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Evaluation of the effectiveness and safety of preoperative drug elution balloon therapy in patients with elective tumor surgery and coronary heart disease: a retrospective clinical study

The best choice of PCI for patients with elective tumor surgery and CHD

BMC Cardiovascular Disorders volume 25, Article number: 171 (2025) Cite this article

Abstract

Background

The selection of percutaneous coronary intervention (PCI) regimen for patients undergoing elective tumor surgery with coronary heart disease(CHD) remains controversial.To evaluate the effectiveness and safety of using Drug Eluting Balloons (DEB) in study patients.

Methods

A retrospective study was conducted on 127 patients undergoing elective tumor surgery with CHD who received preoperative PCI treatment at the Fourth Hospital of Hebei Medical University from January 2022 to May 2023. According to the PCI treatment plan, it is divided into Drug Eluting Balloons (DEB) group (n = 61) and Drug Eluting Stents (DES) group (n = 66). The primary endpoints of follow-up were all-cause mortality and major adverse cardiac events (MACE), while the secondary endpoints were bleeding and Venous thrombotic events. Compare the incidence of all-cause mortality events, MACE, bleeding and Venous thrombotic events between two groups of patients during the perioperative period and 1-year after the surgery.

Results

During perioperative period, no all-cause death occurred in both groups. MACE in DEB group was lower than that in DES group (9.8%VS.27.3%, P = 0.012). For Confirmed the overall treatment time and Interventional-surgical time, DEB group was shorter than DES group(108[60,155]VS.218[170, 320],P< 0.001),(80[45.5,120]VS.210[168,300], P< 0.001). During the follow-up period, there were all-cause mortality (3.3%VS.13.6%, P = 0.038), MACE (9.8%VS.24.2%, P = 0.032)in the DEB and DES groups.

Conclusions

The results of this retrospective study showed that the all-cause mortality and MACE in patients were significantly lower than those in the DES group. DEB can also shorten the Interventional-surgical time, thus greatly reducing the overall treatment time.

Peer Review reports

Introduction

With the increasing aging of the population, the number of patients undergoing elective tumor surgery with coronary heart disease(CHD) is increasing year by year [1]. In the European Union, at least 167,000 cases of major adverse cardiac events caused by non-cardiac surgery occur each year, of which 19,000 are life-threatening [2]. For such patients, in order to avoid the occurrence of MACE and to ensure that the tumor does not metastasize far away, the surgeon usually treats coronary heart disease as the primary strategy, and then performs tumor surgery as the heart function of the patient improves [3]. At present, percutaneous coronary drug-eluting stent(DES) implantation has become the preferred strategy for coronary revascularization in patients with CHD [4]. However, considering that long-term dual anti-platelet therapy (DAPT) is required after the implantation of DES, the occurrence of perioperative bleeding events will be increased and the overall treatment time of patients will be prolonged [5,6,7]. If the duration of anti-platelet therapy is shortened blindly, the occurrence of major adverse cardiac events in perioperative period will be increased. For patients with elective tumor surgery with CHD, weighing the relationship between perioperative bleeding risk and MACE is the primary issue to ensure the long-term prognosis of patients [5]. Due to the complexity of treatment regimens in this study population, multiple disciplines such as cardiology, surgical oncology, and anesthesiology are required to jointly develop individualized treatment regimens [8].

For the population in this study, long-term DAPT with DES will greatly increase the incidence of bleeding events, prolong the interventional-surgical time, and increase the risk of distant tumor spread, so doctors usually do not use DES as the primary PCI treatment strategy. The development of drug-eluting balloon(DEB) successfully solved the thorny problem of DES. Drug-eluting balloon exerts anti-cell proliferation effects by rapidly and accurately acting anti-cell proliferation drugs on target lesions of coronary arteries [9], while reducing the incidence of coronary thrombotic events [10]. Due to the rapid accumulation and remodeling effect of anti-cell proliferation drugs on coronary target diseases [10], DAPT only takes 4 weeks to reduce the risk of perioperative MACE, shorten interventional-surgical time, and then shorten the overall treatment time, which can increase the survival and prognosis of tumor patients.The objective of this study was to investigate the perioperative and postoperative safety and efficacy of DEB in patients undergoing elective tumor surgery with CHD.

