IMR Press / RCM / Volume 23 / Issue 7 / DOI: 10.31083/j.rcm2307227
Open Access Review
Mechanisms of Myocardial Ischemia in Cancer Patients: A State-of-the-Art Review of Obstructive Versus Non-Obstructive Causes
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1 Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI 48073, USA
2 Department of Cardiology, Beaumont Hospital, Royal Oak, MI 48073, USA
3 UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
4 Department of Cardiology, Loma Linda University International Heart Institute, Loma Linda, CA 92354, USA
5 Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
6 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55903, USA
*Correspondence: ivan.hanson@beaumont.org (Ivan Hanson)
Academic Editors: Yen-Wen Wu, Hung-Ju Lin, Yen-Wen Liu and Pei-Wei Shueng
Rev. Cardiovasc. Med. 2022, 23(7), 227; https://doi.org/10.31083/j.rcm2307227
Submitted: 28 March 2022 | Revised: 10 May 2022 | Accepted: 16 May 2022 | Published: 24 June 2022
(This article belongs to the Special Issue Cardio-Oncology)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

In patients with cancer, myocardial infarction (MI) has distinct features and mechanisms compared to the non-oncology population. Triggers of myocardial ischemia specific to the oncology population have been increasingly identified. Coronary plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary oxygen supply-demand mismatch are all causes of MI that have been shown to have specific triggers related to either the treatments or complications of cancer. MI can occur in the presence or absence of atherosclerotic coronary artery disease (CAD). MI with nonobstructive CAD (MINOCA) is a heterogeneous syndrome that has distinct pathophysiology and different epidemiology from MI with significant CAD (MI-CAD). Recognition and differentiation of MI-CAD and MINOCA is essential in the oncology population, due to unique etiology and impact on diagnosis, management, and overall outcomes. There are currently no reports in the literature concerning MINOCA as a unified syndrome in oncology patients. The purpose of this review is to analyze the literature for studies related to known triggers of myocardial ischemia in cancer patients, with a focus on MINOCA. We propose that certain cancer treatments can induce MINOCA-like states, and further research is warranted to investigate mechanisms that may be unique to certain cancer states and types of treatment.

Keywords
cardio-oncology
cancer
MINOCA
myocardial infarction in the absence of obstructive coronary artery disease
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