Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jul 2;14(4):34-41.
doi: 10.55729/2000-9666.1369. eCollection 2024.

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

Fahad Waqar  1 , Ayesha Sultan  1 , Romeet R Bathija  1 , Amin Mehmoodi  2 , Jahanzeb Malik  1
Affiliations
Review

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

Fahad Waqar et al. J Community Hosp Intern Med Perspect. .

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest.

Figures

Fig. 1
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
Fig. 2
Factors influencing the decision for invasive procedures in cancer.
See this image and copyright information in PMC

References

    1. Freeman WK, Gibbons RJ. Perioperative cardiovascular assessment of patients undergoing noncardiac surgery. Mayo Clin Proc. 2009;84(1):79–90. doi: 10.1016/S0025-6196(11)60812-4. - DOI - PMC - PubMed
    1. Shanmugasundaram M. Percutaneous coronary intervention in elderly patients: is it beneficial? Tex Heart Inst J. 2011;38(4):398–403. - PMC - PubMed
    1. Djulbegovic B, Kumar A, Soares HP, et al. Treatment success in cancer: new cancer treatment successes identified in phase 3 randomized controlled trials conducted by the National Cancer Institute-sponsored cooperative oncology groups, 1955 to 2006. Arch Intern Med. 2008 Mar 24;168(6):632–642. doi: 10.1001/archinte.168.6.632. - DOI - PMC - PubMed
    1. Shamoo AE, Resnik DB.Strategies to minimize risks and exploitation in phase one trials on healthy subjects Am J Bioeth 2006. May–Jun63W1–W13. 10.1080/15265160600686281 - DOI - PMC - PubMed
    1. Debela DT, Muzazu SG, Heraro KD, et al. New approaches and procedures for cancer treatment: current perspectives. SAGE Open Med. 2021 Aug 12;9:20503121211034366. doi: 10.1177/20503121211034366. - DOI - PMC - PubMed

LinkOut - more resources