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The Impact of Hematologic Malignancies on the Treatment and Prognosis of Acute Coronary Syndrome

Georg Karanatsios, Stefan Lange

Survival after myocardial infarction has improved but there is still a difference in clinical outcome and mortality. So far, there is very limited information on the effects of patients with an acute coronary syndrome in cancer. Although the survival after a ST-Segment Elevation Myocardial Infarction (STEMI) has improved and data demonstrates mortality 12 months after a STEMI of less than 4 percent, the cancer patients are not included in this clinical data results. As we know, cancer and cardiovascular diseases have a high incidence in elderly days, thus more cancer patients are suffering an Acute Coronary Syndrome (ACS). Patients with cancer have been excluded from most large cardiology studies and registries. Therefore, little is known about the effect of ACS in cancer patients and treatment remains empirical. Even less is known about the influence of hematological tumors on ACS. This review therefore aims to provide clinicians with an overview of how patients with a coexistence of hematologic malignancies and acute coronary syndrome have been treated in the past, what the outcomes were and what treatment might look like in the future. In ACS patients with HM myelodysplastic/myeloproliferative disorders, lymphocytic leukemia and multiple myeloma predominated. These patients were 6 years older, they were less likely to have a STEMI-constellation and more likely to have a NSTEMI. Patients with an ACS and concomitant cancer were more likely to have a previous cardiovascular disease and a worse NYHA status. A generally increased risk of relevant bleeding could not be proven. Nevertheless, fewer of these patients received an invasive therapy regimen, so it can be assumed that the poorer longterm survival could also be due to the avoidance of PCI.