April 1, 1989Journal of Clinical Oncology
Continuous ambulatory ECG monitoring during fluorouracil therapy: a prospective study.
Why the study?
Does fluorouracil infusion increase the incidence of ischemic ST changes in patients with solid tumors?
Population
25 patients undergoing fluorouracil (5-FU) infusion for treatment of solid tumors
Comparison
Fluorouracil (5-FU) infusion vs Baseline period prior to fluorouracil infusion
Design
Cohort
Follow-up
98 +/- 9 hours during infusion
Authors
Discussion
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Implication
May warrant ECG monitoring during 5-FU in patients with CAD; leaves open whether surveillance improves outcomes in prospective trials.
Key Points
- To systematically assess the incidence of ischemic ST-segment changes using continuous ambulatory ECG monitoring in patients receiving fluorouracil chemotherapy.
- Prospective study of N=25 patients with solid tumors undergoing continuous ambulatory ECG monitoring for 23 ± 4 hours before and 98 ± 9 hours during fluorouracil (5-FU) infusion.
- Asymptomatic ST-segment deviation (≥1 mm) increased from 24% (6 of 25 patients) before 5-FU to 68% (17 of 25 patients) during infusion (P < .002), whereas clinical angina occurred in only one patient.
- The frequency of ischemic episodes rose from 0.05 ± 0.02 to 0.13 ± 0.03 per patient per hour (P < .001) and duration increased from 0.6 ± 0.3 to 1.9 ± 0.5 minutes per patient per hour (P < .01), with two sudden deaths observed at treatment conclusion.
Structured PICO
Does fluorouracil infusion increase the incidence of ischemic ST changes in patients with solid tumors?
P
Population
25 patients undergoing fluorouracil (5-FU) infusion for treatment of solid tumors
I
Intervention
Fluorouracil (5-FU) infusion
C
Comparator
Baseline period prior to fluorouracil (5-FU) infusion
O
Outcome
Incidence of ischemic ST changes (greater than or equal to 1 mm ST deviation)surrogate
Fluorouracil infusion is associated with a significant increase in silent ischemic ECG changes, particularly in patients with known coronary artery disease, highlighting potential cardiotoxicity.
Cite This Study
Rezkalla et al. (1989) studied this question.