ABC | Volume 114, Nº6, June 2020

Short Editorial Harinstein Severity of chemotherapy-related CAD Arq Bras Cardiol. 2020; 114(6):1013-1014 Despite the presence of coagulopathies and thrombocytopenia which may be present in patients who receive chemotherapy, these should not be considered contraindications for invasive coronary therapies. It has been demonstrated that percutaneous coronary intervention (PCI) can be performed safely in patients with platelet counts greater than 30,000/mL after micropuncture access and achievement of careful hemostasis. 11 Thus, in patients with obstructive CAD, who fail medical therapy, a treatment strategy of PCI with drug- eluting stent placement with the least length of required dual antiplatelet therapy should still be considered. 12 The limitations of the study are fairly described by the investigators. The sample was small, and this was a single-center retrospective study, performed among a specific population of patients, who had had lung cancer and underwent coronary angiography for suspicion of CAD. A lower number of patients received radiotherapy in the non-chemotherapy group. Half of the patients in the chemotherapy group also received radiation therapy, thus potentially amplifying the effect on the coronary arteries. As noted, it would be helpful to know the stage of lung cancer at initial presentation, since those who received chemotherapy could have had more advanced disease and, consequently, more inflammation for a longer period of time, which may promote atherosclerosis and contribute to the results observed. Additionally, the correlation between anatomical severity of CAD and long-term clinical cardiovascular events was not assessed. The future assessment of outcomes is important to determine if the presence of more complex CAD portends worse prognosis in this group of patients. Thus, understanding not only the association, but also the effect of chemotherapy on anatomical severity of CAD is important when both planning and monitoring a patient’s treatment strategy. Yang et al. 10 took the next step in understanding the significance of CAD in patients treated with chemotherapy by evaluating the severity and complexity of CAD. This highlights the growing need for the field of cardio-oncology to investigate the cardiovascular effects and outcomes in patients who have and are treated for cancer. In order to hopefully minimize unanticipated cardiac events, further investigations of this topic evaluating the many classes of chemotherapeutic agents and different types of cancer are important to our understanding of how best to treat patients and prevent adverse cardiovascular events. 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