Table 5.
Case reports with ICI-related acute coronary syndrome.
| Study | Patient | CV Side Effect | Symptoms | Diagnosis | Preexistent CVD | ICI | Type of Cancer | CVD Onset | CVD Treatment | Evolution |
|---|---|---|---|---|---|---|---|---|---|---|
| Arora, 2020 | ♂,69 | ACS (NSTEMI) | diffuse body pain weakness |
ECG, CK-MB, cTNI, TTE Coronary angiography |
CKD, Hypertension, Hyperlipidemia Type 2 DM CAD |
PD-1i | metastatic urothelial carcinoma |
cycle day 2 |
IV Steroids, MMF |
transition to comfort measures |
| Cheng, (2021) | ♀, 87 | ACS (NSTEMI) | Chest pain and dyspnea | ECG, CK-MB, cTNI, CRP, Coronary angiography | Hypertension, 3-vessel CAD | PD-1i | NSCLC (adenocarcinoma) | 2 days | PCI + DES | Favorable |
| Tomita, (2017) | ♂, 61 | ACS (NSTEMI) | not mentioned | CK, CK-MB, cTNI, Coronary angiography, OCT | Dyslipidemia | PD-1i | NSCLC (adenocarcinoma) | 11th cycle | PCI + DES; thrombus aspiration | Favorable |
| Kwan, (2019) | ♀, 71 | ACS (NSTEMI) | Chest pain | cTNI, ECG, Coronary angiography | Hypertension, T2DM, peripheral artery disease |
PD-1i | Giant cell tumor of the bone | 2 Years | First ACS: atherectomy of the LAD with 3 x DES, aspirin + clopidogrel, atorvastatin; Second ACS: DES, DAPT |
Favorable |
| Cancela-Díez, (2019) | ♂, 79 | ACS (STEMI) | Chest pain, oppression and dyspnea. |
TNI, TTE, ECG, Coronary angiography | Infrarenal abdominal aortic aneurysm | PD-1i | NSCLC (epidermoid) | 10 days after the last cycle (10th) | PCI + DES, aspirin + clopidogrel, nitro-glycerine, beta blockers, enalapril | Favorable |
| Masson, (2020) | ♂, 62 | ACS (NSTEMI) | Chest pain | ECG, TNI, BNP, TTE, Coronary angiography | T2DM, multi-vessel CAD, STEMI | PD-1i | Melanoma | 1 week after cycle 4 of Nivolumab therapy | CABG | Favorable |
| Cautela, (2020) | ♀, 52 | ACS (NSTEMI) | Chest pain | ECG, TNT, NT-proBNP, TTE, Coronary angiography, CMR | not mentioned | PD-1i | NSCLC (?) | 5 days | Methylprednisolone prednisolone; aspirin + clopidogrel, statins | Fatal (due to refractory shock) |
| Otsu, (2020) | ♂, 57 | Vasospastic angina | Rest angina | ECG, Coronary angiography |
not mentioned | PD-1i | Renal cell carcinoma | 4 weeks | CCB, nitrates | Favorable |
| Kumamato, (2022) | ♀, 54 | Vasospastic angina | chest pain at rest for 2 months | ECG, Chest radiography, TTE, Gadolinium enhanced cardiac MRI cardiac catheterization–coronary vasospasm provoked by ergonovine |
not mentioned | PD-1i | Hypopharyngeal cancer | 21 months | Benidipine 8 mg | Favorable |
| Guo, (2022) | ♂, 6o | Coronary Artery Spasm ventricular tachycardia |
1-week history of chest tightness and palpitation |
ECG Thyroid function Holter ECG TTE |
acute coronary syndrome 8 months ago–complete revascularization with stents |
PD-1i | Metastatic liver cancer | Pre-evaluation of 3rd dose | isosorbide mononitrate and diltiazem sedative drug aspirin, clopidogrel, and atorvastatin |
1 week later–discharged |
Abbreviations: ACS, acute coronary syndrome; BNP, brain natriuretic peptide; CABG, coronary artery bypass grafting; CAD, coronary artery disease; CCB, calcium channel blockers; cTnI, cardiac troponin I; CK, creatine kinase; CK-MB, creatine kinase-MB; CMR, Cardiac MRI; CRP, C-reactive protein; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; ECG, electrocardiogram; LAD, left anterior descending artery; NSCLC, non-small cell lung cancer; NSTEMI, non-ST segment elevation myocardial infarction; NT-proBNP, N-terminal pro-brain natriuretic peptide; OCT, Optical coherence tomography; PCI, percutaneous coronary intervention; PD-1i, programmed cell death protein 1 inhibitor; STEMI, ST segment elevation myocardial infarction; T2DM, type 2 diabetes mellitus; TTE, transthoracic echocardiogram.