Clinical presentation, management, and in-hospital outcomes of acute coronary syndrome in active cancer patients vs. survivors

Abstract Background Cancer patients face an increased risk of cardiovascular (CV) events, including acute coronary syndromes (ACS), and viceversa. In ACS patients, cancer is linked to lower use of invasive procedures and worse outcomes. However, short- and long-term ACS outcomes based on cancer status remain unclear. The high risk of both bleeding and ischemic events further complicates treatment decisions. Few studies explore the real-world management of these patients. While clinical presentation, treatment, and prognosis may differ between active cancer (AC) patients and survivors (CS), robust data confirming these differences remain scarce Aim The aim of the present exploratory study was to evaluate the clinical characteristics, treatment, and prognosis during hospitalization and follow-up in patients presenting with ACS who had either AC or were CS. Methods In this dual-center, prospective observational study, we enrolled consecutive ACS patients with cancer admitted to coronary care units between Nov 1, 2023, and Nov 1, 2024. Clinical characteristics and outcomes were recorded during hospitalization. Post-discharge follow-up was conducted via clinical visits or phone calls. Patients scheduled for cancer surgery, receiving anticancer therapy, or with recurrent, metastatic, or inoperable cancer were classified as AC; others as CS. Results We included in the final analysis n=73 patients (53% with AC). The mean age of our cohort was 74±10-year-old (47%male), diagnosis included STEMI 28%, UA/NSTEMI 57%, takotsubo 10%, MINOCA 3%. Coronary angiography was performed in 92% and coronary angioplasty in 67% of patients. As compared with CS, patients with AC had higher prevalence of CV risk factors (hypertension 92% vs 76%, p=0.05; diabetes 33% vs 12%, p= 0.035). After excluding MINOCA and takotsubo patients, AC had higher involvement of the left main (22% vs 4%, p=0.042) and anterior descending artery (75% vs 48%, p=0.034). No relevant differences were noted regarding other variables including left-ventricular ejection fraction on admission (46% vs 48%, p=0.584), coronary angiography (84% vs 79%, p=0.634), angioplasty (63% vs 71%, p=0.504) and dual antiplatelet rates (58% vs 58%, p=0.982). Subtype of ACS as well as invasive approach and antiplatelet therapy strategies were similar between groups. At a median follow-up of 7 months, we observed 5 death (1 in-hospital, 80% cancer-related), all in the AC group. Conclusions Patients with cancer who experience ACS are challenging to manage due to a lack of specific guidelines. They are often excluded from invasive treatment strategies, particularly those with AC. Not surprisingly these patients tend to have worse in-hospital and post-discharge outcomes. However, our preliminary analysis showed that, in our cohort of patients with ACS and cancer, invasive revascularization strategies were undertaken equally in both AC patients and CS, proving to be equally safe and effective in both groups.