Management of Patients with Acute Coronary Syndrome and Cancer
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MANAGEMENT OF ACUTE CORONARY SYNDROMES (H JNEID, SECTION EDITOR)
Management of Patients with Acute Coronary Syndrome and Cancer Tyler B. Moran 1
&
Juan Carlos Plana 1
Accepted: 2 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cancer patients with acute coronary syndrome (ACS) have significantly greater mortality compared with non-cancer patients. This risk is partly directly attributable to the malignancy; however these patients are frequently undertreated with respect to guideline recommended treatments for ACS due to higher bleeding risks from anemia and thrombocytopenia. Due to exclusion from large clinical trials, there is a paucity of data regarding how to best treat these complex and high-risk patients. Purpose of Review To review the literature and identify risk factors among cancer patients associated with poor outcomes, pathophysiology of chemotherapy and radiation therapy contributing to accelerated coronary artery disease and ACS, and data regarding outcomes with medical therapy and invasive management. Recent Findings Despite an elevated bleeding risk, many cancer patients may benefit from ACC/AHA guideline-directed management for ACS including aspirin, P2Y12 inhibitor, statin, and beta-blocker therapies. Summary Cancer patients with ACS are a uniquely vulnerable population who are often undertreated, and with improved cancer treatments, this population is expected to increase. These patients should be included in future randomized trials to better understand how to balance the complexities of increased bleeding and thrombosis risks during ACS. Keywords Cancer . Acute coronary syndrome . Chemotherapy . Coronary artery disease
Introduction Cancer patients with acute coronary syndrome (ACS) represent a particularly high-risk group compared with non-cancer patients with ACS. Current American College of Cardiology and American Heart Association (ACC/AHA) guidelines suggest an early invasive strategy of diagnostic angiography with intent to perform revascularization for patients with STelevation myocardial infarction (STEMI) [1], as well as highrisk patients with non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) [2, 3]. However, due to higher bleeding risks and challenges related to performing necessary surgeries and procedures, cancer patients with ACS do This article is part of the Topical Collection on Management of Acute Coronary Syndromes
not undergo an invasive strategy or receive anti-coagulation and anti-platelet therapy at nearly the same rates as non-cancer patients. Additionally, many cancer treatments including chemotherapy and radiation therapy increase the risk of ACS, and ultimately these patients have a very high mortality rate [4]. Based on data from the Centers for Disease Control and Prevention, cardiovascular disease and cancer are the top two causes of death in the USA [5]. As cancer therapies and therefore life expectancies related to those malignancies continue to improve, more patients are developing coronary
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