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Ameri P, Bertero E, Lombardi M, Porto I, Canepa M, Nohria A, Vergallo R, Lyon AR, López-Fernández T. Ischaemic heart disease in patients with cancer. Eur Heart J 2024; 45:1209-1223. [PMID: 38323638 DOI: 10.1093/eurheartj/ehae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Edoardo Bertero
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Marco Lombardi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rocco Vergallo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Quirón Pozuelo University Hospital, Madrid, Spain
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Nardi Agmon I, Rahat O, Beigel R, Ovdat T, Habib M, Tzuman O, Bushari LI, Kornowski R, Orvin K. Short- and long-term outcomes of patients with active cancer presenting with an acute coronary syndrome. Clin Res Cardiol 2024:10.1007/s00392-024-02438-x. [PMID: 38507056 DOI: 10.1007/s00392-024-02438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Management of cancer patients presenting with an acute coronary syndrome (ACS) may be challenging. In this study, we sought to examine whether and how a concomitant diagnosis of active cancer affects patients' management and outcomes following an event of ACS. METHODS We used a retrospective cohort data analysis of patients from the Acute Coronary Syndrome Israeli Survey (ACSIS) carried out between the years 2016-2021 to compare patients with and without a concomitant diagnosis of active cancer. RESULTS Of 4913 patients who presented with an ACS, 90 (1.8%) patients had a concomitant active cancer. Cancer patients were older, with a higher prevalence of hypertension and chronic renal failure. The rate of ST-elevation myocardial infarction (STEMI) was similar (40%) between both groups. Cancer patients were less likely to undergo coronary angiography during hospitalization; but once it was performed, the rate of percutaneous coronary intervention was similar. The presence of cancer during an ACS was associated with an increased short- and long-term mortality. In a multivariate analysis, the risk for 1-year mortality remained significantly higher in cancer patient (HR 2.72, 95% CI 1.74-4.24, p < 0.001), and was most prominent in patients presenting with STEMI (HR 5.00, 95% CI 2.40-10.39, p < 0.001). Short- and long-term death rates were also higher in cancer patients after a propensity score matching and adjustment for comorbidities other than cancer. CONCLUSION Despite significant advances in oncologic and cardiac care, the presence of active cancer in patients with an ACS is still associated with significantly increased risk for 1-year mortality.
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Affiliation(s)
- Inbar Nardi Agmon
- Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ori Rahat
- Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Beigel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel
| | - Tal Ovdat
- Department of Cardiology, Sheba Medical Center, Ramat Gan, Israel
| | - Manhal Habib
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Oran Tzuman
- Shamir Medical Center, Cardio-Oncology Clinic, The Cardiovascular Division, Be'er Ya'akov, Israel
| | | | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Nobre Menezes M, Tavares da Silva M, Magalhães A, Melica B, Toste JC, Calé R, Almeida M, Fiuza M, Infante de Oliveira E. Interventional cardiology in cancer patients: A position paper from the Portuguese Cardiovascular Intervention Association and the Portuguese Cardio-Oncology Study Group of the Portuguese Society of Cardiology. Rev Port Cardiol 2024; 43:35-48. [PMID: 37482119 DOI: 10.1016/j.repc.2023.04.013] [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: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 07/25/2023] Open
Abstract
The field of Cardio-Oncology has grown significantly, especially during the last decade. While awareness of cardiotoxicity due to cancer disease and/or therapies has greatly increased, much of the attention has focused on myocardial systolic disfunction and heart failure. However, coronary and structural heart disease are also a common issue in cancer patients and encompass the full spectrum of cardiotoxicity. While invasive percutaneous or surgical intervention, either is often needed or considered in cancer patients, limited evidence or guidelines are available for dealing with coronary or structural heart disease. The Society for Cardiovascular Angiography and Interventions consensus document published in 2016 is the most comprehensive document regarding this particular issue, but relevant evidence has emerged since, which render some of its considerations outdated. In addition to that, the recent 2022 ESC Guidelines on Cardio-Oncology only briefly discuss this topic. As a result, the Portuguese Association of Cardiovascular Intervention and the Cardio-Oncology Study Group of the Portuguese Society of Cardiology have partnered to produce a position paper to address the issue of cardiac intervention in cancer patients, focusing on percutaneous techniques. A brief review of available evidence is provided, followed by practical considerations. These are based both on the literature as well as accumulated experience with these types of patients, as the authors are either interventional cardiologists, cardiologists with experience in the field of Cardio-Oncology, or both.
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Affiliation(s)
- Miguel Nobre Menezes
- Unidade de Cardiologia de Intervenção Joaquim Oliveira, Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Grupo de Estudos de Cardio-Oncologia, Sociedade Portuguesa de Cardiologia, Portugal; Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal.
| | - Marta Tavares da Silva
- Grupo de Estudos de Cardio-Oncologia, Sociedade Portuguesa de Cardiologia, Portugal; Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal; Serviço de Cardiologia, Centro Hospitalar e Universitário de São João, Porto, Portugal; UnIC@RISE, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Andreia Magalhães
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Grupo de Estudos de Cardio-Oncologia, Sociedade Portuguesa de Cardiologia, Portugal; Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Portugal
| | - Bruno Melica
- Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal; Cardiology Department, Vila Nova de Gaia Hospital, Vila Nova de Gaia, Portugal
| | - Júlia Cristina Toste
- Grupo de Estudos de Cardio-Oncologia, Sociedade Portuguesa de Cardiologia, Portugal; Department of Cardiology, Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Rita Calé
- Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal; Cardiology Department, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Manuel Almeida
- Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal; Unidade de Intervenção Cardiovascular I Centro Hospitalar de Lisboa Ocidental e CHRC, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Manuela Fiuza
- Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Grupo de Estudos de Cardio-Oncologia, Sociedade Portuguesa de Cardiologia, Portugal; Serviço de Cardiologia, Departamento de Coração e Vasos, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, Portugal
| | - Eduardo Infante de Oliveira
- Associação Portuguesa de Intervenção Cardiovascular, Sociedade Portuguesa de Cardiologia, Portugal; Hospital Lusíadas Lisboa, Portugal; Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
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Acute myocardial infarction and cardiac arrest and cancer, oh my! CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 38:52-53. [DOI: 10.1016/j.carrev.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
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