Cardiovascular complications in CAR T-cell therapy: Insights from a national inpatient database.

Abstract

e24031 Background: CAR T-cell therapy uses engineered T lymphocytes to target tumor antigens and induce immune-mediated tumor killing. Although it has fewer side effects than chemotherapy, serious toxicities persist, particularly cardiotoxicity, with arrhythmias and heart failure most common. Prior studies document cardiovascular complications, but their impact on in-hospital mortality remains poorly defined, highlighting the need for contemporary national analyses. Methods: A retrospective cohort study using the NIS database was conducted evaluating cardiovascular complications (CVc) and outcomes among adults (≥18 years) hospitalized for CAR T-cell therapy from 2019–2023. Patients were stratified by ICD-10 codes into groups with and without CVc. The primary outcome was inpatient mortality. Secondary outcomes included length of stay (LOS), total hospital charges, acute heart failure, arrhythmias, cardiomyopathies, and respiratory failure. Logistic regression identified factors associated with CVc and in-hospital mortality, adjusting for age, sex, race, and comorbidities. Results: A total of 10,690 hospitalized adult patients who received CAR T-cell therapy were identified, of whom 2,600 (24%) experienced CVc. Higher incidence was observed in males (82%) and Whites (80%). In the CVc group, 160 (6%%) patients died during hospitalization. CVc was associated with a significantly higher risk of in-hospital mortality (6% vs. 1.7%; OR 3.72; p < 0.001) and respiratory failure (12% vs. 3%; OR 3.58; p < 0.001) compared with those without complications. They also experienced significantly longer LOS (19.8 vs. 16.3 days; Coefficient: 3.57) and higher hospital charges ($1,312,776 vs. $1,128,782; Coefficient: $183,995). Among specific complications, the highest mortality risks were associated with acute heart failure (16%; OR 7.58), arrhythmias (7.4%; OR 4.3), and cardiomyopathies (7.4%; OR 2.97) (all P < 0.05). Conversely, coronary artery disease, valvulopathy, and myocardial infarction did not significantly increase mortality risk in this cohort. Conclusions: CVc during CAR T-cell therapy hospitalizations are linked to significantly higher in-hospital mortality, worse clinical outcomes, increased economic burden, and longer LOS. This highlights the need for rigorous cardiovascular screening and standardized cardio-oncology protocols to improve survival. Early recognition and targeted management of CVc are critical to improving survival.