Characteristics, management, and outcome of patients with acute coronary syndromes and cancer: Insights from the EYESHOT-2 registry

Abstract Background An increasing proportion of patients with acute coronary syndrome (ACS) presents with concomitant active or recent cancer (1). The contemporary in-hospital management and outcome of these patients have been poorly investigated (2-6). Purpose to compare the characteristics, management and outcome of ACS patients with and without cancer enrolled in the EYESHOT-2 registry (7). Methods The EYESHOT-2 was an observational, nationwide study conducted over a 4-week period (February 1st-29th, 2024) in 183 Italian coronary care units. In the present analysis, the 2806 consecutive ACS patients enrolled, were divided into 3 groups: - active cancer or history of cancer < 2 years (cancer group); - previous cancer >2 years (previous cancer group); no cancer in history (no cancer group). Results There were 98 patients with cancer (3.5%), 135 patients with previous cancer (4.8%), and 2564 patients with no history of cancer (91.4%). The "cancer" group was older and had comparable cardiovascular risk profiles and comorbidities to the other patients (Table 1). Of the 98 patients with active cancer, 85.3% had a solid tumor and 14.7% had a hematologic tumor. In addition, 32.6% of patients with active cancer had stage IV disease, and 60% were treated with pharmacologic therapy, 30% with surgery, and 7.1% with radiotherapy. The most commonly used oncological drug was androgen deprivation therapy (15.2%), followed by endocrine therapy (12.1%). Among STEMI patients, a percutaneous coronary intervention (PCI) was performed in 94%, 97% and 96% of patients without, with previous and with cancer, respectively (p=0.7), with a median time between hospital arrival and coronary angiography of 3.6 (interquartile range (IQR) 0.5-2.2)(no cancer), 3 (IQR 0.4-1.9) (previous cancer), 8 (IQR 0.4-2.4) hours (cancer) (p= 0.6). In NSTEMI, a PCI was performed in 73%, 74% and 70% of patients without, with previous and with active cancer, respectively (p=0.9); the median time between hospital arrival and coronary angiography was 37 (IQR 10-45) (no cancer), 40 (IQR 11-52) (previous cancer) and 53 (IQR 13-52) hours (cancer) (p= 0.2). In both STEMI and NSTEMI settings, all-cause in-hospital mortality and major bleeding rates were comparable between the 3 groups (Table 1). Conclusion Differently from previous findings of the literature, in the present analysis of a contemporary, nationwide registry of ACS we find no difference in the characteristics, management, and outcomes of patients with and without cancer.Table 1