Increased cardiovascular risk among cancer survivors presenting with chest pain

Aims To examine the association between a personal history of cancer and the likelihood of a cardiovascular diagnosis among patients presenting with chest pain. Methods and results We analyzed data from consecutive adult patients hospitalized with a primary diagnosis of chest pain between 2007 and 2022, excluding those with active cancer or ST-elevation myocardial infarction. Patients were categorized into two groups: cancer survivors and other patients. The primary outcome was a cardiovascular probable diagnosis, defined as a composite of non-ST-segment elevation myocardial infarction, pulmonary embolism, new-onset atrial fibrillation, or mortality within 30 days. The final cohort included 37 819 patients with a median age of 65 years (Q1-Q3: 55-75), of whom 24 644 (65%) were men. Among these, 1838 (5%) had a history of cancer. A multivariable logistic regression model demonstrated that cancer survivors were 70% more likely to reach the study primary endpoint compared with other patients (P < 0.001). A propensity score matching model consistently demonstrated that cancer survivors were 40% more likely to meet the study endpoint (95% CI 1.2-1.7, P < 0.001). Over a median follow-up of 4.3 years (Q1-Q3: 2.1-7.3), 7035 (19%) patients died. Kaplan-Meier survival analysis indicated a cumulative probability of death of 29% ± 22% for cancer survivors vs. 12% ± 9% for other patients (P < 0.001, Log rank). Conclusion Among patients admitted to the hospital with chest pain, a personal history of cancer is independently associated with a significantly higher likelihood of receiving a final cardiovascular diagnosis.