Methods

Participants

Retrospective inclusion of 127 patients who underwent elective tumor surgery with coronary heart disease at the our hospital from January 2022 to May 2023 and received preoperative PCI treatment. According to the PCI treatment plan, it was divided into DEB group (n = 61) and DES group (n = 66) (Fig. 1).

Fig. 1
figure 1

Patient flow chart. DEB Drug eluting balloon, DES Drug eluting stent

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Inclusion criteria: ① Age ≥ 30 years but ≤ 85 years old. ② There is evidence of myocardial ischemia, including stable angina, unstable angina, ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, and concurrent coronary angiography, confirming that the diameter of the coronary artery lesion is ≥ 70%.③ Imaging or pathological evidence of malignant tumor, evaluated by a surgeon, indicates surgical treatment. ④ Good compliance, consent, and signing of an informed consent form.

Exclusion criteria: ① Patients with NYHA grade ≥ III heart failure, or those with left ventricular ejection fraction (LVEF) ≤ 35%; ② Patients who have experienced severe bleeding events in the past (including gastrointestinal and intracranial bleeding) ③ Patients who have undergone surgical coronary artery bypass grafting surgery in the past; ④ Coronary angiography shows that the stenosis at the lesion site is ≥ 70%, but no coronary treatment or conventional balloon dilation intervention is performed; ⑤ After PCI, patients underwent PCI for myocardial ischemia again before perioperative period.⑥ Patients with severe liver and kidney dysfunction; Patients with coagulation dysfunction; ⑦ After auxiliary examination (PET-CT examination), it was determined that the tumor had distant metastasis and lost its surgical significance. The patient’s expected life is less than 1 year.

All patients provide written informed consent before PCI and Elective tumor surgery. This study was approved by the Ethics Committee of the our hospital(2024KS202).

The treatment strategy and related medications for PCI are based on current international guidelines [11]. The PCI treatment strategy (DES or DEB) is jointly decided by cardiovascular doctors, surgeons, patients, and patient families. The specifications, inflation time, and corresponding pressure of DES or DEB are determined by the cardiovascular doctor.All patients were given dual anti-platelet therapy after PCI, and all patients received aspirin 100 mg 1/day, clopidogrel 75 mg 1/day, or ticagrelor 90 mg 2/day.Discontinuation of dual anti-platelet therapy 7–14 days before elective tumor surgery (aspirin discontinuation ≥ 7 days, clopidogrel/ticagrelor discontinuation ≥ 5–7 days) [12]. The perioperative period in this study is defined as the period from the start of surgery to 7 days after surgery. Interventional-surgical time (days): The difference between the intervention surgery date and the tumor surgery date.Overall treatment time (days): The difference between the date of tumor diagnosis through pathological or imaging examination and the date of surgical operation.

The main outcome measures of this study were all-cause mortality events and major adverse cardiac events (MACE) during perioperative and follow-up periods. MACE includes fatal arrhythmias (atrial fibrillation, ventricular fibrillation, third degree atrioventricular block), Myocardial infarction(MI), Target lesion revascularization (TLR). The diagnostic criteria for all-cause mortality, MI, and TLR are based on the academic research federation-2 consensus document [13]. A fatal arrhythmia event is defined as the duration determined by the surgeon, starting from anesthesia induction. Confirmed as fatal arrhythmia (atrial fibrillation, ventricular fibrillation, third degree atrioventricular block) through electrocardiogram or electrocardiogram monitoring. Secondary endpoints include bleeding events. The diagnostic criteria for bleeding events are based on the bleeding academic research association [BARC] type 3–5 [14]. The diagnosis and treatment of hyperlipidemia are consistent with the ESC/EAS Guidelines for the Management of Dyslipidemia [15].Venous thrombotic events include deep vein thrombosis (DVT) and pulmonary embolism (PTE). DVT was confirmed by color Doppler ultrasonography and venous angiography. The diagnosis of PTE is based on the 2019 ESC Guidelines for the Diagnosis and Management of Acute pulmonary embolism [16]. Acute coronary syndromes (ACS) include unstable angina pectoris, ST-elevation myocardial infarction and Non-st-elevation myocardial infarction, which meet the European Society of Cardiology guidelines for the Management of acute coronary syndromes [17]. Chronic coronary syndromes (CCS) include stable angina, which meets the definition of the 2023 U.S. Guidelines for the Management of Patients with CCS [18].Patients will be followed up 1-year after surgery through outpatient department or phone calls to clarify the occurrence of clinical events.

