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Ivan VS, Lighezan DF, Ardelean M, Balteș N, Faur AC, Ciubotaru PG, Cutina-Morgovan AF, Buzaș R. What to Do When There Is Something Unexpected? Life (Basel) 2024; 14:213. [PMID: 38398722 PMCID: PMC10890187 DOI: 10.3390/life14020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Myocardial infarction is currently the leading cause of death worldwide, followed by malignant neoplasms. The presence of both within the same patient obviously increases the risk of death, as many coronary events are detected in patients diagnosed with cancer. Diagnosis of an occult digestive cancer in the acute phase of myocardial infarction is most frequently prompted by a hemorrhagic complication. CASE SUMMARY This case features an 81-year-old male patient diagnosed with acute myocardial infarction, treated with primary percutaneous intervention (PCI), who developed post-stenting hemorrhagic complications in the first 24 h due to the presence of two different concomitant malignant neoplasms. The outcome was favorable in the acute phase, even if de-escalation therapy was given immediately post-stenting, and intrastent residual thrombotic risk was high. CONCLUSIONS The presence of bleeding complications in patients with acute myocardial infarction should mobilize resources in search of a neoplastic cause, especially a digestive one. However, other locations should be looked for, depending on the source of bleeding.
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Affiliation(s)
- Vlad Sabin Ivan
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Daniel-Florin Lighezan
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Melania Ardelean
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Nicoleta Balteș
- Gastroenterology Unit, Emergency Clinical Municipal Hospital, 300079 Timișoara, Romania;
| | - Alexandra Corina Faur
- Department of Anatomy and Embriology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Paul-Gabriel Ciubotaru
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adina-Flavia Cutina-Morgovan
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
| | - Roxana Buzaș
- Department of Internal Medicine I, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (V.S.I.); (D.-F.L.); (M.A.); (A.-F.C.-M.); (R.B.)
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Wang T, Liu X, Zhu Y, Zhang Y, Zhang Z, Huang G, Xu J. Antithrombotic strategy in cancer patients comorbid with acute coronary syndrome and atrial fibrillation. Front Cardiovasc Med 2023; 10:1325488. [PMID: 38162143 PMCID: PMC10756915 DOI: 10.3389/fcvm.2023.1325488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
It has been shown that patients with cancer have a longer expected life duration, benefiting from advanced medical therapy. Meanwhile, the risk of suffering from cardiovascular disease (CVD) has been increasing with ageing. A growing number of studies have elucidated the association between cancer and CVD. Cancer, atrial fibrillation (AF) and coronary artery disease share some common factors and interact with each other, such as obesity, aging, diabetes, and inflammation, but the potential specific mechanism is still unclear. In addition, cancer-specific and therapy-related factors may increase the risk of embolism and bleeding in patients with cancer than in general population. However, current available embolic and bleeding risk scores applied in patients with CVD may not be applicable for risk assessment in cancer patients, which would be difficult for clinicians to select an appropriate antithrombotic regimen and ensure the balance between bleeding and embolism. Moreover, different types of cancer have distinct risks, which may increase the complexity of antithrombotic therapy. In this review, we review the literature related to cancer, AF, and acute coronary syndrome, focusing on the epidemiological status, physiological mechanism, embolism and bleeding risks, and strategies of antithrombotic therapy.
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Affiliation(s)
- Tianbo Wang
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Xiaohan Liu
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Yuxin Zhu
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Yue Zhang
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Zhen Zhang
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Gang Huang
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
| | - Junbo Xu
- Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, China
- Affiliated Hospital of Southwest Jiaotong University, College of Medicine, Southwest Jiaotong University, Chengdu, China
- Cardiovascular Disease Research Institute of Chengdu, Chengdu, China
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Barachini S, Ghelardoni S, Varga ZV, Mehanna RA, Montt-Guevara MM, Ferdinandy P, Madonna R. Antineoplastic drugs inducing cardiac and vascular toxicity - An update. Vascul Pharmacol 2023; 153:107223. [PMID: 37678516 DOI: 10.1016/j.vph.2023.107223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/09/2023]
Abstract
With the improvement in cancer prognosis due to advances in antitumor therapeutic protocols and new targeted and immunotherapies, we are witnessing a growing increase in survival, however, at the same timeincrease in morbidity among cancer survivors as a consequences of the increased cardiovascular adverse effects of antineoplastic drugs. Common cardiovascular complications of antineoplastic therapies may include cardiac complications such as arrhythmias, myocardial ischemia, left ventricular dysfunction culminating in heart failure as well as vascular complications including arterial hypertension, thromboembolic events, and accelerated atherosclerosis. The toxicity results from the fact that these drugs not only target cancer cells but also affect normal cells within the cardiovascular system. In this article, we review the clinical features and main mechanisms implicated in antineoplastic drug-induced cardiovascular toxicity, including oxidative stress, inflammation, immunothrombosis and growth factors-induced signaling pathways.
