{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:42:35Z","timestamp":1760143355748,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T00:00:00Z","timestamp":1706659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Myocardial infarction is currently the leading cause of death worldwide, followed by malignant neoplasms. The presence of both within the same patient obviously increases the risk of death, as many coronary events are detected in patients diagnosed with cancer. Diagnosis of an occult digestive cancer in the acute phase of myocardial infarction is most frequently prompted by a hemorrhagic complication. Case summary: This case features an 81-year-old male patient diagnosed with acute myocardial infarction, treated with primary percutaneous intervention (PCI), who developed post-stenting hemorrhagic complications in the first 24 h due to the presence of two different concomitant malignant neoplasms. The outcome was favorable in the acute phase, even if de-escalation therapy was given immediately post-stenting, and intrastent residual thrombotic risk was high. Conclusions: The presence of bleeding complications in patients with acute myocardial infarction should mobilize resources in search of a neoplastic cause, especially a digestive one. However, other locations should be looked for, depending on the source of bleeding.<\/jats:p>","DOI":"10.3390\/life14020213","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T10:44:24Z","timestamp":1706697864000},"page":"213","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["What to Do When There Is Something Unexpected?"],"prefix":"10.3390","volume":"14","author":[{"given":"Vlad","family":"Ivan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel-Florin","family":"Lighezan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melania","family":"Ardelean","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoleta","family":"Balte\u0219","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Emergency Clinical Municipal Hospital, 300079 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Faur","sequence":"additional","affiliation":[{"name":"Department of Anatomy and Embriology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1951-1615","authenticated-orcid":false,"given":"Paul-Gabriel","family":"Ciubotaru","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adina-Flavia","family":"Cutina-Morgovan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7476-6584","authenticated-orcid":false,"given":"Roxana","family":"Buza\u0219","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Luc\u00e0, F., Parrini, I., Abrignani, M.G., Rao, C.M., Piccioni, L., Di Fusco, S.A., Ceravolo, R., Bisceglia, I., Riccio, C., and Gelsomino, S. (2022). Management of Acute Coronary Syndrome in Cancer Patients: It\u2019s High Time We Dealt with It. J. Clin. Med., 11.","DOI":"10.3390\/jcm11071792"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/2048872617729636","article-title":"Treatment of Patients with Myocardial Infarction Depends on History of Cancer","volume":"7","author":"Rohrmann","year":"2018","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1680","DOI":"10.1016\/j.mayocp.2016.06.029","article-title":"Cancer History Portends Worse Acute and Long-term Noncardiac (but Not Cardiac) Mortality after Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction","volume":"91","author":"Wang","year":"2016","journal-title":"Mayo Clin. Proc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/cvr\/cvz058","article-title":"Inflammation: A Common Contributor to Cancer, Aging, and Cardiovascular Diseases\u2014Expandingthe Concept of Cardio-Oncology","volume":"115","author":"Libby","year":"2019","journal-title":"Cardiovasc. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.blre.2015.07.001","article-title":"The Prothrombotic Activity of Cancer Cells in the Circulation","volume":"30","author":"Mitrugno","year":"2016","journal-title":"Blood Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/sj.neo.7900263","article-title":"The Hypercoagulable State of Malignancy: Pathogenesis and Current Debate","volume":"4","author":"Caine","year":"2002","journal-title":"Neoplasia"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/s00392-020-01719-5","article-title":"Assessment of coronary artery disease during hospitalization for cancer treatment","volume":"110","author":"Mrotzek","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Radmilovic, J., Di Vilio, A., D\u2019andrea, A., Pastore, F., Forni, A., Desiderio, A., Ragni, M., Quaranta, G., Cimmino, G., and Russo, V. (2020). The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome. J. Clin. Med., 9.","DOI":"10.3390\/jcm9123926"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Milazzo, V., Cosentino, N., Campodonico, J., Lucci, C., Cardinale, D., Cipolla, C.M., and Marenzi, G. (2020). Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. J. Clin. Med., 9.","DOI":"10.3390\/jcm9113642"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.2217\/fon-2017-0543","article-title":"Statins Use and Cancer: An Update","volume":"14","author":"Zaleska","year":"2018","journal-title":"Futur. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1177\/2048872617706501","article-title":"Prevalence and Outcome of Patients with Cancer and Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A BleeMACSSub-study","volume":"7","author":"Iannaccone","year":"2017","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1002\/clc.22007","article-title":"Treatment and Outcomes of Acute Coronary Syndrome in the Cancer Population","volume":"35","author":"Yusuf","year":"2012","journal-title":"Clin. Cardiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"zwad125.278","DOI":"10.1093\/eurjpc\/zwad125.278","article-title":"Cancer and Acute Coronary Syndrome","volume":"30","author":"Pravecek","year":"2023","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1016\/j.amjcard.2020.03.023","article-title":"Usefulness of Bleeding after Acute Coronary Syndromes for Unmasking Silent Cancer","volume":"125","author":"Rossello","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1001\/jama.2017.13890","article-title":"Association between Use of Antithrombotic Medication and Hematuria-Related Complications","volume":"318","author":"Wallis","year":"2017","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1002\/cncr.30164","article-title":"Risk of second primary malignancies among cancer survivors in the United States, 1992 through 2008","volume":"122","author":"Donin","year":"2016","journal-title":"Cancer"},{"key":"ref_17","first-page":"763","article-title":"Second malignancies","volume":"9","author":"Munker","year":"1996","journal-title":"Int. J. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1161\/CIRCULATIONAHA.108.828541","article-title":"Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: The CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC\/AHA Guidelines) Bleeding Score","volume":"119","author":"Subherwal","year":"2009","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijcard.2021.12.028","article-title":"Early angiography in elderly patients with non-ST-segment elevation acute coronary syndrome: The cardio CHUS-HUSJ registry","volume":"351","author":"Ferrero","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1016\/j.mayocp.2022.03.021","article-title":"Invasive Management in Older Adults (n elderly patients with non-ST-segment elevation acute coronary syndrome","volume":"97","author":"Fishman","year":"2022","journal-title":"Mayo Clin. Proc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/14779072.2022.2063840","article-title":"Acute coronary syndrome in patients with cancer","volume":"20","author":"Shobayo","year":"2022","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1016\/j.jaccao.2023.08.001","article-title":"Chest Pain in Cancer Patients: Prevalence of Myocardial Infarction and Performance of High-Sensitivity Cardiac Troponins","volume":"5","author":"Bima","year":"2023","journal-title":"JACC CardioOncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1002\/jhm.13063","article-title":"Diagnostic delays among COVID-19 patients with a second concurrent diagnosis","volume":"18","author":"Freund","year":"2023","journal-title":"J. Hosp. Med."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/2\/213\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:52:43Z","timestamp":1760104363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/14\/2\/213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,31]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["life14020213"],"URL":"https:\/\/doi.org\/10.3390\/life14020213","relation":{},"ISSN":["2075-1729"],"issn-type":[{"type":"electronic","value":"2075-1729"}],"subject":[],"published":{"date-parts":[[2024,1,31]]}}}