Heart failure during acute coronary syndrome and the longterm risk of cancer death. the abc-9*study on heart disease

Abstract 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.