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Affiliation(s)
- Serena Barachini
- Department of Clinical and Experimental Medicine, Laboratory for Cell Therapy, University of Pisa, Pisa, Italy
| | - Sandra Ghelardoni
- Department of Pathology, Laboratory of Biochemistry, University of Pisa, Pisa, Italy
| | - Zoltán V Varga
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary; HCEMM-SU Cardiometabolic Immunology Research Group, Budapest, Hungary; MTA-SE Momentum Cardio-Oncology and Cardioimmunology Research Group, Budapest, Hungary
| | - Radwa A Mehanna
- Medical Physiology Department, Center of Excellence for Research in Regenerative Medicine and Applications (CERRMA), Faculty of Medicine, Alexandria University, Egypt
| | | | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary; Pharmahungary Group, Szeged, Hungary
| | - Rosalinda Madonna
- Department of Pathology, Cardiology Division, University of Pisa, Pisa, Italy.
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Bima P, Lopez-Ayala P, Koechlin L, Boeddinghaus J, Nestelberger T, Okamura B, Muench-Gerber TS, Sanzone A, Skolozubova D, Djurdjevic D, Rubini Gimenez M, Wildi K, Miro O, Martínez-Nadal G, Martin-Sanchez FJ, Christ M, Keller D, Lindahl B, Giannitsis E, Mueller C. Chest Pain in Cancer Patients: Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac Troponins. JACC CardioOncol 2023; 5:591-609. [PMID: 37969646 PMCID: PMC10635894 DOI: 10.1016/j.jaccao.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 11/17/2023] Open
Abstract
Background Little is known about patients with cancer presenting with acute chest discomfort to the emergency department (ED). Objectives The aim of this study was to assess the prevalence of acute myocardial infarction (AMI), outcomes, and the diagnostic utility of recommended diagnostic tools in this population. Methods Patients presenting with chest pain to the ED were prospectively enrolled in an international multicenter diagnostic study with central adjudication. Cancer status was assessed prospectively and additional cancer details retrospectively. Findings were externally validated in an independent multicenter cohort. Results Among 8,267 patients, 711 (8.6%) had cancer. Patients with cancer had a higher burden of cardiovascular risk factors and pre-existing cardiac disease. Total length of stay in the ED (5.2 hours vs 4.3 hours) and hospitalization rate (49.8% vs 34.3%) were both increased in patients with cancer (P < 0.001 for both). Among 8,093 patients eligible for the AMI analyses, those with cancer more often had final diagnoses of AMI (184 of 686 with cancer [26.8%] vs 1,561 of 7,407 without cancer [21.1%]; P < 0.001). In patients with cancer, high-sensitivity cardiac troponin T (hs-cTnT) but not high sensitivity cardiac troponin I (hs-cTnI) concentration had lower diagnostic accuracy for non-ST-segment elevation myocardial infarction (for hs-cTnT, area under the curve: 0.89 [95% CI: 0.86-0.92] vs 0.94 [95% CI: 0.93-0.94] [P < 0.001]; for hs-cTnI, area under the curve: 0.93 [95% CI: 0.91-0.95] vs 0.95 [95% CI: 0.94-0.95] [P = 0.10]). In patients with cancer, the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms maintained very high safety but had lower efficacy, with twice the number of patients remaining in the observe zone. Similar findings were obtained in the external validation cohort. Conclusions Patients with cancer have a substantially higher prevalence of AMI as the cause of chest pain. Length of ED stay and hospitalization rates are increased. The diagnostic performance of hs-cTnT and the efficacy of both the European Society of Cardiology 0/1-hour hs-cTnT and hs-cTnI algorithms is reduced. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
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Affiliation(s)
- Paolo Bima
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Bernhard Okamura
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Tamar S. Muench-Gerber
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Alessandra Sanzone
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Daria Skolozubova
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Djurdjevic
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiology Department, Herzzentrum Leipzig, Leipzig, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - Oscar Miro
- Emergency Department, Hospital Clinic, Barcelona, Spain
| | | | | | - Michael Christ
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
| | - Dagmar Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Evangelos Giannitsis
- Department of Medicine III, University Hospital Heidelberger, Heidelberg, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
| | - APACE and TRAPID-AMI Investigators
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- GREAT Network, Rome, Italy
- Department of Medical Sciences, University of Torino, Torino, Italy
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- Cardiology Department, Herzzentrum Leipzig, Leipzig, Germany
- Emergency Department, Hospital Clinic, Barcelona, Spain
- Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
- Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Medicine III, University Hospital Heidelberger, Heidelberg, Germany
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