Outcomes of percutaneous coronary interventions in cancer patients

ABSTRACT

Introduction: There are numerous shared risk factors in the etiopathogenesis of coronary artery disease (CAD) and cancer both at epidemiologic and molecular level. Additionally, different modalities of treatment of cancer such as radiation, chemotherapy, immunotherapy, and hormonal therapies further increase the risk of CAD and acute coronary syndrome. Most large database analysis and single-center experiences have shown that cancer patients undergoing PCI are at an increased risk of in-hospital mortality, bleeding, repeat revascularization.

Areas covered: In this review article the authors discuss the associations between CAD and cancer, challenges for PCI in cancer patients and outcome data.

Expert opinion: Interventionists performing PCI on cancer patients should be cognizant of the heightened risk of bleeding, thrombosis, possible need for interruption of dual-antiplatelet therapy, and the increased risk of target lesion revascularization in this cohort. These risks may be partially mitigated by utilization of best practices such as the use of radial artery access, intravascular imaging for lesion assessment and stent optimization and avoidance of complex stenting strategies. Finally, it is of paramount importance to have a multidisciplinary approach consisting of the treating cardiologist, medical and/or surgical oncologist, and palliative medicine, and involve the patient and their family in making informed decisions.

KEYWORDS:

• Coronary artery disease (CAD)
• cancer
• percutaneous coronary interventions (PCI)
• outcomes

Article Highlights

• Coronary artery disease and cancer have numerous shared risk factors.

• Different modalities of cancer treatment such as radiation, chemotherapy, immunotherapy, and hormonal therapy also pose additional risk for the progression of CAD.

• There are numerous challenges for PCI in cancer patients related to their hematologic and coagulation abnormalities.

• Data show increased risk of bleeding, in-hospital mortality, and repeat revascularization in cancer patients undergoing PCI.

• It is of paramount importance to follow safe and best practices while performing PCI and approach these patients from a multidisciplinary standpoint.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.