ST-elevation myocardial infarction halves expected survival in cancer patients even after effective revascularization

BACKGROUND: The impact of ST-elevation myocardial infarction (STEMI) on cancer-specific survival remains poorly defined. We investigated whether successful primary percutaneous coronary intervention restores expected survival in cancer patients experiencing STEMI and assessed for potential diagnostic delays. METHODS: From the prospective EVALFAST registry of 1,330 consecutive STEMI patients (2008-2024), we identified 30 patients with active malignancy undergoing chemotherapy who achieved successful revascularization. We calculated relative survival ratios by dividing observed survival by expected cancer-specific survival based on population registry data matched for cancer type, stage, age, and sex. Time intervals from first medical contact to diagnosis and balloon inflation were compared between cancer and non-cancer patients. RESULTS: Cancer patients (mean age 71.9 years, 76.7% male) predominantly had lung (26.7%), prostate (20.0%), and renal cell carcinoma (10.0%), with 56.7% presenting [with/as] advanced disease. Despite successful revascularization, mean relative survival ratio was 0.493. Marked heterogeneity of survival existed by cancer type (lung cancer 42.6%, prostate cancer 87.8%) and stage (early-stage 69.5%, advanced-stage 38.9%). Time from first medical contact to diagnosis was significantly prolonged in cancer patients (+11.3 minutes, p = 0.038). CONCLUSIONS: Cancer patients with STEMI achieved only half of their expected cancer-specific survival despite successful primary PCI. Significant diagnostic delays were observed compared to non-cancer patients.