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Coronary revascularisation outcomes in patients with cancer
  1. Douglas Leedy1,
  2. Jasleen K Tiwana1,
  3. Mamas Mamas2,
  4. Ravi Hira3,
  5. Richard Cheng1
  1. 1Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
  2. 2Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
  3. 3Division of Cardiology, Pulse Heart Institute, Tacoma, Washington, USA
  1. Correspondence to Dr Richard Cheng, Cardiology, University of Washington Medical Center, Seattle, WA 98195, USA; rkcheng{at}uw.edu

Abstract

Cancer and coronary artery disease (CAD) overlap in traditional risk factors as well as molecular mechanisms underpinning the development of these two disease states. Patients with cancer are at increased risk of developing CAD, representing a high-risk population that are increasingly undergoing coronary revascularisation. Over 1 in 10 patients with CAD that require revascularisation with either percutaneous coronary intervention or coronary artery bypass grafting have either a history of cancer or active cancer. These patients are typically older, have more comorbidities and have more extensive CAD compared with patients without cancer. Haematological abnormalities with competing risks of thrombosis and bleeding pose further unique challenges during and after revascularisation. Management of patients with concurrent cancer and CAD requiring revascularisation is challenging as these patients carry a higher risk of morbidity and mortality compared with those without cancer, often driven by the underlying cancer and associated comorbidities. However, due to variability by different types and stages of cancer, revascularisation outcomes are specific to cancer characteristics such as the timing of onset, cancer subtype and site, stage, presence of metastases, and cancer-related therapies received. Recent studies have provided insights into defining revascularisation outcomes, procedural considerations and best practices in managing patients with cancer. Nevertheless, many gaps remain that require further studies to inform clinical best practices in this population.

  • coronary artery disease
  • coronary artery bypass
  • coronary angiography

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Footnotes

  • Twitter @djleedy, @MMamas1973, @Ravi_Hira_MD, @RichardKCheng2

  • Contributors All authors contributed to the conception and drafting of the review, critical revisions and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DL, JKT, MM and RC have no relevant disclosures. RH is a consultant for Abbott Vascular and Boston Scientific.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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