Navigating percutaneous coronary intervention risks in cancer patients

This editorial refers to ‘Validation of a high bleeding risk definition in cancer patients undergoing percutaneous coronary intervention’, by M. Gitto et al. https://doi.org/10.1093/eurjpc/zwae399. Advances in cancer care have led to improved survival rates, resulting in a growing number of patients requiring percutaneous coronary intervention (PCI). This trend is expected to accelerate, with more patients—both those with active cancer and those in remission—undergoing PCI. However, due to their older age and significant comorbidity burden, cancer patients undergoing PCI are at high risk for both bleeding and ischaemic complications. This dual risk creates a conundrum for decision-making regarding antithrombotic therapy. To evaluate bleeding risk in PCI patients, current guidelines recommend the use of the Academic Research Consortium High Bleeding Risk (ARC-HBR) criteria.1 Patients meeting at least one major or two minor criteria are categorized as high bleeding risk (HBR), for which short durations of dual antiplatelet therapy (DAPT) are recommended. Cancer is included as a major criterion in the ARC-HBR score, automatically classifying all cancer patients as HBR regardless of their specific clinical characteristics. While the inclusion of cancer as an HBR criterion simplifies risk stratification, it overlooks the heterogeneity of this population. Factors such as cancer type, stage, treatment status, comorbidities, and time since diagnosis can substantially influence bleeding and ischaemic risks, underscoring the need for a more nuanced approach.