Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cardiovascular disease in patients with cancer. Intervention: Percutaneous cardiovascular interventions.

Q: What does this research mean for the field?

Percutaneous cardiovascular interventions should not be withheld in patients with cancer, as evidence indicates they derive similar clinical benefits compared to patients without cancer. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Orly Leiva; Uazman Alam; Isaac Bohart; Eric H. Yang

doi:10.1007/s11864-023-01110-2

June 10, 2023Current Treatment Options in OncologyOpen Access

Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

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Why the study?

Patients with cancer are at risk of cardiovascular disease, but trials of percutaneous catheter-based interventions often exclude them, leading to undertreatment despite potential benefit.

Key Points

To review the shared pathophysiology between cancer and cardiovascular disease and assess the outcomes and considerations of percutaneous cardiovascular procedures in cancer patients.
Narrative review synthesizing retrospective cohorts, registry data, and clinical trial evidence regarding percutaneous coronary intervention, transcatheter aortic valve replacement, and left atrial appendage occlusion in patients with cancer.
Evaluation of procedurally related outcomes, bleeding risks, and procedural underutilization across oncology populations.
Among 6.5 million patients hospitalized for acute myocardial infarction, cancer patients experienced higher in-hospital mortality (11.1% vs 5.7%) and bleeding (18.4% vs 8.8%) and were less likely to receive percutaneous coronary intervention (27.1% vs 43.9%).
In a cohort of over 6 million inpatient percutaneous coronary interventions, cancer was linked to heightened risks of in-hospital mortality (lung cancer OR 2.81, 95% CI 2.37–3.34) and bleeding (colon cancer OR 3.65, 95% CI 3.07–4.35), yet cancer patients treated for ST-elevation myocardial infarction achieved mortality reductions comparable to patients without cancer.
In 477 patients undergoing transcatheter aortic valve replacement, prior cancer was not associated with differences in all-cause mortality across a mean follow-up of 851 days, though cancer therapy within 12 months increased death risk (HR 4.38, 95% CI 1.14–16.77).

Structured PICO

P

Population

Patients with cancer and cardiovascular disease, including atherosclerotic heart disease, valvular heart disease, and atrial fibrillation.

I

Intervention

Percutaneous catheter-based treatments (including PCI, transcatheter valve replacement/repair, ablation, and left atrial appendage occlusion devices).

Limitations

Patients with cancer are historically excluded from device and intervention trials.
Paucity of outcome and safety data for several percutaneous cardiac procedures in cancer patients.

Implication

Percutaneous interventions for cardiovascular disease should not be withheld in patients with cancer, as evidence suggests they derive similar benefits to non-cancer patients.

Abstract

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Discussion

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Cite This Study

Leiva et al. (2023) conducted a review in Cardiovascular disease in patients with cancer. Percutaneous cardiovascular interventions was evaluated.

synapsesocial.com/papers/6a7164e5fe4101aa97e08e63 https://doi.org/10.1007/s11864-023-01110-2

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Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Interventional Cardio-Oncology: Unique Challenges and Considerations in a High-Risk Population

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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