A Concomitant Cancer Diagnosis Is Associated With Poor Cardiovascular Outcomes Among Acute Myocardial Infarction Patients

Role and recent progress of P2Y12 receptor in cancer development

P2Y12 receptor (P2Y12R) is an adenosine-activated G protein-coupled receptor (GPCR) that plays a central role in platelet function, hemostasis, and thrombosis. P2Y12R activation can promote platelet aggregation and adhesion to cancer cells, promote tumor angiogenesis, and affect the tumor immune microenvironment (TIME) and tumor drug resistance, which is conducive to the progression of cancers. Meanwhile, P2Y12R inhibitors can inhibit this effect, suggesting that P2Y12R may be a potential therapeutic target for cancer. P2Y12R is involved in cancer development and metastasis, while P2Y12R inhibitors are effective in inhibiting cancer. However, a new study suggests that long-term use of P2Y12R inhibitors may increase the risk of cancer and the mechanism remains to be explored. In this paper, we reviewed the structural and functional characteristics of P2Y12R and its role in cancer. We explored the role of P2Y12R inhibitors in different tumors and the latest advances by summarizing the basic and clinical studies on the effects of P2Y12R inhibitors on tumors.

Risk of mortality and other adverse outcomes from myocardial infarction in cancer survivors: a meta-analysis

BACKGROUND AND PURPOSE

Myocardial infarction (MI) is an acute cardiovascular disease that can increase prognosis risks such as arrhythmia, heart failure, shock, etc. Studies have found that even well-controlled coexistence of cancer could affect the quality of life in MI patients. However, the prognostic impact of cancer on MI patients is controversial. This meta-analysis aimed to assess the influence of cancer on the risk of future all-cause mortality, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) in MI patients.

METHODS

The Embase, PubMed, and Cochrane libraries were searched for cohort studies and case-control from inception to May 2022. The quality of the included pieces of literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analyses were performed using Stata statistical software versions 14.0 and 16.0. Sensitivity analysis assessed the robustness of the results, and funnel plots and Egger's tests evaluated the publication bias.

RESULTS

A total of 10 studies were included, covering 7,210,530 participants. Summary analyses show that compared with non-cancer patients, cancer increased the risk of long-term all-cause mortality in MI patients (HR 1.58, 95% CI 1.36-1.84, I² = 94.2%). However, no significant difference was observed in the risk of cardiovascular mortality (HR 1.18, 95% CI 0.91-1.54, I² = 52.4%) or MACCE (HR 1.26, 95% CI 0.94-1.70, I² = 99.2%). In subgroup analysis, cancer was associated with the risk of recurrent MI (HR 1.18, 95% CI 1.03-1.34, I² = 88.8%), and major bleeding (HR 2.01, 95% CI 1.60-2.52, I² = 93.1%), with no significant difference in the risk of stroke (HR 1.11, 95% CI 0.97-1.27, I² = 85.1%).

CONCLUSION

This meta-analysis shows that cancer increases the risk of all-cause mortality, recurrent MI, and major bleeding in MI patients but is not associated with the risk of cardiovascular death. Therefore, comprehensive multidisciplinary management and monitoring of potential future adverse events in MI patients with cancer are needed.

SYSTEMATIC REVIEW REGISTRATION

The meta-analysis was registered in the International Register of Prospective Systematic Reviews (NO. CRD42022332775).

Cardiogenic shock among cancer patients

Sophisticated cancer treatments, cardiovascular risk factors, and aging trigger acute cardiovascular diseases in an increasing number of cancer patients. Among acute cardiovascular diseases, cancer treatment, as well as the cancer disease itself, may induce a cardiogenic shock. Although increasing, these cardiogenic shocks are still relatively limited, and their management is a matter of debate in cancer patients. Etiologies that cause cardiogenic shock are slightly different from those of non-cancer patients, and management has some specific features always requiring a multidisciplinary approach. Recent guidelines and extensive data from the scientific literature can provide useful guidance for the management of these critical patients. Even if no etiologic therapy is available, maximal intensive supportive measures can often be justified, as most of these cardiogenic shocks are potentially reversible. In this review, we address the major etiologies that can lead to cardiogenic shock in cancer patients and discuss issues related to its management.