Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies
Darryl P. Leong, Filipe Cirne, Nazanin Aghel, Rocío Consuelo Baro Vila, Germano Dallegrave Cavalli, Peter M. Ellis, Jeff S. Healey, Richard Whitlock, Dina Khalaf, Hira Mian, Sanjit S. Jolly, Shamir R. Mehta, Susan Dent
Abstract
Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.