Abstract
Therapeutic management of the cancer patients with symptoms of acute coronary syndrome has to be tailored to patient’s comorbidities while balancing potential risks of invasive revascularization. Careful selection of patients with ischemia-inducing stenosis necessitating cardiac catheterization is required to avoid hazardous complications in cancer patients with good prognosis. In general in patients with acute coronary syndrome, an early invasive strategy (coronary angiography and percutaneous coronary intervention or coronary artery bypass graft) is superior to a conservative strategy of optimum medical treatment alone. Intraprocedural tools for lesion assessment (intravascular ultrasonography, optical coherence tomography) allow a better characterization of the luminal processes and assessment of the hemodynamic impact of the lesion. A fractional flow reserve of >0.75 permits postponing stent placement and prompt continuation on anticancer therapy with no increased mortality risk. Special considerations have to be made in respect to primary or acquired thrombocytopenia, the increased propensity to thrombosis associated with cancer as a pro-inflammatory state, and the potential drug interactions. The use of percutaneous coronary angiography with either bare metal stents or drug eluting stents requires combined antiplatelet therapy (aspirin and P2Y12 inhibitors) to prevent early stent thrombosis. Significant collaborative efforts between cardiologists and hematologists/oncologists is of prime importance in order to optimize the care of oncology patients and increase overall survival.
Keywords
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Abbreviations
- ACS:
-
Acute coronary syndrome
- BMS:
-
Bare metal stents
- CABG:
-
Coronary artery bypass graft surgery
- CAD:
-
Coronary artery disease
- DAPT:
-
Dual antiplatelet therapy (aspirin and a thienopyridine)
- DES:
-
Drug eluting stents
- FFR:
-
Fractional flow reserve
- IVUS:
-
Intravascular ultrasonography
- NSTEMI:
-
Non ST elevation myocardial infarction
- PCI:
-
Percutaneous coronary intervention
- POBA:
-
Plain balloon angioplasty
- UA:
-
Unstable angina
References
Whitlock MC, Yeboah J, Burke GL, Chen H, Klepin HD, Hundley WG. Cancer and its association with the development of coronary artery calcification: an assessment from the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2015;4(11).
Iliescu CA, Grines CL, Herrmann J, et al. SCAI expert consensus statement: evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencionista). Catheter Cardiovasc Interv. 2016;87(5):E202–23.
Yusuf SW, Daraban N, Abbasi N, Lei X, Durand JB, Daher IN. Treatment and outcomes of acute coronary syndrome in the cancer population. Clin Cardiol. 2012;35(7):443–50.
Kurisu S, Iwasaki T, Ishibashi K, Mitsuba N, Dohi Y, Kihara Y. Comparison of treatment and outcome of acute myocardial infarction between cancer patients and non-cancer patients. Int J Cardiol. 2013;167(5):2335–7.
Pratap P, Gupta S, Berlowitz M. Routine invasive versus conservative management strategies in acute coronary syndrome: time for a “hybrid” approach. J Cardiovasc Transl Res. 2012;5(1):30–40.
Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet. 2016;387(10023):1057–65.
Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012;59(9):857–81.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139–228.
Gross CM, Posch MG, Geier C, et al. Subacute coronary stent thrombosis in cancer patients. J Am Coll Cardiol. 2008;51(12):1232–3.
Iliescu C, Durand JB, Kroll M. Cardiovascular interventions in thrombocytopenic cancer patients. Tex Heart Inst J. 2011;38(3):259–60.
Krone RJ. Managing coronary artery disease in the cancer patient. Prog Cardiovasc Dis. 2010;53(2):149–56.
Takashima H, Waseda K, Gosho M, et al. Severity of morphological lesion complexity affects fractional flow reserve in intermediate coronary stenosis. J Cardiol. 2015;66(3):239–45.
Abbott JD. More than addition the use of fractional flow reserve in serial stenoses. J Am Coll Cardiol Interv. 2012;5(10):1019–20.
Pijls NHJ, Van Gelder B, Van der Voort P, et al. Fractional flow reserve: a useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995;92(11):3183–93.
Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. New Engl J Med. 2009;360(3):213–24.
Nascimento BR, Belfort AF, Macedo FA, et al. Meta-analysis of deferral versus performance of coronary intervention based on coronary pressure-derived fractional flow reserve. Am J Cardiol. 2015;115(3):385–91.
Cheneau E, Leborgne L, Mintz GS, et al. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation. 2003;108(1):43–7.
