Management patterns of acute coronary syndrome among patients with malignancy: a systematic review and meta-analysis

Introduction Patients presenting withacute coronary syndrome (ACS) and a history of cancer are high-risk. Priorstudies suggest differences in acute treatment and discharge prescribingcompared with non-cancer patients.Methods PubMed, Scopus, Embase, andClinicalTrials.gov were searched on 24 January 2025, for studies publishedbetween 2000 and 2025. Studies comparing ACS management and medication use inpatients with versus without a history of malignancy were included. Pooled oddsratios (ORs) with 95% confidence intervals (CIs) were calculated using arandom-effects model.Results Seventeen studies wereincluded. During hospitalization, cancer patients with ACS were significantlyless likely to undergo percutaneous coronary intervention (PCI), receive drugeluting stents, or receive glycoprotein IIb/IIIa inhibitors(all p < 0.001),compared to non-cancer patients. No significant differences were observed inthe administration of beta-blockers(p = 0.26) or P2Y12 inhibitors(p = 0.39). Atdischarge, cancer patients were less likely to be prescribed dual antiplatelettherapy (p = 0.02), aspirin (p < 0.001), beta-blockers (p = 0.03), and statins(p = 0.02).No significant differences were found in prescriptions for P2Y12 inhibitors,oral anticoagulants, nitrates, calcium channel blockers, or ACE inhibitors/ARBs.Conclusions Differences in treatmentpersist in both in-hospital management and discharge prescribing for cancerpatients with ACS, underscoring the need for standardized, evidence-basedprotocols to ensure equitable care.Registration This meta-analysis wasprospectively registered with PROSPERO (CRD420251275640.)