Inohara Taku, Endo Ayaka, Melloni Chiara
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Front Cardiovasc Med. 2019 May 17;6:57. doi: 10.3389/fcvm.2019.00057. eCollection 2019.
Patients with cancer face a high short-term risk of arterial thromboembolism. One of the most fatal manifestations of arterial thromboembolism is myocardial infarction (MI), and patients with cancer face a 3-fold greater risk of MI than patients without cancer. The individual risk for arterial thrombotic events in patients with cancer is determined by the complex interaction of baseline cardiovascular risk factors, cancer type and stage, chemotherapeutic regimen, and other general contributing factors for thrombosis. Managing MI 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. When patients with cancer present with MI, a limited proportion are treated with guideline-recommended therapy, such as antiplatelet therapy or invasive revascularization. Despite the limited evidence, existing reports consistently suggest similar clinical benefits of guideline-recommended therapy when administered to patients with cancer presenting with MI. In this review, we briefly summarize the available evidence, clinical challenges, and future perspectives on simultaneous management of MI and cancer, with a focus on invasive strategy.
癌症患者面临较高的动脉血栓栓塞短期风险。动脉血栓栓塞最致命的表现之一是心肌梗死（MI），癌症患者发生MI的风险是无癌症患者的3倍。癌症患者发生动脉血栓事件的个体风险由基线心血管危险因素、癌症类型和分期、化疗方案以及其他导致血栓形成的一般因素的复杂相互作用决定。治疗癌症患者的MI是一项临床挑战，尤其是因为癌症独特的病理生理学，使得在这一特定患者群体中难以平衡血栓形成和出血风险。当癌症患者发生MI时，只有有限比例的患者接受指南推荐的治疗，如抗血小板治疗或侵入性血运重建。尽管证据有限，但现有报告一致表明，对发生MI的癌症患者进行指南推荐的治疗具有相似的临床益处。在本综述中，我们简要总结了关于同时管理MI和癌症的现有证据、临床挑战以及未来展望，重点关注侵入性策略。
