Cardiovascular Interventions in Patients With Active and Advanced Malignancy: An Updated Review

Abstract

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.

Keywords: Active advanced malignancies; Cardiovascular disease; Invasive cardiac interventions; Shared decision-making; Survival expectations.

Fig. 1

Specific considerations for invasive procedures in cancer. Legend: DAPT (dual antiplatelet); CABG (coronary artery bypass graft); PCI (percutaneous coronary intervention); TAVR (transcutaneous aortic valve replacement); GDMT (guideline directed medical therapy); ICD (implantable cardioverter defibrillator).

Fig. 2

Factors influencing the decision for invasive procedures in cancer.