Double Trouble: A Rare Association between Chronic Total Occlusion of the Left Main Coronary Artery and Colonic Malignancy
Emerging evidence has shown an association between cardiovascular (CV) disease and cancer due to shared risk factors and biological mechanisms especially chronic inflammation. The objective of this case report is to highlight the association between these two lethal diseases and the challenges in the management of coronary artery disease in patients with coexisting malignancy.
A 65-year-old nonsmoker, nondiabetic, and normotensive male presented with a history of abdominal pain and significant weight loss. Colonoscopy and biopsy showed adenocarcinoma of the ascending colon, and he was planned for right hemicolectomy. Electrocardiogram exercise stress test performed as a part of preoperative evaluation was strongly positive. Coronary angiography was suggestive of Chronic total occlusion of the left main coronary artery. Though the syntax score was intermediate, coronary artery bypass grafting was decided as the revascularization strategy as he needed early surgery for the colonic malignancy. A month later, he underwent right hemicolectomy.
Clinicians should be aware of the association between CV disease and cancer as they are likely to face similar situations where both coexist. Understanding the connections between heart disease and cancer will help to formulate combined preventive guidelines.
10 November 2020 (online)
© 2020. Nitte University (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Zimmern SH, Rogers WJ, Bream PR. et al. Total occlusion of the left main coronary artery: the Coronary Artery Surgery Study (CASS) experience. Am J Cardiol 1982; 49 (08) 2003-2010
- 2 Valle M, Virtanen K, Hekali P, Frick MH. Survival with total occlusion of the left main coronary artery. Significance of the collateral circulation. Cathet Cardiovasc Diagn 1979; 5 (03) 269-275
- 3 Hasin T, Iakobishvili Z, Weisz G. Associated risk of malignancy in patients with cardiovascular disease: evidence and possible mechanism. Am J Med 2017; 130 (07) 780-785
- 4 Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation 2016; 133 (11) 1104-1114
- 5 Wang SC, Schulman-Marcus J, Fantauzzi J. et al. Colon cancer laterality is associated with atherosclerosis and coronary artery disease. J Gastrointest Oncol 2019; 10 (01) 30-36
- 6 Niederseer D, Stadlmayr A, Huber-Schönauer U. et al. Cardiovascular risk and known coronary artery disease are associated with colorectal adenoma and advanced neoplasia. J Am Coll Cardiol 2017; 69 (18) 2348-2350
- 7 Morice MC, Serruys PW, Kappetein AP. et al. Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation 2014; 129 (23) 2388-2394
- 8 Stone GW, Sabik JF, Serruys PW. et al. EXCEL Trial Investigators. Everolimus-eluting stents or bypass surgery for left main coronary artery disease. N Engl J Med 2016; 375 (23) 2223-2235
- 9 Pal M. Proportionate increase in incidence of colorectal cancer at an age below 40 years: an observation. J Cancer Res Ther 2006; 2 (03) 97-99
- 10 Rasmussen-Torvik LJ, Shay CM, Abramson JG. et al. Ideal cardiovascular health is inversely associated with incident cancer: the Atherosclerosis Risk In Communities study. Circulation 2013; 127 (12) 1270-1275