Contemporary clinical characteristics, management strategies, and outcomes of fluoropyrimidine-induced angina – A descriptive study

Fluoropyrimidines can cause angina-like chest pain, often attributed to coronary vasospasm. We retrospectively reviewed 137 patients at Cleveland Clinic (2017–2023) who developed chest pain during 5-fluorouracil or capecitabine treatments. Most events occurred early (75 % within four cycles). Troponin elevation (42 %) and ischemic electrocardiographic changes (43 %) were common, yet most catheterized patients had no obstructive coronary disease. Rechallenge was attempted in 64 % of patients, with recurrence in 36 %, and no predictors of recurrence were identified. Fluoropyrimidine-associated angina is therefore frequent, with high rates of recurrence, and unpredictable, highlighting the need for standardized diagnostic and management strategies.