Prediction of Coronary Heart Disease Events in Blood or Marrow Transplantation Recipients

Gangaraju, R; Chen, Y; Hageman, L; Landier, W; Balas, N; Ross, E; Francisco, L; Bosworth, A; Te, HS; Wong, FL; Weisdorf, DJ; Bhatia, R; Forman, SJ; Armenian, SH; Bhatia, S

doi:10.1016/j.jaccao.2023.03.013

Coronary disease & ACS

Prediction of Coronary Heart Disease Events in Blood or Marrow Transplantation Recipients

JACC CardioOncolPublished 16 May 2023Retrospective cohort study

Main finding · CHD after BMTResultOdds ratio 1.6 95% CI 1.09–2.40

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Authors' conclusion

This study identified BMT recipients at high risk for CHD, informing targeted screening for early detection and aggressive control of risk factors.

Study context

Population: Blood or marrow transplantation recipients transplanted 1974–2014 at City of Hope, University of Minnesota or University of Alabama at Birmingham, surviving ≥2 years
Participants: 6,677 BMT recipients

Exposure: BMT survivors vs sibling cohort
BMT survivorsn = 6,677
Outcome: CHD risk after BMT and associated risk factors

Methodological detailsmulticentre, sibling comparison cohort, risk prediction nomogram

Multicentre
Sibling comparison cohort
Risk prediction nomogram

Main finding

CHD after BMT · 20 years

Odds ratio

1.6

95% CI 1.09–2.40

BMT survivorsvs Siblings

OR 1.6 (95% CI 1.09–2.40)

As reported in the abstract

Coronary heart disease (CHD) reported in BMT recipients: 249
20-year cumulative incidence of CHD: 5.45% ± 0.39%

Observational data: associations, not effects.

Further findings

Nomogram predictors of CHD at 10 and 20 years after BMT

	← Lower risk ←→ Higher risk →	HR (95% CI)
Age at BMT		1.06/y (1.04–1.08)
Male sex	0.20.5125	1.89 (1.15–3.11)
History of smoking	0.20.5125	1.61 (1.01–2.58)
Diabetes	0.20.5125	2.45 (1.23–4.89)
Hypertension	0.20.5125	2.02 (1.15–3.54)
Arrhythmia	0.20.5125	1.90 (0.89–4.06)
	0.20.5125Hazard ratio (log scale)

Outcome	← Lower risk vs no ←→ Higher risk vs no →	HR (95% CI)
Nomogram predictors of CHD at 10 and 20 years after BMTPre-BMT chest radiation: yesvs no	0.10.31310	2.83 (1.20–6.67)
Nomogram predictors of CHD at 10 and 20 years after BMTPre-BMT chest radiation: unknownvs no	0.10.31310	0.88 (0.34–2.28)
	0.10.31310Hazard ratio (log scale)

Nomogram discrimination (test set)

C-statistic: 0.77 (95% CI: 0.70-0.83)

Original publication

Prediction of Coronary Heart Disease Events in Blood or Marrow Transplantation Recipients. JACC CardioOncol. Published 16 May 2023. doi:10.1016/j.jaccao.2023.03.013

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