CONGRESS ABSTRACT

Background: There's increasing evidence on the possible pro-atherogenic side effect of immune checkpoint inhibitors (ICIs) leading to an increased risk of atherosclerotic cardiovascular disease (ASCVD) in long-term treated patients. Methods: We retrospectively collected data on acute coronary syndrome (ACS) in active cancer patients receiving ICIs for more than 6 months in 2023. Any baseline information on cancer site, type of ICIs, treatment-line as well as ACS diagnosis, management, outcome and physician attitude towards ICIs was recorded. Results: Ten patients were identified (8/2 M/F; median age 74[70-81]years; lung cancer as prevalent site; ICIs as first-line treatment mainly). Most frequent cardiovascular risk factors included hypertension (70%), smoking (70%), lipids disorders (30%) and diabetes (20%). 3/10 pts presented with STEMI, 5/10 with NSTEMI and 2/10 with unstable angina. All pts underwent coronary angiography with 9/10 PTCA stent (1 MINOCA) with no procedure-related complications plus guideline-oriented medical therapy. 8/10 pts restarted ICIs one months after ACS; in two patients immunotherapy was stopped due to oncologist decision (planned stop after 2yrs of treatment with disease control). No cardiovascular issues were recorded after ICIs re-start at one year follow-up. Conclusions: Immunotherapy resumption after ICIs-related ASCVD appears to be safe with no new ACS episodes. Further prospective confirmation on a larger sample size is needed.