Features and predictors of 1-year outcomes in cancer patients discharged after acute coronary syndrome: insights from a multicenter registry

Background Patients with cancer who experience acute coronary syndrome (ACS) represent a complex population with an elevated risk of adverse outcomes due to the interplay between cancer-related factors, cardiovascular disease, and treatment-related complications (1). There is limited evidence on the long-term prognosis and key predictors of mortality and major bleeding in these high-risk patients. Purpose This study aimed to assess clinical features, treatment patterns, and predictors of 1-year mortality and major bleeding in cancer patients discharged after ACS. Methods The PRAISE registry is a retrospective multicenter cohort of 23,270 patients enrolled between 2003 and 2019 discharged after ACS. Out of this cohort we included 21,347 patients, of whom 1,188 (5.6%) had cancer. The primary endpoint was 1-year mortality, and the secondary endpoint was 1-year major bleeding. Multivariate logistic regression models identified independent predictors for the outcomes of interest, adjusting for demographic, clinical, procedural, and pharmacological variables. Results Cancer patients were older (mean age 70.2 ± 10.5 years vs. 62.7 ± 12.5 years, p<0.001), had more comorbidities, cardiovascular risk factors, and a higher prevalence of prior coronary artery disease and prior bleeding compared to non-cancer patients. Furthermore, cancer patients more frequently presented with NSTEMI (49.0% vs. 42.1%, p<0.001). At discharge, cancer patients were less likely to receive beta-blockers (74.3% vs. 79.4%, p<0.001), ACEi/ARBs (70.3% vs. 76.3%, p<0.001), and statins (90.8% vs. 93.3%, p=0.002). At 1-year follow-up, mortality (11.4% vs. 3.5%, p<0.001) and major bleeding rates (6.4% vs. 2.9%, p<0.001) were significantly higher among cancer patients. For 1-year major bleeding, significant predictors included prior bleeding history (OR 4.99, 95% CI 1.32–18.89, p=0.018) and surprisingly radial access (OR 4.76, 95% CI 1.38–16.49, p=0.014). Independent predictors of 1-year mortality in cancer patients included age (OR 1.05, 95% CI 1.003–1.09, p=0.033), lower hemoglobin levels (OR 0.997, 95% CI 0.995–0.999, p=0.008), reduced left ventricular ejection fraction (LVEF) (OR 0.96, 95% CI 0.93–0.99, p=0.005) and thrombolysis (OR 22.61, 95% CI 2.95–173.29, p=0.003), while the use of ACEi/ARBs was protective (OR 0.46, 95% CI 0.23–0.93, p=0.030). Conclusions Cancer patients discharged after ACS have worse 1-year outcomes, probably due to less frequent use of guideline-directed therapies. Optimised management is essential to improve outcomes in this high-risk group.