Waqar Fahad, Sultan Ayesha, Bathija Romeet R, Mehmoodi Amin, Malik Jahanzeb
Department of Cardiovascular Analytics Group, Islamabad, Pakistan.
Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan.
J Community Hosp Intern Med Perspect. 2024 Jul 2;14(4):34-41. doi: 10.55729/2000-9666.1369. eCollection 2024.
In the context of active, advanced malignancies, the recommendation for invasive cardiac interventions is grounded primarily in evidence from trials focused on specific cardiovascular conditions. However, the inclusion of individuals with advanced malignancies in these trials has historically been limited, and the intricate interplay between cancer and cardiovascular disease poses unique challenges for treatment decisions. In this comprehensive review, we delve into the complex landscape of invasive cardiac interventions and their applicability in patients with active, advanced cancer. Our analysis encompasses a range of cardiovascular scenarios, including ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. We critically examine the available data and evidence, shedding light on the benefits and potential risks associated with invasive cardiac procedures in the presence of advanced malignancies. Acknowledging the competing risk of mortality posed by advanced cancers, we delve into the contemporary survival expectations for patients across various types of active, advanced malignancies. By synthesizing current literature and exploring cardiovascular interventions within these populations, we aim to establish a well-informed framework. Our ultimate goal is to provide clinicians with a rational guide for making nuanced clinical recommendations regarding the utilization of invasive cardiac interventions in the challenging context of active, advanced cancer.
在活跃的晚期恶性肿瘤背景下，侵入性心脏干预的建议主要基于针对特定心血管疾病的试验证据。然而，历史上这些试验纳入晚期恶性肿瘤患者的情况有限，并且癌症与心血管疾病之间复杂的相互作用给治疗决策带来了独特挑战。在这篇全面综述中，我们深入探讨侵入性心脏干预的复杂情况及其在活跃的晚期癌症患者中的适用性。我们的分析涵盖一系列心血管情况，包括ST段抬高型心肌梗死、非ST段抬高型急性冠状动脉综合征、多支血管冠状动脉疾病、严重症状性主动脉瓣狭窄和心肌病。我们严格审查现有数据和证据，阐明在存在晚期恶性肿瘤的情况下侵入性心脏手术的益处和潜在风险。认识到晚期癌症带来的相互竞争的死亡风险，我们深入研究各种活跃的晚期恶性肿瘤患者的当代生存预期。通过综合当前文献并探索这些人群中的心血管干预措施，我们旨在建立一个信息充分的框架。我们的最终目标是为临床医生提供一个合理的指南，以便在活跃的晚期癌症这一具有挑战性的背景下，就侵入性心脏干预的使用做出细致入微的临床建议。
