Primary Percutaneous Coronary Interventions in Cancer Patients

Iliescu, Cezar; Tsitlakidou, Despina; Giza, Dana Elena; Marmagkiolis, Konstantinos

doi:10.17980/2017.64

Cited by 4 publications

(11 citation statements)

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“…Many cancer therapies can induce or aggravate acute and chronic injury to coronary arteries (4). Cancer itself, cancer therapy and common cardiovascular risk factors synergistically account for ACS risk (78). Malignant tumors induce a chronic inflammatory state (79).…”

Section: Cad and Acsmentioning

confidence: 99%

“…In preclinical models, cancer cells secrete inflammatory cytokines, which promote endothelial damage and accelerate atherosclerosis (79). Furthermore, malignant diseases often promote a prothrombotic milieu in the vasculature (78,79). Common cardiovascular risk factors including arterial hypertension, hypercholesterolemia, smoking and history of CAD causes a further increase in ACS risk (8,80).…”

Section: Cad and Acsmentioning

confidence: 99%

“…In addition, prolonged life expectancy of cancer patients raises their baseline CAD risk. Monitoring of blood pressure and serum LDL are recommended regularly in cancer patients (78).…”

Section: Cad and Acsmentioning

confidence: 99%

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Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Michel¹,

Rassaf²,

Totzeck³

2018

J. Thorac. Dis

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Progress in cancer therapy over the past decades improved long-term survival but increased cancer therapy-related cardiotoxicity. Many novel treatment options have been implemented with yet incompletely characterized cardiovascular side effects including heart failure, coronary artery disease, arrhythmias, valvular disease, venous thromboembolism and myocarditis. Diagnosis of potential cardiotoxic side effects is essential for an optimal treatment but remains challenging. Cardiac biomarkers troponin and brain natriuretic peptide/N-terminal proBNP (BNP/NT-proBNP) have been extensively studied in heart failure and acute coronary syndromes. Emerging evidence implicates a significant role in the detection of cardiotoxicity and guidance of therapy in cancer patients. Elevated troponin or BNP/NT-proBNP levels were associated with increased all-cause mortality in cancer patients and have been shown to predict manifest heart failure. BNP/NT-proBNP may be useful for the prediction of cancer therapy-related heart failure and response to heart failure therapy in adult and pediatric cancer patients while troponin can indicate acute myocardial infarction in patients with cancer therapy-related risk for coronary artery disease. Furthermore, troponin may be used for the identification of immune checkpoint inhibitor-related myocarditis with very high sensitivity. Finally, even D-dimer levels have been shown to improve risk stratification and diagnosis in cancer-associated venous thromboembolism. This review aims to summarize the current knowledge about biomarkers in cancer therapy-related cardiotoxicity. We also outline possible clinical recommendations for the detection and treatment of subclinical and clinically apparent cardiotoxic effects using biomarkers.

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Section: Cad and Acsmentioning

confidence: 99%

Section: Cad and Acsmentioning

confidence: 99%

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Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Michel¹,

Rassaf²,

Totzeck³

2018

J. Thorac. Dis

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“…In primary prevention of progressive coronary disease each patient after chest radiotherapy should be screened for classic cardiovascular risk factors, with adequate management and correction of modifiable risk factors. A model of screening for CAD depends on the Systemic Coronary Risk Estimation (SCORE) result and accompanying symptoms, and among cancer survivors, it does not differ from the general population [32,33]. The main issue is the time to start a screening program, because radiotherapy leads to premature onset of CAD mainly in asymptomatic patients.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

“…Invasive treatment: percutaneous coronary intervention (PCI) with stent implantation is recommended in patients with acute coronary syndrome or stable CAD refractory to pharmacological therapy. Conservative treatment in these conditions leads to poorer prognosis [33].…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cardiovascular complications after radiotherapy

et al. 2020

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Over the past decades, effective cancer therapies have resulted in a significant improvement in the survival rates for a number of cancers and an increase in the number of cancer survivors. Radiation therapy is widely used in the treatment of cancer, and it can induce various cardiotoxicities that differ considerably from chemotherapy-induced cardiotoxicity. They occur primarily as late radiation-induced complications, several years from the end of anticancer treatment and present as coronary artery disease, heart failure, pericardial disease, valvular heart disease and arrhythmias. Patients who recovered from cancer disease suffer from cardiac complications of anticancer treatment, it affects the quality of their lives and life expectancy, especially if the diagnosis is delayed. These patients may present distinct symptoms of cardiac injury, resulting from radiation-induced neurotoxicity and altered pain perception, which makes diagnosis difficult. This review highlights the need for a screening programme for patients who have undergone radiation therapy and which will subsequently have a potentially profound impact on morbidity and mortality.

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Acute coronary syndrome in patients undergoing anticancer therapies: A single-center, controlled case study

Nabiałek-Trojanowska¹,

Dąbrowska−Kugacka²,

Lewicka-Potocka³

et al. 2019

Adv Clin Exp Med

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Background. Anticancer therapies can be accompanied by cardiovascular complications, including acute coronary syndrome (ACS). In turn, the presence of cancer can influence therapeutic decisions if ACS occurs.Objectives. The aim of the study was to analyze ACS treatment in patients with cancer. Material and methods.The study consisted of a retrospective analysis based on the medical records of patients who were admitted due to ACS, with cancer diagnoses. Patients currently undergoing cancer treatment or having treatment which ended up to 6 months before the ACS were included. They were compared to a control group consisting of consecutive patients admitted for ACS during the same period, but who did not have a diagnosis of cancer; they were matched with the experimental group in terms of age, gender and clinical type of ACS.Results. Thirty-two consecutive cancer patients (70 ±9 years; 53% men) met the inclusion criteria. In 22 of them (69%), ACS occurred during their cancer treatment, and in 10 (31%), it presented within 6 months of completing cancer treatment. Upon hospital admission, 19 (59%) cancer patients complained of dyspnea and 7 of typical angina, while in the control group 28, (87%) and 4 (13%) reported such symptoms, respectively.The clinical manifestation of ACS was NSTEMI in 16 patients (50%), UA in 10 (31%) and STEMI in 5 (15.6%). Coronary angiography was done in 25 (78%) of the cancer patients and in all members of the control group. Percutaneous coronary angioplasty (PCA) was performed in 17 (53%) and 23 (72%) of the patients from the respective groups. The median time to percutaneous coronary intervention (PCI) was 10 h (30 min-10 days) among the cancer patients and 7.5 h among the control group (30 min-6 days). There were no PCI-related complications or severe bleeding in both groups. In-hospital mortality was 6.25% in the cancer group and there were no reported hospital deaths in the control group.Conclusions. Dyspnea is the most common symptom of ACS in cancer patients who are treated invasively too rarely: the presence of cancer and active anticancer treatment should not limit the management of ACS in accordance with current guidelines.

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Primary Percutaneous Coronary Interventions in Cancer Patients

Cited by 4 publications

References 0 publications

Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Biomarkers for the detection of apparent and subclinical cancer therapy-related cardiotoxicity

Cardiovascular complications after radiotherapy

Acute coronary syndrome in patients undergoing anticancer therapies: A single-center, controlled case study

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