Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, 7200 Cambridge St., Houston, TX, 77030, USA.
Curr Cardiol Rep. 2020 Oct 10;22(12):159. doi: 10.1007/s11886-020-01409-8.
Cancer patients with acute coronary syndrome (ACS) have significantly greater mortality compared with non-cancer patients. This risk is partly directly attributable to the malignancy; however these patients are frequently undertreated with respect to guideline recommended treatments for ACS due to higher bleeding risks from anemia and thrombocytopenia. Due to exclusion from large clinical trials, there is a paucity of data regarding how to best treat these complex and high-risk patients. PURPOSE OF REVIEW: To review the literature and identify risk factors among cancer patients associated with poor outcomes, pathophysiology of chemotherapy and radiation therapy contributing to accelerated coronary artery disease and ACS, and data regarding outcomes with medical therapy and invasive management. RECENT FINDINGS: Despite an elevated bleeding risk, many cancer patients may benefit from ACC/AHA guideline-directed management for ACS including aspirin, P2Y inhibitor, statin, and beta-blocker therapies. Cancer patients with ACS are a uniquely vulnerable population who are often undertreated, and with improved cancer treatments, this population is expected to increase. These patients should be included in future randomized trials to better understand how to balance the complexities of increased bleeding and thrombosis risks during ACS.
癌症合并急性冠状动脉综合征（ACS）患者的死亡率明显高于非癌症患者。这种风险部分是直接归因于恶性肿瘤；然而，由于贫血和血小板减少症导致的出血风险较高，这些患者在 ACS 指南推荐的治疗方面往往治疗不足。由于被排除在大型临床试验之外，关于如何最好地治疗这些复杂和高危患者的数据很少。
综述目的： 回顾文献并确定与不良预后相关的癌症患者的风险因素、化疗和放疗导致加速冠状动脉疾病和 ACS 的病理生理学，以及关于药物治疗和介入管理结果的数据。
最新发现：尽管出血风险增加，但许多癌症患者可能受益于 ACC/AHA 指南指导的 ACS 管理，包括阿司匹林、P2Y 抑制剂、他汀类药物和β受体阻滞剂治疗。ACS 合并癌症的患者是一个特别脆弱的人群，他们往往治疗不足，随着癌症治疗的改善，预计这一人群将会增加。这些患者应纳入未来的随机试验中，以更好地了解如何平衡 ACS 期间增加的出血和血栓形成风险的复杂性。
