---
title: "CAR-T Therapy and Major Adverse Cardiovascular Events in US Medicare Beneficiaries"
id: "pubmed-42199067"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42199067"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42199067/"
doi: "10.1093/eurheartj/ehag394"
published_at: "2026-09-16T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# CAR-T Therapy and Major Adverse Cardiovascular Events in US Medicare Beneficiaries
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42199067
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42199067/)
- **DOI:** [10.1093/eurheartj/ehag394](https://doi.org/10.1093%2Feurheartj%2Fehag394)
- **Published At:** 2026-09-16T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This national Medicare study evaluated cardiovascular outcomes among older adults (age >65) who received inpatient **CAR-T** therapy between 2018 and 2023. - The cohort included 3,292 fee-for-service beneficiaries; 191 patients (5.8%) experienced **MACE** during the index hospitalization. - The most frequent MACE was **acute heart failure** (3.1%); ischaemic stroke occurred in 1.3% and haemorrhagic stroke in 1.0% of patients. - Pre-existing cardiovascular conditions independently associated with MACE included **atrial fibrillation/flutter** (aOR 1.52, 1.08–2.16), **cardiomyopathy** (aOR 2.49, 1.75–3.54), and cerebrovascular disease (aOR 2.40, 1.30–4.43). - In the 2021–2023 subgroup, higher-grade **cytokine release syndrome** and immune effector cell-associated neurotoxicity syndrome were also linked to MACE. - MACE strongly predicted worse outcomes: higher in-hospital mortality (aOR 16.9, 11.0–26.1) and higher 1-year mortality after discharge (adjusted HR 1.91, 1.46–2.49). - Investigators used baseline characteristics from the 12 months before CAR-T and adjusted multivariable models for demographics, malignancy type, and baseline cardiovascular comorbidities. - The authors conclude that MACE occurred in 5.8% of older adults receiving CAR-T and were associated with increased short- and longer-term mortality, highlighting the need for preventive and mitigating strategies. - Keywords listed: **CAR-T**, Cardio-oncology, Chimeric antigen receptor, **MACE**, Medicare. - Study details such as center-level practices, specific CAR-T products, or granular timing of events beyond what was reported were not described in the abstract.
## Clinical Analysis & Structured Key Points
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Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA."), [Walter Schiffer](https://pubmed.ncbi.nlm.nih.gov/?term=Schiffer+W&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA."), [Nischit Baral](https://pubmed.ncbi.nlm.nih.gov/?term=Baral+N&cauthor_id=42199067)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-4 "Cardiovascular Division, Columbia University, Mount Sinai Medical Center, Miami, FL, USA."), [R J Waken](https://pubmed.ncbi.nlm.nih.gov/?term=Waken+RJ&cauthor_id=42199067)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-5 "Division of Biostatistics, Washington University School of Medicine, St.Louis, MO, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-6 "Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA."), [Bonnie Ky](https://pubmed.ncbi.nlm.nih.gov/?term=Ky+B&cauthor_id=42199067)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-7 "Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA."), [Karen E Joynt Maddox](https://pubmed.ncbi.nlm.nih.gov/?term=Joynt+Maddox+KE&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-6 "Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA."), [Joshua D Mitchell](https://pubmed.ncbi.nlm.nih.gov/?term=Mitchell+JD&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#full-view-affiliation-3 "Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA.") Affiliations Expand ### Affiliations * 1 Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA. * 2 Division of Oncology, Department of Medicine, Washington University School of Medicine, St.Louis, MO, USA. * 3 Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA. * 4 Cardiovascular Division, Columbia University, Mount Sinai Medical Center, Miami, FL, USA. * 5 Division of Biostatistics, Washington University School of Medicine, St.Louis, MO, USA. * 6 Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA. * 7 Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. * PMID: **42199067** * PMCID: [ PMC13380970 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13380970/) * DOI: [ 10.1093/eurheartj/ehag394 ](https://doi.org/10.1093/eurheartj/ehag394) Item in Clipboard # Chimeric antigen receptor T-cell therapy and cardiovascular outcomes in US Medicare beneficiaries Raja Zaghlol et al. Eur Heart J. 2026. Show details Display options Display options Format Abstract PubMed PMID Eur Heart J Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Eur+Heart+J%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Eur+Heart+J%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42199067/) . 