All data were analyzed using SPSS 25.0 statistical software, and continuous data were presented within the MEAN ± Standard Deviation(SD)or median and interquartile range (IQR), and compared using t-tests or Mann Whitney rank sum tests. Categorical data is expressed as percentiles (%), and pairwise comparisons are conducted using Pearson’s chi-square test, or Fisher’s exact test. Use logistic regression analysis to analyze the risk factors for perioperative MACE. Use Cox regression analysis to evaluate the correlation between a certain risk indicator and the occurrence of adverse events. The Kaplan Meier method (K-M method) was used to describe the occurrence of events in two groups of patients, and the log rank test was used to evaluate whether there was a statistically significant difference in the incidence of events between the groups. P < 0.05 indicates a statistically significant difference.

Results

Patient characteristics

The proportion of each tumor in this study (Fig.S1 Table S3). Baseline and clinical characteristics of patients were comparable between the two treatment groups (Table 1). The DEB group is younger(66.84 ± 7.11VS.69.94 ± 6.61 P = 0.012)and has a higher proportion of stable angina pectoris (63.9%VS.36.4% P = 0.002). In terms of Oral medication status for CHD, it can be observed that there were fewer people taking aspirin (70.5%VS.93.9% P< 0.001), more people taking indobufen. (29.5%VS.6.1% P<0.001) In the DEB group.

Procedural and angiographic characteristics of patients

Before perioperative period, the stenosis degree of the original target lesions was examined by percutaneous coronary angiography again. The Re-stenosis degree of DEB group was less than that of DES group(10[0,30]VS.20[10, 60],P< 0.020).It can also be observed that the surgical time for tumors in the DEB group is significantly shorter than that in the DES group(154.87 ± 96.93VS.176.41 ± 73.37 P = 0.012).No significant differences were observed with regard to other procedural characteristics (Table 2). In terms of treatment time, the DEB group had a shorter overall treatment time(108[60,155]VS.218[170,320],P< 0.001),interventional-surgical time(80[45.5,120]VS.210[168,300],P< 0.001), anti-platelet time (90[47.5,113]VS.229[160,293],P< 0.001),and stop anti-platelet time(7[7,10]VS.9[7,14],P< 0.035)compared to the DES group(Fig. 2; Table 3).

Table 1 Baseline and clinical characteristics of patients
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Table 2 Procedural and angiographic characteristics of patients
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Fig. 2
figure 2

Treatment time

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Table 3 Treatment time
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Table 4 Primary and secondary endpoints in the perioperative period
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Table 5 Primary and secondary endpoints in the 1 year
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Table 6 MACE analysis of CCS/ACS
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Primary and secondary endpoints in the perioperative period

Perioperative data were obtained for all patients (Table 4). During the perioperative period, the incidence of MACE in the DEB group was lower than that in the DES group, especially the incidence of MI(9.8%VS.27.3% P = 0.012), (11.5%VS.34.8% P = 0.002). There was no significant difference in other perioperative indexes between the two groups (P > 0.05). There was no all-cause mortality event during the perioperative period between the two groups.In order to identify certain factors that may affect the occurrence of perioperative MACE, it was found that Type of PCI(DES)、Hypertension III、Hyperlipemia、Diabetes、Lower LVEF、Multi-arterial disease、greater Re-stenosis、Longer Surgical time was a risk factor for the occurrence of perioperative MACE in univariate logistic logistic regression analysis(P < 0.05). These indicators with statistically significant differences (P < 0.05) in univariate logistic regression analysis were included as independent variables in multivariate logistic regression analysis. Hosmer-Lemeshow Goodness-of-Fit showed good fit (P>0.05), and the results of multivariate logistic regression analysis showed that Lower LVEF、Multi-arterial disease are independent predictive risks factor for perioperative MACE (P<0.05) (Fig. 3A Table S1).

