Acute coronary syndrome in patients undergoing anticancer therapies: A single-center, controlled case study

Anticancer therapies can be accompanied by cardiovascular complications, including acute coronary syndrome (ACS). In turn, the presence of cancer can influence therapeutic decisions if ACS occurs.

The aim of the study was to analyze ACS treatment in patients with cancer.

The study consisted of a retrospective analysis based on the medical records of patients who were admitted due to ACS, with cancer diagnoses. Patients currently undergoing cancer treatment or having treatment which ended up to 6 months before the ACS were included. They were compared to a control group consisting of consecutive patients admitted for ACS during the same period, but who did not have a diagnosis of cancer; they were matched with the experimental group in terms of age, gender and clinical type of ACS.

Thirty-two consecutive cancer patients (70 ±9 years; 53% men) met the inclusion criteria. In 22 of them (69%), ACS occurred during their cancer treatment, and in 10 (31%), it presented within 6 months of completing cancer treatment. Upon hospital admission, 19 (59%) cancer patients complained of dyspnea and 7 of typical angina, while in the control group 28, (87%) and 4 (13%) reported such symptoms, respectively.The clinical manifestation of ACS was NSTEMI in 16 patients (50%), UA in 10 (31%) and STEMI in 5 (15.6%). Coronary angiography was done in 25 (78%) of the cancer patients and in all members of the control group. Percutaneous coronary angioplasty (PCA) was performed in 17 (53%) and 23 (72%) of the patients from the respective groups. The median time to percutaneous coronary intervention (PCI) was 10 h (30 min-10 days) among the cancer patients and 7.5 h among the control group (30 min-6 days). There were no PCI-related complications or severe bleeding in both groups. In-hospital mortality was 6.25% in the cancer group and there were no reported hospital deaths in the control group.

Dyspnea is the most common symptom of ACS in cancer patients who are treated invasively too rarely: the presence of cancer and active anticancer treatment should not limit the management of ACS in accordance with current guidelines.