The impact of acute coronary syndrome on long-term survival in cancer patients

BACKGROUND: Although cancer and atherosclerosis are based on shared risk factors, the impact of the acute coronary syndrome (ACS) on long-term survival in cancer patients is still unclear. METHODS: We retrospectively analyzed 441 patients with initial diagnosis of cancer prior to ACS who were subjected to cardiac catheterization (CC) with a follow-up of at median 4.78 years (IQR: 0.58–9.33). These patients were compared to non-cancer ACS patients via propensity score matching according to the cardiac risk factors age, sex, arterial hypertension and diabetes. RESULTS: We found ACS, and overall Non-ST-elevation myocardial infarction (NSTEMI), as a relevant predictor of outcome in cancer patients with the highest mortality rates (88 deaths (40%) in non-cancer patients with NSTEMI vs. 174 deaths (64.9%), in the respective cancer patients p < 0.001). In multivariable COX models including other comorbidities, cancer was found to independently influence mortality as well as cardiovascular hospital readmission (HR all-cause mortality: 1.47, p < 0.001, HR readmission: 1.54, p < 0.001). Other risk factors, such as renal dysfunction, diabetes or impaired left ventricular function showed comparable influence on mortality. Percutaneous coronary intervention (PCI) rates did not differ between the groups (228/441 non-cancer patients (51.7%) vs. 227/441 cancer patients (51.5%), p = 0.95), but optimized medical treatment was less present in the cancer group. In a subgroup of cancer patients with available biomarker data, NT-proBNP, but not hs-cTnT, was found to be useful for risk stratification (HR univariate: 1.28, HR multivariate considering risk factors and hs-cTnT: 1.26, p < 0.001 . CONCLUSIONS: Our data indicate a relevant effect of ACS, especially NSTEMI, in cancer patients with impact on long-term mortality and cardiac morbidity. Cancer patients with NSTEMI warrant special care, considering comorbidities and optimized medical treatment of the cardiac disease.