Mechanisms of Myocardial Ischemia in Cancer Patients: A State-of-the-Art Review of Obstructive Versus Non-Obstructive Causes

Dinu V. Balanescu, Richard Bloomingdale, Teodora Donisan, Eric H. Yang, Purvi Parwani, Cezar Iliescu, Joerg Herrmann, Ivan Hanson

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Article number227
JournalReviews in cardiovascular medicine
Volume23
Issue number7
DOIs
StatePublished - 2022

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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