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Active cancer associated with higher mortality in acute coronary syndromes, PCI may mitigate riskPatients with active cancer face higher death risk during heart attack hospital stays

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Key Takeaway
Consider that active cancer in ACS patients is linked to higher mortality and bleeding, with PCI potentially mitigating some risk.

This is a systematic review and meta-analysis synthesizing evidence on patients with acute coronary syndromes (ACS) with and without active cancer. The analysis included a total sample size of 1,154,050 patients. The population comprised patients with ACS, some of whom had active cancer, compared to ACS patients without active cancer. The intervention or exposure was the presence of active cancer, with the comparator being ACS patients without active cancer. The primary outcome was mortality, and key secondary outcomes included myocardial infarction (MI) and bleeding risks.

The main results showed that in-hospital mortality was significantly higher in patients with cancer, with a relative risk (RR) of 2.56 (95% CI 1.07 to 6.15). Long-term mortality was also significantly higher in patients with cancer, with an RR of 3.55 (95% CI 1.71 to 7.36). For in-hospital mortality in patients not undergoing percutaneous coronary intervention (PCI), the RR was 4.02, indicating a significantly higher risk in cancer patients. However, for in-hospital mortality in patients undergoing PCI, the RR was 1.45, which was not significant. For long-term mortality without PCI, the RR was 6.13, showing an increased risk. For long-term mortality with PCI, the RR was 2.16, indicating a lower risk compared to those without PCI.

Key secondary outcomes included bleeding risk and MI risk. Bleeding risk was consistently higher in cancer patients, with an RR of 1.47. MI risk did not differ significantly between groups, with an RR of 1.01. Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported in the input.

These results can be compared to prior landmark studies in this therapeutic area, though specific comparisons are not detailed in the input. The analysis highlights that patients with active cancer are often under-represented in clinical trials, which is a key methodological limitation and potential bias. This under-representation may affect the generalizability of findings.

Clinical implications from the practice relevance note suggest that invasive management, such as PCI, may be beneficial for this vulnerable population. The causality note indicates that active cancer is associated with increased mortality and bleeding, but the certainty note states that further prospective studies are required. The do not overstate note specifies that PCI appears to mitigate early mortality risk and reduce the magnitude of long-term mortality risk.

Key questions remain unanswered, including the optimal management strategies for ACS patients with active cancer, the role of PCI in different cancer types, and the mechanisms underlying the increased bleeding risk. The findings underscore the need for tailored approaches in this high-risk group.

This study looked at more than one million people who had a heart attack. Some of these patients also had active cancer at the time. The main goal was to see if having cancer changed the risk of dying or having other serious heart problems. The results show that patients with cancer are much more likely to die in the hospital than those without cancer. This risk is very high for those who did not get a stent procedure to open their blocked arteries.

Even in the long term, patients with cancer had a much higher chance of dying. This risk was especially high for those who did not receive a stent. However, getting a stent helped lower the risk of dying later on. It also made the difference in survival rates smaller compared to patients without cancer who did not get the procedure.

Patients with cancer also had a higher chance of bleeding during their hospital stay. This is a common concern because cancer treatments can affect how blood clots. Despite this bleeding risk, the study suggests that doctors should still consider stent procedures for these patients. The benefit of opening the blocked artery seems to be worth the extra risk of bleeding.

The risk of having another heart attack did not change much between patients with and without cancer. This means the main difference was in how likely they were to die. The study found that cancer makes the heart attack much more dangerous overall. This is because cancer weakens the body and makes it harder to recover from surgery.

Many heart attack studies do not include patients with cancer because they are hard to study. This study helps fill that gap by looking at a very large group of people. It shows that doctors need to be extra careful when treating heart attack patients who also have cancer. Getting a stent is an important step to help these vulnerable patients survive their heart attack.

What this means for you:
Cancer increases death risk during heart attacks, but stents help lower it and improve survival chances.

Study Details

Study typeMeta analysis
Sample sizen = 1,154,050
EvidenceLevel 1
PublishedMay 2026
View Original Abstract ↓
Acute coronary syndromes (ACS) are a leading cause of mortality, yet patients with active cancer are often under-represented in clinical trials, leaving a gap in evidence for their management. We conducted a PRISMA-compliant systematic review and meta-analysis (PROSPERO-registered) searching PubMed, Cochrane, Web of Science, and Scopus through August 2025. We compared mortality, myocardial infarction (MI), and bleeding risks between ACS patients with and without active cancer using random-effects models to calculate risk ratios (RR). Twenty studies involving 1,154,050 patients were analyzed; 5.0% had active cancer. Patients with cancer had significantly higher in-hospital (RR 2.56; 95% CI 1.07 to 6.15) and long-term mortality (RR 3.55; 95% CI 1.71 to 7.36). Notably, the increased in-hospital mortality risk was significant only in those not undergoing percutaneous coronary intervention (PCI) (RR 4.02) and was non-significant in the PCI group (RR 1.45). While cancer patients faced higher long-term mortality regardless of treatment, the risk was lower for those treated with PCI (RR 2.16) compared to those without (RR 6.13). Bleeding risk was consistently higher in cancer patients (RR 1.47) across all management strategies, while MI risk (RR 1.01) did not differ significantly between groups. In conclusion, active cancer is associated with increased mortality and bleeding in ACS patients. PCI appears to mitigate early mortality risk and reduce the magnitude of long-term mortality risk. These findings suggest that invasive management may be beneficial for this vulnerable population, though further prospective studies are required.
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