Impact of Cancer History on Clinical Outcomes Among Patients Without Standard Modifiable Cardiovascular Risk Factors Who Received PCI

Background Coronary artery disease (CAD) has traditionally been attributed to a cluster of standard modifiable cardiovascular risk factors (SMuRFs), including hypertension, diabetes, dyslipidemia, and smoking. Among SMuRF‐less patients (those with none of the four SMuRFs), cancer emerges as an increasingly recognized nontraditional risk factor. Objective The purpose of this study was to evaluate the influence of coexisting cancer on the clinical outcomes among SMuRF‐less patients who underwent percutaneous coronary intervention (PCI). Methods This single‐center prospective cohort study enrolled 1416 SMuRF‐less CAD patients from August 2016 to December 2024; 493 who received PCI with stents were included, and 468 were analyzed after exclusions (67 with cancer, 401 without). The primary outcome was the incidence of major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal myocardial infarction (MI), heart failure hospitalization, and nonfatal stroke. The secondary outcome was all‐cause mortality. Results After a median follow‐up of 46 months, the cancer group showed poorer prognosis than the noncancer group in terms of MACEs (25.37 vs. 10.97%; HR, 2.828; 95% CI, 1.614–4.957; p < 0.001) and all‐cause mortality (13.43 vs. 3.49%; HR, 4.078; 95% CI, 1.764–9.427; p < 0.001). Moreover, proportional hazards analyses identified cancer history as an independent predictor for MACEs (HR 3.40, 95% CI 1.73–6.68, p < 0.001) and all‐cause mortality (HR 5.44, 95% CI 2.14–13.84, p < 0.001) following coronary stent implantation. In addition, serum C‐reactive protein (CRP) levels were significantly higher in the cancer group than in the noncancer group, and we determined the optimal cutoff value of CRP as 1.25 mg/L. Kaplan–Meier analysis showed that the high CRP group had lower MACE‐free survival than that of the low CRP group ( p = 0.030) in cancer subgroup analyses. Among the cancer group, patients who were presented as having current cancer had more MACE events than those who were presented as having past cancer at the time of PCI (HR 3.60, 95% CI 1.28–10.13, p = 0.015). Conclusion Cancer history was a potent, independent predictor of poorer prognosis in SMuRF‐less CAD patients following PCI. Routine measurement of CRP may help identify cancer patients at highest risk.