We appreciate the points raised regarding our study.1 Recent acute coronary syndrome (ACS) constitutes a limitation for some oncological treatments, which could explain the increased noncardiovascular mortality in patients with prevalent or incident malignant tumors. Likewise, we agree that prevalent tumors limit revascularization both quantitively and qualitatively.
However, we would like to qualify the opinion that the results of our study should constitute a starting premise for cardio-oncology units. Cancer affects less than 8% of patients with ACS, which could call into question the efficiency of a having a cardio-oncologist in all care settings. Most patients discharged following ACS receive care at nontertiary hospitals,2 where it is virtually impossible to have specific units for ACS, heart failure, imaging, and cardio-oncology. Rather, we would advocate continuity of care in ACS in such a way that patients receive a personalized follow-up depending on their risk of the more common and serious complications, such as heart failure or reinfarction.3 In fact, we have demonstrated that follow-up in a clinic specific for high-risk ACS is associated with better control of risk factors and improved prognosis.4 Thus, we advocate continuity of care in ACS and personalized follow-up depending on each patient's risk, with rational coordination of those involved in each situation.
CONFLICTS OF INTERESTA. Cordero received a research grant from the Spanish Society of Cardiology in 2017. A. Cordero and V. Bertomeu-González have received research support from CIBERCV.
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