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Review
. 2023 Jul 11;5(4):415-430.
doi: 10.1016/j.jaccao.2023.05.008. eCollection 2023 Aug.

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review

Darryl P Leong  1   2 , Filipe Cirne  2 , Nazanin Aghel  2 , Rocio C Baro Vila  2 , Germano D Cavalli  2 , Peter M Ellis  3 , Jeff S Healey  1   2 , Richard Whitlock  1   4 , Dina Khalaf  3 , Hira Mian  3 , Sanjit S Jolly  1   2 , Shamir R Mehta  1   2 , Susan Dent  5
Affiliations
Review

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review

Darryl P Leong et al. JACC CardioOncol. .

Abstract

Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.

Keywords: cancer; cardio-oncology; dual antiplatelet therapy; implantable cardioverter-defibrillator; revascularization; survivorship.

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Conflict of interest statement

Dr Leong has received speaking or consulting fees from Abbvie, Ferring Pharmaceuticals, Myovant Sciences, Janssen, Novartis, Tolmar, AstraZeneca, and Paladin; and has received a research grant from Novartis. Dr Ellis has received speaking or advisory board fees from AstraZeneca, Pfizer, Takeda, Lilly, BMS, Merck, Sanofi, Janssen, Jazz, and Novartis. Dr Healey has received speaking or consulting fees from Bayer, BMS/Pfizer, Boston Scientific, and Servier; and has received research grants from Medtronic, Boston Scientific, BMS/Pfizer, and Novartis. Dr Khalaf has received consulting fees or honoraria from Paladin, Pfizer, Astellas, Jazz, and Taiho. Dr Jolly has received honoraria from Penumbra and Teleflex; and has received institutional grants from Boston Scientific. Dr Dent has received honoraria from AstraZeneca and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
The Continuum in Decision Making for the Role of Invasive Cardiac Intervention in Active, Advanced Cancers There is a continuum in the decision making with respect to the role of interventions in patients with advanced cancers. Cardiac interventions with earlier or larger benefits should be implemented in most patients, and interventions with delayed or modest benefit should only be offered in select cases. Recommended indicates that the intervention is advisable for most of the given cancer cases. Select cases indicates that the decision to offer the intervention needs to be highly individualized for the given cancer cases. Not recommended indicates that the intervention is generally not advisable for the given cancer cases. In all instances, individual circumstances need to be incorporated into the decision-making process as the evidence to guide these recommendations is limited. CRT-P = cardiac resynchronization therapy–pacemaker; ICD = implantable cardioverter-defibrillator; NSTEACS = non–ST-segment elevation acute coronary syndrome; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction; TAVR = transcatheter aortic valve replacement.
Figure 1
Figure 1
Factors Influencing the Decision to Undertake Invasive Cardiac Interventions Decision making should incorporate information on the cancer and cardiovascular disease (CVD), comorbidities, patient goals of care, interruption of cancer therapies, thrombocytopenia, and the elevated risk of procedural complications.
See this image and copyright information in PMC

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