Fig. 3
figure 3

(A) Multivariate Logistic regression analysis of perioperative MACE

(B) Multivariate Cox regression analysis of MACE during follow-up

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Followed up for 1 year after surgery primary and secondary endpoints in the 1 year

Through 1-year postoperative follow-up, according to the data obtained by our research center, the safety and effectiveness of DEB group was better than that of DES group, which was reflected in the incidence of All-cause death(3.3%VS.13.6% P = 0.038), MACE (9.8% VS.24.2% P = 0.032), TLR (3.3%VS.18.2% P = 0.007) and Bleeding events (0.0%VS.9.1% P = 0.046) significantly lower than that of DES group (Table 5). The Kaplan-Meier analysis of the primary endpoint All cause death、MACE、Fatal arrhythmias、MI、TLR and Secondary endpoint Bleeding events、Venous thrombotic even are presented in Fig. 4 (Fig. 4). Univariate COX regression model was used to analyze the influence of certain factors on MACE during follow-up, and it was found that Type of PCI (DES) 、Stopping taking anti-platelet therapy for longer, greater Re-stenosis, and longer Total length of lesion were risk factors for MACE(P<0.05). These indicators were included in multivariate COX regression model analysis. The Stopping taking anti-platelet therapy for longer, greater Re-stenosis were found to be risk factors for MACE during follow-up (P<0.05) (Fig. 3B Table S2).

Fig. 4
figure 4

Kaplan–Meier survival curve for (A) all cause death, (B) major adverse cardiac events(MACE), (C) fatal arrhythmias, (D) myocardial infarction, (E)target lesion revascularization (TLR), (F)bleeding events, (G)venous thrombotic events

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MACE analysis of ACS/CCS

Patients were classified into acute coronary syndrome(ACS) and chronic coronary syndrome (CCS) according to the diagnosis of CHD registered at the first admission. During perioperative period, MACE in the DEB group was significantly lower than that in the DES group (12.8% VS.37.5% P = 0.022) in CCS, in the ACS, The MACE of the DEB group was lower than that of the DES group (4.5% VS.21.4% P = 0.160), but the difference was not statistically significant. During 1-year follow-up, MACE in the DEB group was lower than that in the DES group in both CCS and ACS, but there was no statistical difference (10.3%VS.25% P = 0.230), (9.1%VS.16.7% P = 0.653)(Table 6).

Discussion

According to the center, this is the first study to evaluate the efficacy and safety of DEB in treating patients with elective tumor surgery combined with CHD. Compared with patients treated with DES, DEB treatment strategy significantly reduced the incidence of MACE, all-cause death events and bleeding events, and DEB may have better safety and efficacy in this study population, especially in patients with elective tumor surgery combined with CCS. At the same time, it was found that the higher the LVEF value, the better the heart function, which was considered to be a protective factor in this study population.The risk factors for MACE in this population are multi-arterial disease, the longer the time of stopping anti-platelet and the more severe the re-stenosis of the target lesions found in coronary angiography.

