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

## TL;DR

This study finds that cancer patients with acute coronary syndrome, especially NSTEMI, have higher mortality and need special care.

## Contribution

The study identifies ACS, particularly NSTEMI, as a strong predictor of mortality in cancer patients, independent of other comorbidities.

## Key findings

- Cancer patients with NSTEMI had significantly higher mortality rates compared to non-cancer patients with NSTEMI.
- Cancer independently increased all-cause mortality and cardiovascular readmission risks in ACS patients.
- NT-proBNP was a useful biomarker for risk stratification in cancer patients with ACS.

## Abstract

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.

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.

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 .

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.

The online version contains supplementary material available at 10.1186/s40959-026-00451-9.