Lucà Fabiana, Parrini Iris, Abrignani Maurizio Giuseppe, Rao Carmelo Massimiliano, Piccioni Laura, Di Fusco Stefania Angela, Ceravolo Roberto, Bisceglia Irma, Riccio Carmine, Gelsomino Sandro, Colivicchi Furio, Gulizia Michele Massimo
Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy.
Cardiology Department, Ospedale Mauriziano Umberto I, 10128 Torino, Italy.
J Clin Med. 2022 Mar 24;11(7):1792. doi: 10.3390/jcm11071792.
Cancer patients have an increased risk of cardiovascular disease and, notably, a significant prevalence of acute coronary syndrome (ACS). It has been shown that an elevated presence of cardiovascular risk factors in this setting leads to an interaction between these two conditions, influencing their therapeutic strategies and contributing to higher mortality. Nonetheless, cancer patients have generally not been evaluated in ACS trials, so that the treatment in these cases is still not fully known. We reviewed the current literature and discussed the best management for these very high-risk patients. The treatment strategy must be tailored based on the cancer type and stage, balancing thrombotic and bleeding risks. When the prognosis is longer than six months, especially if a clinical instability coexists, patients with ACS and cancer should be referred for percutaneous coronary intervention (PCI) as soon as possible. Moreover, an invasive strategy should be preferred in STEMI patients as well as in NSTEMI patients who are considered as high risk. On the contrary, in clinically stable NSTEMI patients, a conservative non-invasive strategy could be adopted, especially in cases of a poor life expectancy and/or of high risk of bleeding. Drug-Eluting-Stents (DES) should be the first choice if an invasive strategy is adopted. Conservative therapy could instead be considered in cancer patients with more stable CAD at an increased risk of major bleeding complications. However, the duration of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended, but it should be as short as possible, whereas triple antithrombotic therapy is non-advised because it significantly increases the risk of bleeding. ACS management among cancer patients should be based on an accurate evaluation of the risk of thrombosis and bleeding. Future studies focused on choosing optimal strategies in tumor patients with ACS should be performed to treat this subset of patients better.
癌症患者患心血管疾病的风险增加，尤其是急性冠状动脉综合征（ACS）的患病率显著升高。研究表明，在这种情况下心血管危险因素的升高会导致这两种疾病之间的相互作用，影响其治疗策略并导致更高的死亡率。然而，癌症患者一般未纳入ACS试验进行评估，因此这些病例的治疗方法仍不完全清楚。我们回顾了当前的文献，并讨论了这些高危患者的最佳管理方法。治疗策略必须根据癌症类型和分期进行调整，平衡血栓形成和出血风险。当预后超过6个月，特别是如果同时存在临床不稳定情况时，ACS合并癌症的患者应尽快转诊进行经皮冠状动脉介入治疗（PCI）。此外，对于ST段抬高型心肌梗死（STEMI）患者以及被认为是高危的非ST段抬高型心肌梗死（NSTEMI）患者，应优先采用侵入性策略。相反，对于临床稳定的NSTEMI患者，可以采用保守的非侵入性策略，特别是在预期寿命较短和/或出血风险较高的情况下。如果采用侵入性策略，药物洗脱支架（DES）应作为首选。对于患有更稳定冠心病且大出血并发症风险增加的癌症患者，可考虑采用保守治疗。然而，建议使用阿司匹林和氯吡格雷进行双联抗血小板治疗（DAPT），但疗程应尽可能短，不建议使用三联抗栓治疗，因为它会显著增加出血风险。癌症患者的ACS管理应基于对血栓形成和出血风险的准确评估。未来应开展针对ACS肿瘤患者选择最佳策略的研究，以更好地治疗这部分患者。
