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The Society for Cardiovascular Angiography and Interventions (SCAI) released recommendations for the cardiac catheterization of cancer patients, with specific diagnostic and interventional considerations for their treatment.

"Cancer patients are exposed to cardiovascular morbidity and mortality more than ever before" due to the rising number of cancer survivors and their exposure to radiation and chemotherapy, , of Citizens Memorial Hospital in Bolivar, Mo., and fellow guideline committee members wrote in the .

Among other suggestions, the group recommended the following:

• In high-risk groups, cardiovascular screening to begin 2 years after chest radiation therapy
• Right and left heart catheterization to evaluate pericardial constriction and restrictive cardiomyopathy if non-invasive imaging is insufficient for a diagnosis
• Therapeutic platelet transfusions for patients with thrombocytopenia
• Access through the radial artery during cardiac catheterization; for those receiving hemodialysis or multiple radial procedures, and those with abnormal Allen's tests in both arms, femoral access is preferred
• Use of smaller sheath sizes and their prompt removal
• Intravascular imaging, such as intravascular ultrasound, after stent placement to detect complications given the potential for early dual antiplatelet therapy interruption

The document also reviewed the mechanisms of vascular toxicities in cancer patients; the use of fractional flow reserve; rational for deferring stenting, if possible; endomyocardial biopsy and pericardiocentesis; and aortic valvuloplasty and transcatheter aortic valve implantation.

"Anticancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes, stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage that might occur," the authors wrote. "Moreover, cancer is generally associated with a hypercoagulable state, which increases the risk of acute thrombotic events."

However, "little data exists as cancer patients have been excluded from national percutaneous coronary interventions (PCI) registries and from most randomized trials involving PCI," committee member , an interventional cardiologist at MD Anderson Cancer Center in Houston, noted in a SCAI press release.

The recommendations are the first of their kind, , an oncologist at the Mayo Clinic in Scottsdale, Ariz., told MedPage Today in an email.

As "cardiac problems in cancer patients are becoming increasingly common," Northfelt noted that "cardio-oncology is rapidly emerging as a bona fide specialty within cardiology that will be an important clinical and research focus in coming years."

In line with the budding discipline, a growing number of institutions are dedicating new facilities to cardio-oncology clinics around the world. Though the exact number of such clinics has not been pinned down, there were 418 participants from 150 institutions in an held in 2013.

Additionally, "onco-cardiology/cardio-oncology departments and fellowship training programs" are also on the rise, the authors reported.

"Collaboration between cardiologists and hematologists/oncologists is of prime importance" in this new field, Marmagkiolis and colleagues emphasized.

The SCAI expert consensus statement was also endorsed by the Cardiological Society of India and Sociedad Latino Americana de Cardiología Intervencionista.

Though the new SCAI guidelines are the first for cancer patients in the cath lab, they are not the first to make cardiovascular considerations for this patient subset.

The in 2012 for cardiovascular risk prevention, assessment, and management during cancer treatment. The same year, the American Society of Echocardiography and the European Association of Echocardiography joined to produce echocardiography guidelines for cancer patients.

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