NSTEMI and Cancer: A Missed Opportunity for Early Detection?

Introduction: Cardiovascular diseases are linked to increased cancer risk, yet evidence on the association between ischemic heart disease (IHD) and cancer incidence remains limited and inconsistent. This study aimed to evaluate cancer incidence and risk factors among patients recovering from a non-ST segment elevation myocardial infarction (NSTEMI) event.

Methods: A historical prospective cohort study was conducted on patients aged ≥18 years hospitalized at Sheba Medical Center between 2008 and 2022. Demographic, clinical, and procedural data were collected from institutional records, with cancer incidence determined using the Israeli National Cancer Registry. Cox proportional hazards models were employed for univariate and multivariate analyses, and a time-dependent Cox model assessed mortality risk associated with cancer development.

Results: The cohort comprised 8,036 patients (median age 71 [Q1-Q3: 61-83], 68% male) followed for a median of 3 years (Q1-Q3: 1-5.7). During the follow-up period, cancer was diagnosed in 457 patients (5.7%), with lung (15%), hematologic (14%), and prostate (11%) cancers being most common. Multivariate models, adjusted for gender, norton score, glomerular filtration rate, catheterization, IHD, atrial fibrillation, diabetes, peripheral artery disease, hypertension, dyslipidemia, and smoking, identified independent predictors of cancer included age >70 years (HR 2.07; 95% CI: 1.61-2.66, p<0.001), hemoglobin <10 mg/dL (HR 1.42; 95% CI: 1.11–1.83, p=0.006), and COPD (HR 1.48; 95% CI: 1.04–2.10, p=0.03). When compared with all other patients, the multivariate model demonstrated that patients aged >70 with hemoglobin below 10 were at an 84% higher risk of cancer (HR 1.84; 95% CI: 1.38–2.46, p<0.001). Cancer development was independently associated with a 180% increased risk of mortality (95% CI: 2.44-3.21, p<0.001).

Conclusions: Cancer diagnosis following NSTEMI hospitalization is not uncommon and is significantly associated with increased mortality risk. Older, anemic NSTEMI survivors are particularly vulnerable, highlighting the need for targeted cancer screening efforts in this population.