Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study

Iannaccone, Mario; ́ascenzo, Fabrizio D; Filippo, Ovidio De; Gagliardi, Marco; Southern, Danielle; Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Henriques, José P.S.; Saucedo, Jorge; González-Juanatey, José Ramón; Wilton, Stephen B.; Kikkert, Wouter J.; Núñez‐Gil, Iván J.; Arizá-Solé, Albert; Song, Xiantao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Huczek, Zenon; Nie, Shaoping; Fujii, Toshiharu; Correia, Luís Cláudio Lemos; Kawashiri, Masa‐aki; Garcı́a-Acuña, José Marı́a; Alfonso, Emilio; Terol, Belén; Garay, Alberto; Zhang, Dongfeng; Chen, Yalei; Xanthopoulou, Ioanna; Osman, Neriman; Möllmann, Helge; Shiomi, Hiroki; Kowara, Michał; Filipiak‬, Krzysztof J.; Wang, Xiao; Yan, Yan; Fan, Jingyao; Ikari, Yuji; Nakahashi, Takuya; Sakata, Kenji; Yamagishi, Masakazu; Moretti, Claudio; Gaïta, Fiorenzo; Kalpak, Oliver; Kedev, Saško

doi:10.1007/s40256-016-0196-x

Cited by 13 publications

(5 citation statements)

References 35 publications

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“…A less frequent use of PCI or drug eluting stents in patients with a history of cancer admitted for ACS has been reported [9,11,12] but current data remain conflicting [8]. A recent study reported that optimal medical therapy was prescribed in only one third of cancer patients at discharge [27]. The higher comorbidities associated with cancer such Hyperlipidemia n/a n/a n/a n/a n/a n/a PCI n/a n/a n/a n/a n/a n/a CABG n/a n/a n/a n/a 185 ( as renal impairment, asthenia and anemia [8,9,11,16] may contribute to the suboptimal use of invasive strategy and evidence-based recommended medication.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention

Roule

Verdier

Blanchart

et al. 2020

BMC Cardiovasc Disord

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Background: Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods: We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results: Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53])but not cardiac death were higher in cancer patients admitted for PCI. Conclusion: Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention

Roule

Verdier

Blanchart

et al. 2020

BMC Cardiovasc Disord

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“…Therefore, therapeutic options may be individualized according to the risk of the revascularization methods, the urgency of coronary artery disease, the risk of the surgery, and the likelihood of severe coronary artery disease. 176) 177) According to the Society for Cardiovascular Angiography and Interventions Consensus, when selecting a stent, bare-metal stents or new-generation drug-eluting stents are recommended because of their low risk of thrombosis. 178) To reduce the need for DAPT, drug-eluting balloons, or bio-absorbable polymers/scaffolds may be used.…”

Section: Management Of Cardiovascular Toxicitymentioning

confidence: 99%

Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography

Kim

Chung

Cho

et al. 2018

J Cardiovasc Ultrasound

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Cardiovascular (CV) toxicity associated with anti-cancer treatment is commonly encountered and raises critical problems that often result in serious morbidity or mortality. Most cardiac toxicities are related to the cumulative dose of chemotherapy; however, the type of chemotherapy, concomitant agents, and/or conventional CV risk factors have been frequently implicated in CV toxicity. Approximately half of the patients exhibiting CV toxicity receive an anthracycline-based regimen. Therefore, serologic biomarkers or cardiac imagings are important during anti-cancer treatment for early detection and the decision of appropriate management of cardiotoxicity. However, given the difficulty in determining a causal relationship, a multidisciplinary collaborative approach between cardiologists and oncologists is required. In this review, we summarize the CV toxicity and focus on the role of cardiac imaging in management strategies for cardiotoxicity associated with anti-cancer treatment.

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“…Plain old balloon angioplasty (POBA) is more often used in oncological patients, especially in those with a higher bleeding risk: it allows shorter DAPT time than PCI with DES [35].…”

Section: Interventional Approachmentioning

confidence: 99%

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

Radmilovic

Vilio

D’Andrea

et al. 2020

JCM

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Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert prothrombotic, vasospastic, and proinflammatory actions. The management of cancer patients with ACS is quite challenging: percutaneous revascularization is often underused, and antiplatelet and anticoagulant pharmacological therapy should be individually tailored to the thrombotic risk and to the bleeding complications. Sometimes oncological patients also show different degrees of thrombocytopenia, which further complicates the pharmacological strategies. The aim of this review is to summarize the current evidence regarding the treatment of ACS in cancer patients and to suggest the optimal management and therapy to reduce the risk of adverse coronary events after ACS in this high-risk population.

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Optimal Medical Therapy in Patients with Malignancy Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome: a BleeMACS Sub-Study

Abstract: In patients with ACS and malignancy, OMT reduces the risk of adverse events at 1 year; in particular, ACEIs/ARBs and statins were the most protective drugs. (Clinical trials identifier: NCT02466854).

Cited by 13 publications

References 35 publications

Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention

Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention

Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

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