Safety of PCI treatment strategy

At present, percutaneous coronary DES implantation is the most important treatment for patients with simple CHD [19]. However, considering the bleeding risk of patients undergoing elective tumor surgery with CHD and MACE, long-term dual anti-platelet therapy with DES (≥ 12months) will prolong the intervention-surgery time and increase the risk of tumor metastasis. It is more likely to lose surgical significance, which seriously affects the survival and prognosis of patients. For this special population, balancing bleeding events and MACE, shorten the time of dual anti-platelet as much as possible, and strive for surgery as soon as possible. In the early era, bare metal stents treated coronary artery stenosis with their four-week DAPT strategy, performing surgical treatment in a short period of time [20, 21]. In a US study of different PCI strategies in CHD patients with tumor, the BMS group was significantly higher than the DES group in terms of in-hospital mortality and major bleeding events.BMS is being phased out [21]. DEB has its own advantages, which can reduce the stimulation of metal stent and steel beam on the intima of coronary artery, inhibit chronic inflammatory response, and shorten DAPT [10]. A DEBUT trial comparing the safety and efficacy of DEB versus BMS for new onset in patients at high risk for bleeding (tumors) showed that the incidence of MACE was significantly lower in the DEB group than in the BMS group during the 9-month follow-up period (1.0% VS.14%, P < 0.00001). There was no significant difference in bleeding events between the two groups (13.0%VS.10.0%, P = 0.59) [22].

Acute coronary syndrome (ACS) is an important problem affecting human health, and DES was previously considered to be safe and effective. However, the long-term risk of dual antiplatelet therapy (DAPT) and stent-related complications has made DEB an increasing concern [23]. In a study evaluating the safety and efficacy of DEB in patients with ACS and vulnerable plaques, less late loss of coronary lumen diameter was found in the DEB group (P < 0.05). The safety analysis showed a decrease in MACE during hospitalization and follow-up in the DEB group compared with DES (7.3% VS.8.8%) during follow-up [24]. Compared with DES, DEB treatment has a lower incidence of MACE and bleeding events in tumor patients with MI, indicating that DEB has good safety and efficacy for tumor patients with MI [25]. For stable angina, a study to measure perioperative myocardial infarction (PMI) by measuring “the peak mean values of creatine kinase-myocardial band”and “high sensitivity troponin T peak” during perioperative PCI to evaluate patient outcomes found that the incidence of PMI was significantly higher in the DES group(DES:20.4% VS. DEB:1.9% P = 0.002). It is concluded that in patients with stable angina, DEB is a safe and effective PCI strategy for stable angina with a significant reduction in the risk of using PMI compared with the new generation DES [26]. The same conclusion was reached in this study, regardless of ACS/CCS, MACE in DEB group was lower than that in DES group, especially for stable angina. This confirms the safety of DEB treatment in clinical settings. For patients with tumors combined with CHD, the increased inflammatory response and stent thrombosis rate in tumor patients can lead to a very high risk of cardiovascular events, which can explain the high incidence of MACE in the DES group of our study center. In our research center, the surgical time for tumors in the DES group was significantly longer than that in the DEB group, indicating a higher level of surgical difficulty in the DES group, which may increase the incidence of MACE in the DES group. This is just our speculation, and larger sample sizes and multi center studies are needed to further validate the relationship between MACE and surgical time.

Issues related to anti-platelet therapy

Patients with tumors are at higher risk of bleeding due to tumor-related coagulation dysfunction and thrombocytopenia due to myelosuppression [27,28,29,30]. Anti-platelet therapy is still a difficult problem in the PCI of patients undergoing elective tumor surgery with CHD, and the duration of DAPT treatment will seriously affect the overall treatment time and prognosis survival of patients.The BleeMACS study found that anti-platelet therapy alone was not associated with adverse events in patients with tumors combined with MI, and found that DAPT was a protective factor (RR 0.5, 95% CI [0.3–0.9], P = 0.05) [31]. Therefore, DAPT may be safe and effective in the treatment of patients undergoing tumor with CHD. In a meta-analysis of patients with CHD treated with DES (N = 15000), shortening DAPT duration (≤ 6 months) was found to be associated with a significant reduction in major bleeding complications, and no significant increase in MACE was found. Therefore, the relevant teams strongly request to shorten the DAPT of DES [32]. However, the latest ACC/AHA guidelines and ESC guidelines still emphasize that the DAPT of DES for treating patients with simple CHD is at least 6 months for non-acute coronary syndromes and 12 months for acute myocardial infarction (ACS), without involving tumor-related factors [33, 34]. A study of anti-platelet management in elective surgery after DES, conducted by Kim’s team, found that the optimal duration of discontinuation of anti-platelet therapy was 4–8 days, as this was associated with the lowest risk of MACE (P = 0.019) [35].

