From the Guidelines
Interventional cardiology in cancer patients requires a highly individualized approach, prioritizing cardiovascular treatment while considering the unique aspects of ongoing cancer care, as emphasized by the American Society of Clinical Oncology clinical practice guideline 1. When managing patients with cancer who are undergoing interventional cardiology procedures, it is crucial to assess their risk for cardiac dysfunction based on their cancer treatment and pre-existing cardiovascular risk factors, as outlined in the guideline 1. This includes considering the type and dose of chemotherapy, such as high-dose anthracycline or trastuzumab, and the presence of cardiovascular risk factors like hypertension, diabetes, or compromised cardiac function.
Key Considerations
- Patients with cancer often have an increased risk of cardiovascular complications due to both the malignancy itself and cardiotoxic cancer therapies, highlighting the need for close collaboration between cardiologists and oncologists 1.
- Drug-eluting stents are preferred over bare metal stents to reduce the risk of restenosis in cancer patients undergoing percutaneous coronary interventions (PCIs) 1.
- Dual antiplatelet therapy should be tailored to the individual patient's risk factors, including a shortened duration of 3-6 months to accommodate potential cancer surgeries or procedures, and modified or temporarily discontinued in patients with thrombocytopenia (platelet count <50,000/μL) 1.
- Radial artery access is preferred over femoral access to minimize bleeding complications, particularly in patients with coagulopathies or at high risk of bleeding 1.
- Comprehensive assessment and close monitoring are essential to optimize outcomes, including evaluating bleeding risk, thrombocytopenia, anemia, and expected cancer treatment course, as well as monitoring for cardiotoxicity from cancer treatments 1.
Multidisciplinary Approach
A multidisciplinary approach, involving close collaboration between cardiologists, oncologists, and other healthcare professionals, is crucial to coordinate timing of interventions around chemotherapy cycles, manage antiplatelet therapy during periods of increased bleeding risk, and monitor for cardiotoxicity from cancer treatments, ultimately improving morbidity, mortality, and quality of life outcomes for patients with cancer undergoing interventional cardiology procedures 1.
From the Research
Considerations for Interventional Cardiology in Patients with Cancer
- Patients with cancer undergoing percutaneous coronary intervention (PCI) experience higher risk of both ischemic and bleeding events 2
- The use of potent P2Y12 inhibitors (P2Y12i; prasugrel and ticagrelor) in cancer patients undergoing PCI is associated with similar bleeding risk and lower incidence of ischemic events compared to clopidogrel 2
- Factors associated with potent P2Y12i use in cancer patients include acute coronary syndrome presentation and lesion length, while clopidogrel use is associated with active cancer status, thrombocytopenia, older age, and femoral access 2
- Coronary angiography and percutaneous coronary intervention can be performed safely in cancer patients with chronic thrombocytopenia, with aspirin therapy and dual antiplatelet therapy showing a trend of improved overall survival 3
- Comorbidities specific to the cardio-oncology population contribute to the challenges in the interventional management of patients with cancer and cardiovascular disease (CVD) 4
- Endovascular procedures may represent a valid option in patients with cancer with a range of CVDs due to their minimally invasive nature 4
- Cancer patients have unique psychological needs and require a humane approach to managing their cardiac problems, with practical suggestions on how to best communicate with cancer patients in different phases of oncology care 5
- Advances in cancer treatments have improved clinical outcomes, but are associated with high rates of short- and long-term cardiovascular toxicities, requiring a multidisciplinary approach to care 6
- The development of the cardio-oncology subspecialty aims to provide optimal care for patients with cancer and cancer survivors, with research needed to better define strategies for early identification, follow-up, and management of cancer therapy-related cardiotoxicities 6