Abstract 16592: Cancer as a New Risk Factor for Major Adverse Cardiovascular Events in Secondary Prevention

Introduction: The inflammatory mechanisms of cancer can be associated to the formation and progression of atherosclerosis. There is scarce evidence about the evolution of oncologic patients in secondary prevention after an Acute Coronary Syndrome (ACS).

Methods: An observational retrospective study was done with 937 patients who underwent a PCI for Acute Coronary Syndrome (ACS) from 2008 to 2022. Patients with a prior history or Major Cardiovascular Events (MACE) were excluded, leaving a total of 787 patients. They were then divided into two subgroups according to the presence or absence of cancer: G1 non-oncologic, and G2 oncologic. The primary endpoint was a composite of MACE in secondary prevention within 3 years of STEMI.

Results: G1 group consisted of 698 patients, and G2 of 89 patients. A total of 180 (22.9%) MACE were identified in the follow-up period in both groups combined, with a median follow-up time of 45 months [IQR= 14-72]. The cumulative incidence of MACE for G1 was 22.2% (155/698) and 28.4% (25/88) for G2. The median follow-up time for G1 was 48 months (IQR=15-84), and for G2 was 36 months (IQR=11-48). G2 presented a density index of MACE significantly superior compared to G1 (0.78 MACE/100 patients/month CI 95% [0.51-1.12] vs 0.48 MACE/100 patients/month CI 95% [0.37-0.50], p 0.01). Kaplan-Meier analysis showed a significantly higher probability of MACE in G2 compared to G1 (P = 0.0086). Multivariable Cox Hazard analysis showed that a history of cancer was an independent and significant predictor of MACE (HR 1.66, 95% CI [1.1-2.6], P = 0.025) adjusted for other risk factors (hypertension, diabetes, smoking history, sedentarism, obesity, age, sex, and family history).

Conclusions: In our population, patients with cancer (G2) had a higher incidence of MACE during follow-up. History of cancer behaved as a significant and independent risk factor for MACE adjusted for other classical risk factors. Further studies are warranted to investigate this phenomenon.