DEB Because of the “leave nothing behind” strategy, the duration of DAPT is short, in some cases as little as 4 weeks, such as in patients at high risk of bleeding (tumors) [22].However, at present, relevant guidelines do not clearly specify the DAPT strategy for using PCI in patients with tumor and CHD [36,37,38].DAPT strategies for these patients require further prospective studies with large sample sizes. As far as we know, the literature on DAPT in patients undergoing elective tumor surgery with CHD is very limited. This study is the first to evaluate preoperative and survival prognosis of patients with CHD after elective surgery, filling the gap in this field.

Issues related to Re-stenosis

With regard to the re-stenosis of DEB, some researchers believe that the main function of DEB is to deliver anti-intimal hyperplasia drugs to the lesion site and transfer them to the vascular wall, rather than simply dilating vascular stenosis, they believe that there is no necessary association between re-stenosis and MACE [39]. For DEB, re-stenosis of ≤ 30% at the target lesion site is acceptable. For DES, it must be completely dilated and adhere well to the vessel wall. In order to compare the probability re-stenosis and MACE events between the two, a study from Italy on DES vs. DEB evaluated the difference in re-stenosis between the two through coronary angiography after 6 months. It was found that there was no significant difference in re-stenosis% between the two (21.6 ± 13%VS.25.1 ± 11% P = 0.37), and no difference in MACE was found during a 12-month follow-up (7.5%VS.5.6% P = 0.55) [40]. However, in the recent Chinese publication of the ROSE SVD, re-stenosis was used as the primary endpoint of the study. By obtaining 9-month coronary angiography, it was found that the re-stenosis% in the DEB group was higher than that in the DES group (29.6 ± 2.0%VS.24.1 ± 2.0% P < 0.001). After 1-year follow-up, there was no significant difference in MACE between the DCB group and the DES group [41].

Re-stenosis often presents different results depending on the follow-up time, but the difference in MACE between DEB and DES is not significant. In this research center, it was found that the re-stenosis of the DEB group was significantly lower than that of the DES group, mainly due to the relationship with follow-up time. The relationship between re-stenosis and follow-up time is still unknown and requires more prospective studies for further exploration and research.

Predictors of MACE

MACE is an important issue for patients undergoing non-cardiac surgery, especially high-risk patients such as tumors [42, 43].In the past, relevant surgical risk assessment has been improved based on patient symptoms, medical history, known risk factors, and related cardiac examinations (ECG, echocardiography, blood pressure test), but the possibility of predicting MACE is still limited. 50% of perioperative cardiac deaths occur in patients with no history of heart disease [44].Elevated Troponin levels are associated with pre-existing CHD, HF, and MI. Several studies have evaluated perioperative Troponin elevation as a prognostic indicator of mortality and cardiac morbidity in surgical patients [45].LVEF is a recognized predictor of perioperative and postoperative MACE [46, 47]. One study reported that a reduction in LVEF ≤ 35% is a strong predictor of cardiac events after vascular surgery [46]. According to international guidelines, decreased LVEF values and increased circulating BNP levels are closely associated with perioperative and postoperative morbidity and mortality [47, 48]. According to the results of this study, the elevated LVEF values suggest that the heart function is resistant to the stress effects of surgery and anesthesia, which serves as a protective factor for the researchers. With the accumulation of sample size, this study will continue to improve the evaluation of myocardial injury markers (BNP, Troponin, etc.) in predicting MACE.

