https://doi.org/10.1007/s00392-025-02625-4
1University Hospital Muenster Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure Muenster, Deutschland; 2University of Muenster Institute of Biostatistics and Clinical Research Muenster, Deutschland; 3University Hospital Muenster Dept. of Cardiology III - Adults with congenital heart disease Muenster, Deutschland
Background: Cancer diagnosis is associated with an unfavourable outcome in acute coronary syndrome (ACS) Patients. In this nationwide analysis, we assessed patients with ACS with the comorbidity of cancer and metastatic cancer, including comorbidities, therapy interventions, mortality and complications.
Methods: This analysis included 1,851,588 patients who were admitted to hospital with ACS (STEMI/ NSTEMI) in Germany between January 1, 2014, and December 31, 2022, acquired from the german federal statistical office (DESTATIS). Of these, 34,091 (1.8%) had a cancer diagnosis.
Results: Between 2014 and 2022, ACS admissions decreased significantly, while the relative number of cardiac catheterizations, percutaneous coronary intervention (PCI), use of Drug-eluting stents (DES) and bare-metal stents (BMS) and Drug-eluting balloons (DEB) increased in all three groups. DES were used more frequently in patients without cancer, while DEB was similar in patients with and without cancer, and lower in the group of metastatic disease. The number of coronary artery bypass grafting (CABG) operations increased slightly in the metastatic group. Mortality remained relatively stable over the years. The year 2019 was an outlier in the data, possibly related to underreporting during the Covid-19 pandemic. Bleeding complications were twice as common in ACS patients with cancer and metastatic cancer compared to patients without cancer. Patients with colorectal cancer (OR 6.58 CI 6.10-7.10) and acute renal failure (ARF) (OR 3.57 CI 3.52-3.62) had the highest risk of bleeding. ARF increased significantly over the years in all groups and was twice as high in patients with cancer and metastatic cancer compared to patients without cancer. Active bleeding (OR 3.67 CI 3.62-3.72), thrombocytopenia/platelet transfusion (OR 3.1 CI 3.02-3.18), chronic kidney disease (OR 2.09 CI 2.07-2.12) and bladder cancer (OR 1.43 CI 1.29-1.60) were associated with a high risk of ARF. Mortality was generally higher in ACS patients with the comorbidities ARF (OR 6.13 CI 6.04-6.21), thrombocytopenia/platelet transfusion (OR 2.56 CI 1.78-1.84) and metastatic cancer (OR 1.73 CI 1.61-1.86).
Conclusion: In the years 2014-2022, cardiac catheterization procedures in ACS patients generally increased, with no change in relative mortality. ARF and bleeding remain the most significant complications in cancer patients with ACS. Cancer patients with ACS represent a special patient population in which the decision for cardiac catheterization, the choice of PCI procedure and antiplatelet therapy must be made on an individual basis.