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Acute Coronary Syndrome in Patients with Cancer

  • Ezequiel Munoz
  • Dana Elena Giza
  • Ricardo Bellera
  • Cezar Iliescu
Chapter

Abstract

Therapeutic management of the cancer patients with symptoms of acute coronary syndrome has to be tailored to patient’s comorbidities while balancing potential risks of invasive revascularization. Careful selection of patients with ischemia-inducing stenosis necessitating cardiac catheterization is required to avoid hazardous complications in cancer patients with good prognosis. In general in patients with acute coronary syndrome, an early invasive strategy (coronary angiography and percutaneous coronary intervention or coronary artery bypass graft) is superior to a conservative strategy of optimum medical treatment alone. Intraprocedural tools for lesion assessment (intravascular ultrasonography, optical coherence tomography) allow a better characterization of the luminal processes and assessment of the hemodynamic impact of the lesion. A fractional flow reserve of >0.75 permits postponing stent placement and prompt continuation on anticancer therapy with no increased mortality risk. Special considerations have to be made in respect to primary or acquired thrombocytopenia, the increased propensity to thrombosis associated with cancer as a pro-inflammatory state, and the potential drug interactions. The use of percutaneous coronary angiography with either bare metal stents or drug eluting stents requires combined antiplatelet therapy (aspirin and P2Y12 inhibitors) to prevent early stent thrombosis. Significant collaborative efforts between cardiologists and hematologists/oncologists is of prime importance in order to optimize the care of oncology patients and increase overall survival.

Keywords

Coronary artery disease (CAD) Cancer Thrombocytopenia Percutaneous coronary intervention (PCI) Fractional flow reserve (FFR) Intravascular ultrasound (IVUS) Optical coherence tomography (OCT) Coronary artery bypass graft (CABG) Cardiotoxicity Takotsubo syndrome 

Abbreviations

ACS

Acute coronary syndrome

BMS

Bare metal stents

CABG

Coronary artery bypass graft surgery

CAD

Coronary artery disease

DAPT

Dual antiplatelet therapy (aspirin and a thienopyridine)

DES

Drug eluting stents

FFR

Fractional flow reserve

IVUS

Intravascular ultrasonography

NSTEMI

Non ST elevation myocardial infarction

PCI

Percutaneous coronary intervention

POBA

Plain balloon angioplasty

UA

Unstable angina

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ezequiel Munoz
    • 1
  • Dana Elena Giza
    • 1
  • Ricardo Bellera
    • 2
  • Cezar Iliescu
    • 1
  1. 1.Department of CardiologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of CardiologyThe University of Texas Health Science CenterHoustonUSA

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