Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis – report from an international registry

Abstract Purpose Immune-checkpoint-blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis. Methods An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence artery disease (CAD) defined as stenosis >70% in patients undergoing angiogram. Results Among 261 clinically suspected ICB-myocarditis who underwent angiography, CAD 59/261 (22.6%) (Table 1). Coronary revascularization performed during the index hospitalization 19/59 (32.2%) patients. Patients less frequently received steroids administration within 24h admission compared groups (p=0.029). Myocarditis related 90-day mortality 9/17 (52.7%) revascularized cohort, 5/31 (16.1%) those not and 25/156 (16.0%) without (p=0.001). irAE-related 6/31 (19.4%) 31/156 (19.9%) no (p=0.007) (Figure All-cause 11/17 (64.7%) 13/31 (41.9%) 60/158 (38.0%) (p=0.10). After adjustment on age sex, remained ICB-myocarditis-related death at 90 days (Hazard ratio [HR]=4.03, 95%confidence interval [CI] 1.84–8.84, p<0.001) marginally all-cause (HR=1.88, 95% CI 0.98–3.61, p=0.057). Conclusion exist concomitantly portend poorer outcome when is performed. This potentially mediated thru delayed diagnosis treatment or more severe presentation Funding Acknowledgement Type funding sources: None.