Introduction: Emerging evidence suggests that patients with coronary artery disease carry an increased risk of cancer death.
Methods: To assess the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the very long-term cancer death risk, we enrolled 572 patients admitted with ACS to 3 Italian hospitals and discharged alive and free from neoplasia. Patients were followed prospectively for 24 years or until death.
Results: All except for three patients completed the follow-up, representing 6913 person-years. Patients' mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow-up, 107 patients (19%) died due to cancer; of them, 81 with no HF [79% of patients without HF] and 26 had baseline HF [14% of patients with HF].
The incidence rates for cancer death were 17 and 14 per 1000 person-years for patients with and without baseline HF, respectively (p = 0.48).
The risks for cancer death associated with HF were (HR: 1.37; 95% CI: 0.88-2.15; p=0.16). Similar associations were observed among men and women and in patients younger and older than 75 years of age. The unadjusted HRs for incident cancer were (HR: 1.25; 95% CI: 0.61-2.53; p=0.53) and (HR: 1.26; 95% CI: 0.66-2.39; p=0.49) for patients with HFrEF and HFpEF respectively.
We observed a positive interaction between age and LVEF for the risk of cancer death (HR: 1.002; 95% CI: 1.001 -1.004; p=0.01) in the unadjusted model. Results were the same in the fully adjusted model.
Conclusions: A lack of association between clinical HF at admission for ACS and the long-term cancer death risk has been observed in this prospective study of unselected ACS patients. A positive independent interaction between age and LVEF has been also observed.