cardiovascular comorbidities. The primary outcome occurred in 36 cases (15%) at a median of 94 (IQR 48–338) days from the first ICIs dose. The Positive CAC group observed a non-significant trend toward a higher hazard for CV irAEs (HR 1.66, 95% CI 0.86–3.21, p = 0.13), with no significant difference in all-cause mortality (HR 1.15, 95% CI 0.88–1.51, p = 0.30).

Conclusion

Pre-treatment CAC deposition did not demonstrate an independent predictive role in assessing the risk of CV irAEs and all-cause mortality in patients treated with ICIs.