Abstract
Patients with cancer face a high short-term risk of arterial thromboembolism. One of the most fatal manifestations of arterial thromboembolism is myocardial infarction (MI), and patients with cancer face a 3-fold greater risk of MI than patients without cancer. The individual risk for arterial thrombotic events in patients with cancer is determined by the complex interaction of baseline cardiovascular risk factors, cancer type and stage, chemotherapeutic regimen, and other general contributing factors for thrombosis. Managing MI in patients with cancer is a clinical challenge, particularly due to cancer's unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. When patients with cancer present with MI, a limited proportion are treated with guideline-recommended therapy, such as antiplatelet therapy or invasive revascularization. Despite the limited evidence, existing reports consistently suggest similar clinical benefits of guideline-recommended therapy when administered to patients with cancer presenting with MI. In this review, we briefly summarize the available evidence, clinical challenges, and future perspectives on simultaneous management of MI and cancer, with a focus on invasive strategy.
Highlights
Advances in cancer treatments have significantly contributed to a decline in cancer-specific mortality rates; as a result, cardiovascular disease has become the leading cause of death among cancer patients [1]
We provide an overview of the pathophysiologic mechanism, presentation, and management of myocardial infarction (MI) in patients with cancer, with a particular focus on invasive strategy
The Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) Percutaneous Coronary Intervention (PCI)/Coronary Artery Bypass Grafting (CABG) Registry Cohort-2 reported that patients with active cancer who were undergoing PCI trended toward higher adjusted risk for definite or probable stent thrombosis as compared with patients without cancer, this finding did not reach statistical significance [23]
Summary
Advances in cancer treatments have significantly contributed to a decline in cancer-specific mortality rates; as a result, cardiovascular disease has become the leading cause of death among cancer patients [1]. In patients with metastatic colorectal, breast, or non-small cell lung carcinoma, the combination therapy of bevacizumab, humanized monoclonal antibody against VEGF, and chemotherapy has been associated with an increased risk of arterial thrombosis compared with chemotherapy alone (5.5 vs 3.1 events per 100 person-years) [14].
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