Limitations

There are four important limitations to this study. (1) The number of patients in each tumor group is small, and meaningful subgroups based on tumor type cannot be further analyzed to evaluate the impact of tumor type on MACE, bleeding, and venous thrombosis events in such patients. (2) Due to the openness of this study, although confounding factors were adjusted to minimize bias between different baseline features, inherent bias cannot be completely avoided. (3) This study was a single-center retrospective study with potential biases in patient selection and data collection. According to the particularity and high mortality of the subjects in this study, more detailed clinical data of patients undergoing elective tumor surgery with CHD should be collected in large-scale multi-study registries to better verify the safety and effectiveness of DEB.4. This retrospective study lacked the analysis of chemotherapy drug data on MACE, and this study only focused on the effects of DAPT and coronary artery vascular conditions on MACE.

Conclusions

The results of this retrospective study showed that the all-cause mortality events and MACE in patients undergoing selective tumor surgery combined with coronary heart disease were significantly lower than those in the DES group. DEB can also shorten the Interventional-surgical time, thus greatly reducing the overall treatment time.DEB may be a safe and effective treatment strategy for patients undergoing elective tumor surgery with CHD. However, large trials are needed to evaluate the efficacy and safety of DEB in patients undergoing elective tumor surgery with CHD.

Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or its supplementary materials.

Abbreviations

CHD:

Coronary heart disease

PCI:

Percutaneous coronary intervention

DEB:

Drug elution balloon

DES:

Drug elution stent

MACE:

Major adverse cardiac event

MI:

Myocardial infarction

TLR:

Target lesion revascularization

ACS:

Acute coronary syndrome

CCS:

Chronic coronary syndrome

PMI:

Perioperative myocardial infarction

BMI:

Body mass index

STEMI:

ST elevation myocardial infarction

NSTEMT:

Non-st elevation myocardial infarction

CK:

Creatine Kinase

CK-MB:

Creatine kinase isoenzyme MB

TNI:

Troponin I

BNP:

Brain-type natriuretic peptide

LVEF:

Left ventricular ejection fraction

TC:

Total cholesterol

TG:

Triglyceride

HDL-C:

High-density lipoprotein cholesterol

LDL-C:

Low-density lipoprotein cholesterol

ACEI/ARB:

Angiotensin converting enzyme inhibitors/angiotensinogen type II receptor blockers

ARNI:

Angiotensin receptor neprilysin inhibitors

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Acknowledgements

The authors thank all patients and investigators who participated in this study.

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Authors and Affiliations

  1. Department of Cardiology, The Fourth Hospital of Hebei Medical University, 12 Jiankang Road, Shijiazhuang, 050011, People’s Republic of China

    Ruipu Gao, Ling Guo, Jing Liu, Tiezhu Yao, Guang Liu, Zhengkun Guan & Jingtao Ma

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  1. Ruipu Gao
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Contributions

M-JT, G-RP, L-J, and G-L conceived the study design. M-JT, G-RP, Y-TZ, L-G and L-J performed the report screening, study inclusion, data extraction. G-ZK, G-L and G-RP analysed the data. M-JT, G-RP, G-L and G-ZK drafted the manuscript. M-JT, G-RP, G-L and G-ZK reviewed the manuscript for important intellectual content. All authors have significantly contributed to the design of study, analysis of data and drafting or revising manuscript. All authors have read and approved this article.

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Correspondence to Jingtao Ma.

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Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Fourth Hospital of Hebei Medical University and complied with the Declaration of Helsinki.Oral and/or written informed consent was obtained from all participants prior to the start of the experiment.The research Center Ethics number:2024KS202.This study was a retrospective study without additional intervention for patient diagnosis and treatment, so the clinical trial number was not applicable.

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This study does not include any personal details, images or videos and is noted not applicable.

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The authors declare no competing interests.

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Gao, R., Guo, L., Liu, J. et al. Evaluation of the effectiveness and safety of preoperative drug elution balloon therapy in patients with elective tumor surgery and coronary heart disease: a retrospective clinical study. BMC Cardiovasc Disord 25, 171 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12872-025-04623-w

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Keywords

BMC Cardiovascular Disorders

ISSN: 1471-2261

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