Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stag...

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Main Authors: Valentina Milazzo, Nicola Cosentino, Jeness Campodonico, Claudia Lucci, Daniela Cardinale, Carlo M. Cipolla, Giancarlo Marenzi
Format: Article
Language:English
Published: MDPI AG 2020-11-01
Series:Journal of Clinical Medicine
Subjects:
Online Access:https://www.mdpi.com/2077-0383/9/11/3642
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spelling doaj-a68db83761c340bb97df664729fca8ff2020-11-25T04:07:03ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-0193642364210.3390/jcm9113642Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with CancerValentina Milazzo0Nicola Cosentino1Jeness Campodonico2Claudia Lucci3Daniela Cardinale4Carlo M. Cipolla5Giancarlo Marenzi6Centro Cardiologico Monzino IRCCS, 20138 Milan, ItalyCentro Cardiologico Monzino IRCCS, 20138 Milan, ItalyCentro Cardiologico Monzino IRCCS, 20138 Milan, ItalyCentro Cardiologico Monzino IRCCS, 20138 Milan, ItalyCardioncology Unit, European Institute of Oncology, IRCCS, 20141 Milan, ItalyCardiology Division, European Institute of Oncology, IRCCS, 20141 Milan, ItalyCentro Cardiologico Monzino IRCCS, 20138 Milan, ItalyPatients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.https://www.mdpi.com/2077-0383/9/11/3642acute coronary syndromecancerchemotherapyprognosis
collection DOAJ
language English
format Article
sources DOAJ
author Valentina Milazzo
Nicola Cosentino
Jeness Campodonico
Claudia Lucci
Daniela Cardinale
Carlo M. Cipolla
Giancarlo Marenzi
spellingShingle Valentina Milazzo
Nicola Cosentino
Jeness Campodonico
Claudia Lucci
Daniela Cardinale
Carlo M. Cipolla
Giancarlo Marenzi
Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
Journal of Clinical Medicine
acute coronary syndrome
cancer
chemotherapy
prognosis
author_facet Valentina Milazzo
Nicola Cosentino
Jeness Campodonico
Claudia Lucci
Daniela Cardinale
Carlo M. Cipolla
Giancarlo Marenzi
author_sort Valentina Milazzo
title Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
title_short Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
title_full Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
title_fullStr Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
title_full_unstemmed Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer
title_sort characteristics, management, and outcomes of acute coronary syndrome patients with cancer
publisher MDPI AG
series Journal of Clinical Medicine
issn 2077-0383
publishDate 2020-11-01
description Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.
topic acute coronary syndrome
cancer
chemotherapy
prognosis
url https://www.mdpi.com/2077-0383/9/11/3642
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