Older age (HR 3.07) and anaemia (HR 1.36) significantly increased cancer risk post-NSTEMI; new cancer diagnosis raised mortality risk 1.9-fold during follow-up.
Diagnosis of cancer following NSTEMI hospitalization is not uncommon (5.7% over median 3.1 years) and is independently linked to a 1.9-fold increased risk of mortality, with older age and anemia identified as key predictors.
Abstract Introduction Cardiovascular disease is associated with an elevated risk of cancer, yet evidence regarding the relationship between ischaemic heart disease (IHD) and cancer incidence remains limited and inconsistent. Purpose This study aimed to identify predictors of new cancer diagnosis among patients recovering from non-ST segment elevation myocardial infarction (NSTEMI). Methods A historical prospective cohort study was conducted, including patients aged 18 years or older who were hospitalised with NSTEMI at a tertiary medical centre in Israel between 2008 and 2022. Demographic, clinical, and procedural data were extracted from institutional records, while cancer incidence was determined using the Israeli National Cancer Registry. Frailty was based on Norton score with non-frail defined as having a Norton score ≥ 18. Older age was defined as Age 60. Anaemia was defined as a haemoglobin 13.5 g/dL for males and 12 g/dL for females. Univariate and multivariate analyses were performed using Cox proportional hazards models and competing risk analysis via the Fine and Gray model. Additionally, a time-dependent Cox model was used to assess the mortality risk associated with cancer development. Results The final cohort consisted of 7,992 patients (median age 71 years Q1–Q3: 61–83, 68% male) with a median follow-up of 3.1 years (Q1–Q3: 1.1–5.7). During follow-up, cancer was diagnosed in 457 patients (5.7%), with a median time from the NSTEMI event to cancer diagnosis of 2.3 years (Q1-Q3: 0.95-4.5). The most prevalent cancers were lung (15%), haematological (14%), and prostate (11%). Kaplan-Meier survival analysis demonstrated that the cumulative probability of cancer at 3 years was 4.7% (95% CI: 4.2%-5.3%). Univariate Cox model identified older age, glomerular filtration rate ≥ 45mL/min, non-frail status, anaemia, and hypertension as predictors of new cancer diagnosis during follow-up (p 0.05 for all). Multivariate Fine and Gray model demonstrated that older age and anaemia were associated with a 3-fold and 1.4-fold increased risk of cancer diagnosis during follow-up (subdistribution HR 3.07 and 1.36; 95% CI: 2.07–4.55 and 1.01–1.83, p 0.001 and 0.04 respectively). Finally, a time-dependent analysis demonstrated that new cancer diagnosis during follow-up was independently linked to a 1.9-fold increased risk of mortality (95% CI: 2.35–3.65, p 0.001). Conclusions We show that diagnosis of cancer following NSTEMI hospitalisation is not uncommon and is significantly associated with an increased risk of mortality. Older, anaemic NSTEMI survivors are particularly vulnerable, suggesting possible cancer screening initiatives in this population.Kaplan-Meier Curve: cancer-free survival Cancer distribution by type
Yarkoni et al. (2025) studied this question. Older age (HR 3.07) and anaemia (HR 1.36) significantly increased cancer risk post-NSTEMI; new cancer diagnosis raised mortality risk 1.9-fold during follow-up.