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Emerging evidence links ICI therapies to atherosclerotic cardiovascular disease rather than limited focus on myocarditis alone. In patients with cancer, higher baseline thrombosis and bleeding risks make ICI-associated acute coronary syndrome difficult to manage, requiring tailored multidisciplinary care.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/immune-checkpoint-inhibitor-therapy-and-acute-coronary-syndrome-a-review-of-mechanisms-and-management/373956/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/immune-checkpoint-inhibitor-therapy-and-acute-coronary-syndrome-a-review-of-mechanisms-and-management/373956.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main focus of ICI-associated acute coronary syndrome management?","Question",{"text":113,"@type":114},"The review emphasizes that safe and effective management of ICI-associated acute coronary syndrome is challenging due to cancer patients’ higher risk of thrombosis and bleeding, requiring tailored multidisciplinary approaches.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How do immune checkpoint inhibitors work in cancer therapy?",{"text":118,"@type":114},"ICIs are monoclonal antibodies that target regulatory mechanisms limiting aberrant immune responses and autoinflammation; in tumors, these pathways are hijacked to evade immune surveillance.",{"name":120,"@type":111,"acceptedAnswer":121},"What cardiovascular risks have been increasingly associated with ICI therapy?",{"text":122,"@type":114},"Beyond myocarditis, emerging evidence shows an association between ICI therapies and atherosclerotic cardiovascular disease, contributing to acute coronary syndrome risk in predisposed patients.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},373956,1790493935,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":41},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Journal of the American Heart Association  \nCONTEMPORARY REVIEW  \n\n| Immune Checkpoint Inhibitor Therapy and Acute Coronary Syndrome: A Review of Mechanisms and Management\u003Cbr>Rachel S Saganty  , MD; Orly Leiva  , MD; Elizabeth Hutchins  , MD, PhD; Ashley F. Stein-Merlob  , MD, PhD; Eric H. Yang  , MD\u003Cbr>ABSTRACT: Immune checkpoint inhibitor (ICI) therapy is a class of immune-activating therapies that has revolutionized the treatment of various cancers over the past decade. With expanding clinical indications of this drug class, understanding the short-term and long-term implications of checkpoint inhibitor therapy has grown in importance. Numerous reports have highlighted potential inflammatory adverse effects, including cardiotoxicity. Efforts to characterize cardiovascular adverse events, however, have largely focused on myocarditis with emerging evidence demonstrating the association between ICI therapies and atherosclerotic cardiovascular disease. Given the inherently higher risk of thrombosis and bleeding in patients with cancer, the safe and effective management of ICI-associated acute coronary syndrome remains a therapeutic challenge requiring a tailored and multidisciplinary approach. In this review, we discuss the pathophysiology of ICI-associated atherosclerosis, the complexities of acute coronary syndrome management in patients with cancer, and the opportunities for risk prevention in patients receiving ICI therapies.\u003Cbr>Key Words: acute coronary syndrome ■ atherosclerosis ■ cardio-oncology ■ immune checkpoint inhibitor ■ immunotherapy ■\u003Cbr>myocardial infarction |  |\n| --- | --- |\n| The development of immune checkpoint inhibitors\u003Cbr>(ICIs) marked a paradigm shift in the prognosis\u003Cbr>and therapeutic landscape of numerous cancers. Since the approval of the first checkpoint inhibitor in 2011, the eligibility of patients with cancer in the United States for ICIs increased from 1.54% to 55 .57% in 2023 with approval for >80 cancer indications.1 Checkpoint inhibitors have emerged as standard modalities alongside and often in combination with cytotoxic chemotherapy, radiation therapy, and targeted therapy.2,3 To date, the US Food and Drug Administration has approved 13 checkpoint inhibitors for the treatment of 20 cancer types, with expanding indications in adjuvant, neoadjuvant, and metastatic settings.4,5 A growing number of studies have reported the role of ICIs in the progression of atherosclerosis, highlighting the risk of acute coronary syndrome (ACS) in this predisposed | population. With the World Health Organization projecting a rise in the global burden of cancer by 2050 and the increasing proliferation of these revolutionary therapies, understanding the associated cardiovascular risk and atherosclerotic sequelae of ICI therapies is essential to effectively caring for patients with longterm survivorship.6\u003Cbr>OVERVIEW OF ICI THERAPIES\u003Cbr>Tumor immunotherapies are predicated on the ability to harness the immune system to detect and eradicate nascent cancer cells. ICIs are monoclonal antibodies that target key regulatory mechanisms designed to physiologically limit aberrant immune responses and autoinflammation within the body. In tumor states, these negative modulatory pathways have been hijacked |\n\nCorrespondence to: Eric H. Yang, MD, Ronald Reagan UCLA Medical Center, UCLA Cardiovascular Center, 100 Medical Plaza, Los Angeles, CA 900095.  \nEmail: [ehyang@mednet.ucla.edu](ehyang@mednet.ucla.edu)  \nThis manuscript was sent to June-Wha Rhee, MD, Associate Editor, for review by expert referees, editorial decision, and final disposition.  \nFor Sources of Funding and Disclosures, see page 10.  \n© 2025 The Author(s) . Published on behalf of the American Heart Association, Inc. , by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercia","cbCaioqycEVurSDk","https://ap.wps.com/l/cbCaioqycEVurSDk","pdf",1769676,12,"English","# Abstract\n## Overview of ICI therapies\n## Cardiovascular immune-related adverse events","[{\"question\":\"What is the main focus of ICI-associated acute coronary syndrome management?\",\"answer\":\"The review emphasizes that safe and effective management of ICI-associated acute coronary syndrome is challenging due to cancer patients’ higher risk of thrombosis and bleeding, requiring tailored multidisciplinary approaches.\"},{\"question\":\"How do immune checkpoint inhibitors work in cancer therapy?\",\"answer\":\"ICIs are monoclonal antibodies that target regulatory mechanisms limiting aberrant immune responses and autoinflammation; in tumors, these pathways are hijacked to evade immune surveillance.\"},{\"question\":\"What cardiovascular risks have been increasingly associated with ICI therapy?\",\"answer\":\"Beyond myocarditis, emerging evidence shows an association between ICI therapies and atherosclerotic cardiovascular disease, contributing to acute coronary syndrome risk in predisposed patients.\"}]","Immune Checkpoint Inhibitor Therapy and Acute Coronary Syndrome - A Review of Mechanisms and Management | PDF",1790200901]