Hong SJ, Kim BK, Shin DH, et al. Effect of intravascular ultrasound-guided vs angiography-guided everolimus-eluting stent implantation: the IVUS-XPL randomized clinical trial. JAMA. 2015;314(20):2155–63.
Jang JS, Song YJ, Kang W, et al. Intravascular ultrasound-guided implantation of drug-eluting stents to improve outcome: a meta-analysis. JACC Cardiovasc Interv. 2014;7(3):233–43.
Khandhar SJ, Yamamoto H, Teuteberg JJ, et al. Optical coherence tomography for characterization of cardiac allograft vasculopathy after heart transplantation (OCTCAV study). J Heart Lung Transplant. 2013;32(6):596–602.
Jang IK, Tearney GJ, MacNeill B, et al. In vivo characterization of coronary atherosclerotic plaque by use of optical coherence tomography. Circulation. 2005;111(12):1551–5.
Otsuka F, Joner M, Prati F, Virmani R, Narula J. Clinical classification of plaque morphology in coronary disease. Nat Rev Cardiol. 2014;11(7):379–89.
Sinclair H, Bourantas C, Bagnall A, Mintz GS, Kunadian V. OCT for the identification of vulnerable plaque in acute coronary syndrome. JACC Cardiovasc Imaging. 2015;8(2):198–209.
Miyamoto Y, Okura H, Kume T, et al. Plaque characteristics of thin-cap fibroatheroma evaluated by OCT and IVUS. JACC Cardiovasc Imaging. 2011;4(6):638–46.
Tearney GJ, Regar E, Akasaka T, et al. Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol. 2012;59(12):1058–72.
Yusuf SW, Sami S, Daher IN. Radiation-induced heart disease: a clinical update. Cardiol Res Pract. 2011;2011:317659. doi:10.4061/2011/317659.
Buszman PE, Buszman PP, Banasiewicz-Szkróbka I, et al. Left main stenting in comparison with surgical revascularization: 10-year outcomes of the (Left Main Coronary Artery Stenting) LE MANS Trial. JACC: Cardiovasc Interv. 2016;9(4):318–27.
Dash D, Chen SL. Stenting of left main coronary artery stenosis: data to clinical practice. J Cardiovasc Dis Diagn. 2015;3:222.
Tornvall P, Collste O, Ehrenborg E, Jarnbert-Petterson H. A case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy. J Am Coll Cardiol. 2016;67(16):1931–6.
Munoz E, Iliescu G, Vejpongsa P, et al. Takotsubo stress cardiomyopathy: “good news” in cancer patients? J Am Coll Cardiol. 2016;68(10):1143–4.
Akashi YJ, Nef HM, Lyon AR. Epidemiology and pathophysiology of Takotsubo syndrome. Nat Rev Cardiol. 2015;12(7):387–97.
Fakhri Y, Dalsgaard M, Nielsen D, Lav Madsen P. 5-Fluorouracil-induced acute reversible heart failure not explained by coronary spasms, myocarditis or takotsubo: lessons from MRI. BMJ Case Rep. 2016;2016.
Akashi YJ, Goldstein DS, Barbaro G, Ueyama T. Takotsubo cardiomyopathy: a new form of acute, reversible heart failure. Circulation. 2008;118(25):2754–62.
Vejpongsa P, Banchs J, Reyes M, Iliescu G, Akinyemi M, Yusuf SW, Iliescu C. Takotsubo cardiomyopathy in cancer patients. Triggers, recovery, and resumption of therapy. J Am Coll Cardiol. 2015;65(10S):A927.
Elting LS, Rubenstein EB, Martin CG, et al. Incidence, cost, and outcomes of bleeding and chemotherapy dose modification among solid tumor patients with chemotherapy-induced thrombocytopenia. J Clin Oncol. 2001;19(4):1137–46.
Wang J, Cai X, Cheng X, Song P, Jiang S, Gong J. Acute myocardial infarction caused by tumor-associated thrombotic thrombocytopenic purpura: case report. Med Princ Pract. 2014;23(3):289–91.
Sarkiss MG, Yusuf SW, Warneke CL, et al. Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes. Cancer. 2007;109(3):621–7.
Yusuf SW, Iliescu C, Bathina JD, Daher IN, Durand JB. Antiplatelet therapy and percutaneous coronary intervention in patients with acute coronary syndrome and thrombocytopenia. Tex Heart Inst J. 2010;37(3):336–40.
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Munoz, E., Giza, D.E., Bellera, R., Iliescu, C. (2018). Acute Coronary Syndrome in Patients with Cancer. In: Yusuf, S., Banchs, J. (eds) Cancer and Cardiovascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-62088-6_8
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