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[Emergency coronary angioplasty following treatment with 5-fluorouracil]
F Prunier1, J Monségu, G Coutant
1Service de pathologie cardiovasculaire, hôpital d'instruction des armées du Val-de-Grâce, Paris, France.
Introduction:
The incidence of cardiac toxicity due to 5-fluorouracil (5-FU) ranges from 1.2 to 18%. Most complications occur at the time of the first cure. Their mechanisms have not yet been clearly defined.
Exegesis:
The authors report a case of unstable angina induced by 5-FU. A coronary angioplasty was performed on a previously ignored coronary lesion.
Conclusion:
Recent studies support the hypothesis that 5-FU has endothelial toxicity resulting in thrombogenic effect and release of vasoactive substances. Unstable angina pectoris would be related to plaque rupture caused by 5-FU. Patients with previous history of coronary disease are at significantly increased risk for 5-FU-induced cardiotoxicity. They probably would benefit from continuous electrocardiographic monitoring. Rechallenge with 5-FU after cardiotoxicity problems should include only those patients for whom there is no alternative treatment.