2026 Sep 16;47(35):4957-4969. doi: 10.1093/eurheartj/ehag394. ### Authors [Raja Zaghlol](https://pubmed.ncbi.nlm.nih.gov/?term=Zaghlol+R&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA."), [Elena Deych](https://pubmed.ncbi.nlm.nih.gov/?term=Deych+E&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA."), [Daniel A Ladin](https://pubmed.ncbi.nlm.nih.gov/?term=Ladin+DA&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA."), [David A Russler-Germain](https://pubmed.ncbi.nlm.nih.gov/?term=Russler-Germain+DA&cauthor_id=42199067)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-2 "Division of Oncology, Department of Medicine, Washington University School of Medicine, St.Louis, MO, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-3 "Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA."), [Walter Schiffer](https://pubmed.ncbi.nlm.nih.gov/?term=Schiffer+W&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA."), [Nischit Baral](https://pubmed.ncbi.nlm.nih.gov/?term=Baral+N&cauthor_id=42199067)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-4 "Cardiovascular Division, Columbia University, Mount Sinai Medical Center, Miami, FL, USA."), [R J Waken](https://pubmed.ncbi.nlm.nih.gov/?term=Waken+RJ&cauthor_id=42199067)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-5 "Division of Biostatistics, Washington University School of Medicine, St.Louis, MO, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-6 "Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA."), [Bonnie Ky](https://pubmed.ncbi.nlm.nih.gov/?term=Ky+B&cauthor_id=42199067)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-7 "Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA."), [Karen E Joynt Maddox](https://pubmed.ncbi.nlm.nih.gov/?term=Joynt+Maddox+KE&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-6 "Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA."), [Joshua D Mitchell](https://pubmed.ncbi.nlm.nih.gov/?term=Mitchell+JD&cauthor_id=42199067)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-1 "Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42199067/#short-view-affiliation-3 "Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA.") ### Affiliations * 1 Division of Cardiovascular Disease, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St.Louis, MO 63110, USA. * 2 Division of Oncology, Department of Medicine, Washington University School of Medicine, St.Louis, MO, USA. * 3 Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4500 Forest Park Avenue, St.Louis, MO, 63108, USA. * 4 Cardiovascular Division, Columbia University, Mount Sinai Medical Center, Miami, FL, USA. * 5 Division of Biostatistics, Washington University School of Medicine, St.Louis, MO, USA. * 6 Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St.Louis, MO, USA. * 7 Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. * PMID: **42199067** * PMCID: [ PMC13380970 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13380970/) * DOI: [ 10.1093/eurheartj/ehag394 ](https://doi.org/10.1093/eurheartj/ehag394) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background and aims:** Chimeric antigen receptor T-cell (CAR-T) therapies are cellular immunotherapies that improve survival in patients with relapsed haematologic malignancies. However, their association with major adverse cardiovascular events (MACE) has received limited study, particularly in older adults. This study investigated the incidence of MACE, associated risk factors, and their impact on survival among older patients undergoing CAR-T in the USA. **Methods:** Medicare fee-for-service beneficiaries over 65 who received inpatient CAR-T therapy between 2018 and 2023 were included. Baseline characteristics were assessed during the 12 months preceding CAR-T. MACE were defined as a composite of acute heart failure (HF), cardiogenic shock, myocardial infarction, cardiac tamponade, ventricular arrhythmia, complete heart block, or stroke. Multivariable models were adjusted for demographics, malignancy type, and baseline cardiovascular comorbidities. **Results:** Among 3292 patients receiving CAR-T, 191 (5.8%) had MACE. Most common events were acute HF (3.1%), followed by ischaemic (1.3%) and haemorrhagic stroke (1%). Pre-treatment atrial fibrillation/flutter [adjusted odds ratio (aOR) 1.52 (1.08-2.16)], cardiomyopathy [aOR 2.49 (1.75-3.54)], and cerebrovascular disease [aOR 2.40 (1.30-4.43)] were independently associated with MACE. In 2021-23, MACE were also associated with immune effector cell-associated neurotoxicity syndrome and higher-grade cytokine release syndrome. MACE were associated with higher in-hospital mortality [aOR 16.9 (11.0-26.1)] and 1-year mortality after discharge [adjusted hazard ratio 1.91 (1.46-2.49)]. **Conclusions:** In the largest national sample of older adults receiving CAR-T, MACE occurred in 5.8% of patients and were associated with increased in-hospital and 1-year mortality. Further investigation into preventive and mitigating measures is needed. **Keywords:** CAR-T; Cardio-oncology; Chimeric antigen receptor; MACE; Major adverse cardiovascular event; Medicare. © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Figures [ ![Figure 1](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b64c/13380970/cd6cfa03d0b6/nihms-2194093-f0002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b64c/
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