Impella CP®-Assisted High-Risk Percutaneous Coronary Intervention in an Elderly Patient with Complex Coronary Artery Disease and Active Prostate Cancer Under Androgen Deprivation and Radiotherapy: A Case Report

Abstract

Background: Complex coronary artery disease presents a severe therapeutic challenge when coexisting with advanced age and active malignancy. Patients with active cancer are frequently deemed ineligible for surgical revascularisation due to frailty, bleeding risks, and cancer-related coagulopathies, despite complete revascularisation being a key determinant for long-term survival. The authors report a case where mechanical circulatory support enabled complete percutaneous revascularisation in an octogenarian patient with active prostate cancer under oncologic therapy who was previously turned down for surgery. Case Summary: An 81-year-old male with active, hormone-responsive prostate cancer (Eastern Cooperative Oncology Group [ECOG] Performance Status: 1; Activities of Daily Living [ADL]: 6/6) presented with non-ST-segment elevation acute coronary syndrome. Coronary angiography revealed extreme anatomical complexity (SYNTAX Score: 48; British Cardiovascular Intervention Society-1 Myocardial Jeopardy Score (BC