Coronary intervention in cancer patients: the need for personalized cardiac care

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Romanian Journal of Cardiology


Since 1999, we have witnessed signifi cant improvements in both cancer and cardiovascular care, translating into decreased mortality in both disease processes during the initial decade of the century. Since 2011, the parallel improvement in survivorship in both groups diverged, with cancer survivorship continuing to improve (with an overall decrease of 19%) while cardiovascular survivorship witnessed a 4% increase in mortality as opposed to the 22% reduction seen in the fi rst decade1 . Prevention of cardiovascular disease (CVD) has been a main focus of current cardiovascular research, since >80% of CVD is thought to be potentially prevented based on aggressive modifi cation of traditional cardiovascular risk factors2 . Aggressive modifi cation of same risk factors has been shown to decrease the incidence of cancer3 . Despite efforts to decrease the prevalence of both diseases, cancer and heart disease continue to be the leading causes of death of middle-aged adults and represent 50% of all deaths in this age group. It is evident that the same risk factors drive molecular pathways toward concomitant expression of both diseases4 . Investigations to the association between cancer and cardiovascular disease as a comorbid group has been limited to few studies as previous research trends focused on a single cause and effect paradigm4–11. This has driven further research into the comorbid conditions that affl ict those with cancer as evidenced by a high number of percutaneous coronary interventions (PCI) in those with a cancer history13. However, more clinical data recognizes the increased use of PCI in cancer patients as refl ected in the Nationwide Inpatient Sample (NIS) database, while majority of randomized clinical trials continue to have cancer as exclusion criteria and indirectly lead to a paucity of evidence that can be used to make life-saving clinical decisions in cancer patients with CVD. Until recently, the focus of CVD in cancer patients has not lent itself to studying each cancer individually but rather if cancer is present or not. As every cancer patient is unique, recent publications like Potts et al., have evaluation of in-hospital outcomes in patients undergoing PCI in specifi c groups (i.e. leukemia, lymphoma) using the Nationwide Inpatient Sample (NIS); leukemia patients had a 40% increase in the odds of mortality compared to those without leukemia14. Identifying the temporal trends in subcategories of cancer diagnoses may better help to understand the effect of PCI in cancer patients. Overall, revascularization is the treatment of choice for acute coronary syndrome in cancer patients and continued efforts should be made to evaluate the effectiveness and safety of these techniques in those with different cancer types.