Acute Coronary Syndrome in Cancer Patients

Abstract

Cardiologists are seeing an increasing number of oncology patients every day, and acute coronary syndrome (ACS) is one of the problems patients encounter during follow-up. Cardio-oncology is the care of patients with cancer and cardiovascular disease, whether overt or occult, already established or acquired during treatment. Cardiovascular complications can occur acutely during or shortly after treatment and persist as long-term effects for months to years after treatment. As a delayed effect of cancer treatment, cardiovascular damage can occur months to years after the initial treatment. Vasospasm, thrombosis, and radiation-induced cardiovascular diseases can all cause ACS. Careful surveillance of ACS symptoms and regular screening during follow-up of patients with malignancy are suggested. In this review, we summarize the ACS we usually encounter during a range of cancer treatments or post cancer survival by providing illustrative case examples.

Challenges and Management of Acute Coronary Syndrome in Cancer Patients

“…Fluoropyrimidines (5-FU and capecitabine) and anti-microtubule agents (taxanes and vinca alkaloids) are the classes of chemotherapies most related associated with acute vasospasm ( 23 ). Considering only documented myocardial ischaemia, the incidence in patients receiving 5-FU may be as high as 10% and is influenced by dose and the time of administration ( 21 ).…”

“…Myocardial ischaemia can manifest from asymptomatic ST segment changes on electrocardiography (ECG) through to angina or MI ( 23 ). Vasospasm tends to occur at sites of thrombus and plaque formation; thus, preexisting CAD remains a risk factor for 5-FU-related vasospastic angina.…”

“…Vasospasm tends to occur at sites of thrombus and plaque formation; thus, preexisting CAD remains a risk factor for 5-FU-related vasospastic angina. Other chemotherapies, such as bevacizumab, have a synergistic effect on vascular complications ( 23 ).…”

“…In one larger retrospective study involving 81 patients receiving nilotinib, the incidence of AMI was 7.5% ( 23 ). In the analysis of 82 patients treated with nilotinib, the cumulative incidence of atherosclerotic events at 48 months was 8.5%, which was higher among patients with elevated cardiovascular risk ( 36 ).…”

Acute Cardiac Care – an Interdisciplinary Approach

“…For instance, preexisting chronic kidney disease, HIV infection, lung diseases, diabetes, inflammatory diseases, or oncological illnesses may lead to a more severe evolution of acute coronary syndromes, as inflammatory reactions play a pivotal role in the pathophysiology of ACS, and systemic inflammation may be exacerbated by these coexisting conditions. [6][7][8][9][10][11] The history of stem cell transplantation in patients with AMI is another evidence that integrating multiple disciplines (in this case cardiology, hematology, and translational research) in a common effort may lead to better results for cardiac care. [12][13][14] Another example of the strong multidisciplinary di- [17][18][19] All these data suggest that the perspective of acute cardiac care has been rapidly expanded from a narrow field…”