Acute coronary syndrome in patients with cancer

ABSTRACT

Introduction

Improvement in cancer survival has led to an increased focus on cardiovascular disease as the other major determinant of survivorship. As a result, there has been an increasing interest in managing cardiovascular disease during and post cancer treatment.

Areas covered

This article reviews the current literature on the pathogenesis, risk factors, presentation, treatment and clinical outcomes of acute coronary syndrome (ACS) in patients with cancer.

Expert opinion

There is growing evidence that both medical therapy and invasive management of ACS improve outcomes in patients with cancer. Appropriate patient selection, risk stratification and tailored therapy represents the cornerstone of management in these patients.

KEYWORDS:

• Acute coronary syndrome
• ACS
• coronary artery disease
• CAD
• radiation therapy
• chemotherapy
• cancer
• myocardial infarction

Article highlights

• When compared to the general population, ACS occurs more frequently in patients with cancer.

• Cancer and ACS share common risk factors such as tobacco use and older age. In addition, specific risk factors such as chemotherapy agents and radiotherapy have a contributory role in the pathogenesis of ACS in patients with cancer.

• Patients with cancer and ACS have higher mortality when compared to non-cancer patients.

• The general medical management of ACS in patients with cancer should include aspirin, a second antiplatelet therapy (preferably clopidogrel), beta-blockers, and statins.

• There is increasing evidence that the invasive strategy improves mortality in appropriately selected patients, and this approach should be taken when clinically indicated and feasible, in this population.

• A multidisciplinary approach involving the oncologist and the cardiologist is imperative for optimal therapy and outcome in patients with cancer and ACS.

Acknowledgments

Dr. Deswal is supported in part by the Ting Tsung and Wei Fong Chao Distinguished Chair. Dr. Palaskas is supported by the Cancer Prevention & Research Institute of Texas and the Andrew Sabin Family Foundation.

Reviewer disclosures

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

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.