Usefulness of Bleeding After Acute Coronary Syndromes for Unmasking Silent Cancer

Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Muñoz-Pousa, Isabel; Rosselló, Xavier; Cespón‐Fernández, María; Melendo-Viu, María; Caneiro‐Queija, Berenice; Paz, Rafael Cobas; Bastos, Guillermo; Íñiguez‐Romo, Andrés

doi:10.1016/j.amjcard.2020.03.023

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…Previous studies reported that patients with new cancer diagnoses following cardiovascular disease were older and more likely to have comorbidities. 16 , 17 , 19 Meanwhile, the patient's age did not affect the risk of new cancer after gastrointestinal and genitourinary bleeding in our subgroup analysis. Bleeding that led to a cancer diagnosis after myocardial infarction may be the only sign induced by the development of the cancer.…”

Section: Discussionmentioning

confidence: 60%

“…The relationship between clinically relevant bleeding after antithrombotic treatment and a new cancer diagnosis was also examined in patients with stable atherosclerosis, 15 patients with acute coronary syndrome, 16 and patients with atrial fibrillation. 17 , 18 Clinically relevant bleeding was quite frequent in these studies, occurring in 10% to 30% of the patients depending on the follow‐up period and antithrombotic treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction

Ahn

Lee

Choo

et al. 2022

JAHA

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Background Antithrombotic agents to treat patients with acute myocardial infarction can cause bleeding, which may reveal undiagnosed cancer. However, the relationship between bleeding and new cancer diagnosis and the prognostic impact is still unclear. Methods and Results We analyzed the new cancer diagnosis, Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and all‐cause death of 10 364 patients with acute myocardial infarction without a history of previous cancer in a multicenter acute myocardial infarction registry. During a median of 4.9 years, 1109 patients (10.7%) experienced Bleeding Academic Research Consortium 2, 3, or 5 bleeding, and 338 patients (3.3%) were newly diagnosed with cancer. Bleeding Academic Research Consortium 2, 3, or 5 bleeding was associated with an increased risk of new cancer diagnosis (subdistribution hazard ratio [sHR] 3.29 [95% CI, 2.50–4.32]). In particular, there were robust associations between gastrointestinal bleeding and new gastrointestinal cancer diagnosis (sHR, 19.96 [95% CI, 11.30–29.94]) and between genitourinary bleeding and new genitourinary cancer diagnosis (sHR, 28.95 [95% CI, 14.69–57.07]). The risk of all‐cause death was not lower in patients diagnosed with new gastrointestinal cancer after gastrointestinal bleeding (hazard ratio [HR], 4.05 [95% CI, 2.04–8.02]) and diagnosed with new genitourinary cancer after genitourinary bleeding (HR, 2.79 [95% CI, 0.81–9.56]) than in patients newly diagnosed with cancer without previous bleeding. Conclusions Clinically significant bleeding, especially gastrointestinal and genitourinary bleeding, in patients with AMI was associated with an increased risk of new cancer diagnoses. However, the bleeding preceding new cancer detection was not associated with better survival. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02385682 and NCT02806102.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction

Ahn

Lee

Choo

et al. 2022

JAHA

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“… 24 A study reported that one of 13 cases of post-discharge bleeding in ACS patients was related to a newly diagnosed malignant tumor. 27 Bleeding in related parts of the urogenital system, gastrointestinal tract, and bronchopulmonary system was more likely to be diagnosed with a new tumor. Data from baseline and follow-up of our study showed that approximately 10% of patients ≥ 75 years of age had malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study

Meng¹,

Guo²,

Ye³

et al. 2022

CIA

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Background Age is a strong predictor of adverse outcomes due both to a higher risk of bleeding and ischemia. The purpose of this study was to evaluate the safety and efficacy of ticagrelor in elderly patients. Methods Patients ≥75 years of age admitted to our center from January, 2015 to December, 2019 who had undergone percutaneous coronary intervention (PCI) and received dual antiplatelet therapy (DAPT) were included in our study. Eligible patients were divided into clopidogrel and ticagrelor groups according to the P2Y 12 receptor inhibitor and were followed up for 1 year. The primary safety endpoint was types 2, 3, and 5 bleeding, as defined by Bleeding Academic Research Consortium (BARC), and the primary efficacy endpoint was combined major adverse cardiovascular and cerebrovascular events (MACCEs). A Cox proportional hazard model and propensity score matching were used to correct confounding factors. Results Of 1505 patients enrolled in this study, 442 were assigned to ticagrelor group and 1063 were assigned to clopidogrel group. The incidence of BARC 2, 3, and 5 bleeding (HR, 2.304; 95% CI, 1.540–3.447), and any bleeding (HR, 2.476; 95% CI, 1.802–3.403) in ticagrelor group was significantly higher than clopidogrel group. There were no significant difference between the two groups with respect to BARC 3 and 5 bleeding (HR, 1.566; 95% CI, 0.767–3.198) and MACCEs (HR, 0.957; 95% CI, 0.702–1.305). Conclusion Compared with clopidogrel, DAPT with ticagrelor significantly increased the risk of BARC 2, 3, and 5 bleeding without reducing MACCEs in elderly patients who underwent PCI. Trial Registration The study was retrospectively registered in clinicaltrials.gov (NCT 04999293).

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“…Active malignancy, which is defined as a diagnosis within the previous 12 months or ongoing active cancer therapy including surgery, chemotherapy, or radiotherapy, is considered one of the major criteria for high bleeding risk, as outlined by the Academic Research Consortium for High Bleeding Risk [15,16]. In a study by Raposeiras-Roubin et al [17], 1 in 13 post-discharge bleeding events noted in ACS patients was associated with new cancer (positive predictive value for cancer diagnosis of post-discharge bleeding = 7.7%), affecting mainly the gastrointestinal, genitourinary, and bronchopulmonary systems [18]. Moreover, radiation-induced CAD (RICAD), which results from both direct and indirect effects of radiation exposure, is the second most frequent cause of morbidity and mortality among patients exposed to radiotherapy for breast cancer and Hodgkin lymphoma [16].…”

Section: Challenges Of Treating Acs In Cancer Patientsmentioning

confidence: 99%

Acute coronary syndromes in patients with cancer: Recent advances

Doolub,

Bharadwaj,

Mamas

2024

Pol Heart J

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Coronary artery disease is presently one of the leading causes of death among cancer survivors. Due to the number of cancer survivors projected to reach 26 million by 2040 managing coronary disease in this population presents a unique challenge. Cancer patients face an elevated risk of atherosclerotic disease due to shared cardiovascular risk factors and the cardiotoxic effects of cancer therapies, predisposing them to acute coronary syndromes. Challenges in treating cancer patients presenting with acute coronary syndromes include atypical presentations, obscured symptoms, and the impact of cancer-related processes on traditional biomarkers. This review explores the complexities of acute coronary syndrome management in cancer patients, addressing challenges involved, recent advances in percutaneous strategies, pharmacology, and considerations for these high-risk individuals. This review discusses a balance between invasive vs. medical strategy, technical advances in multimodal imaging, intravascular physiology, intracoronary imaging, and evolving stent options, highlighting the need for tailored approaches in this complex patient population.

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Usefulness of Bleeding After Acute Coronary Syndromes for Unmasking Silent Cancer

Cited by 7 publications

References 19 publications

Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction

Association Between Bleeding and New Cancer Detection and the Prognosis in Patients With Myocardial Infarction

Comparison of Clinical Outcomes Between Ticagrelor and Clopidogrel in Elderly Patients Undergoing Percutaneous Coronary Intervention: A Cohort Study

Acute coronary syndromes in patients with cancer: Recent advances

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