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Acute Coronary Syndrome in Patients with Cancer

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Cancer and Cardiovascular Disease

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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.

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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

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Authors and Affiliations

  1. Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1451, Houston, TX, 77030, USA

    Ezequiel Munoz, Dana Elena Giza & Cezar Iliescu M.D.

  2. Department of Cardiology, The University of Texas Health Science Center, Houston, TX, USA

    Ricardo Bellera

Authors
  1. Ezequiel Munoz
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  2. Dana Elena Giza
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  3. Ricardo Bellera
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  4. Cezar Iliescu M.D.
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Corresponding author

Correspondence to Cezar Iliescu M.D. .

Editor information

Editors and Affiliations

  1. Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Syed Wamique Yusuf

  2. Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Jose Banchs

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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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  • DOI: https://doi.org/10.1007/978-3-319-62088-6_8

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