Malignancy after Acute Coronary Syndrome: Incidence and Features

Aim: Aim of the present analysis of the ABC-4 on Heart Disease Study is to describe the presence, incidence, time to onset, duration, and mortality related to malignant neoplasia in an unselected sample of patients enrolled in three intensive coronary care units and discharged alive after hospitalization with acute coronary syndrome (ACS) and followed-up 17 years.
Methods: The present study includes 589 patients with ACS, and the following data have been recorded: 1) presence of malignant neoplastic disease on index admission; 2) time of onset of the neoplastic disease during the follow-up; 3) duration of neoplasia; 4) site of the malignancy.
Results: Median(IQ) age was 67(58-74), female 29%, NSTEMI 38%, Killip class >1 33%. At enrolment 19 patients had confirmed neoplasia, and during the follow-up 99 patients developed malignant neoplastic disease. Patients with neoplasia had no difference in age at enrolment (p=0.43), prevalence of neoplasia was higher among males (p=0.01). The most frequent sites interested by neoplastic disease were the respiratory and digestive systems. The risk of earlier onset of neoplasia was higher for hematologic and respiratory sites (even not significant in our analysis), while it was lower for urinary and upper digestive sites. Duration of neoplasia was shorter in the patients who developed a neoplasia after enrolment (1.4(0.6-5.0)) than in those with pre-existing neoplasia (10.0(5.9-17.1)) (HR=2.0(1.5-2.6), p=0.001). Neoplastic patients who died during the follow-up, had earlier onset of neoplasia (6.2(2.6-10.4)) (HR=1.8(1.1-2.9), p=0.01), and shorter duration than survivors with neoplasia (1.0(0.6-2.2)) (HR=4.1(2.4-7.0), p<0.0001). The shortest duration of neoplasia was observed for hematologic, upper-digestive and respiratory sites. The longest one for breast and prostatic sites.
Conclusions: This prospective study showed that incidence of neoplastic disease after ACS was similar in men and women, and higher in the elderly, with an unfavorable prognosis, at least when compared to neoplasia preexisting to enrolment.