Cancer is increasingly common among patients presenting with acute myocardial infarction (AMI), yet the influence of cancer status and tumor type on post-AMI outcomes remains incompletely understood. In a study published in the Journal of Clinical Medicine, investigators evaluated the prognostic impact of cancer in a large real-world population of patients hospitalized with a first AMI.

Using linked administrative databases from Lombardy, Italy, researchers identified 124,403 adults hospitalized with a first AMI between 2014 and 2022. The primary outcome was in-hospital mortality, while secondary outcomes included 1-year all-cause mortality and rehospitalization for recurrent AMI or acute heart failure (AHF).

Findings

• Of 124,403 patients hospitalized with a first AMI, 18,463 (14.8%) had a history of cancer.
• Cancer history was associated with higher 1-year mortality after AMI (adjusted HR 1.46; 95% CI 1.40–1.52), while the association with in-hospital mortality was more modest (adjusted RR 1.06; 95% CI 0.99–1.13).
• Active cancer conferred the greatest risk, with higher in-hospital mortality (adjusted RR 1.07; 95% CI 1.00–1.15) and a 60% increased risk of death within 1 year (adjusted HR 1.60; 95% CI 1.53–1.68).
• Lung cancer (adjusted HR 2.69; 95% CI 2.15–3.37) and hematological malignancies (adjusted HR 2.19; 95% CI 1.88–2.56) were associated with the highest 1-year mortality risks.
• Past cancer was not associated with excess mortality after adjustment, and risks of rehospitalization for recurrent AMI or AHF were comparable between patients with and without cancer.

The investigators concluded that cancer, particularly active malignancy, is associated with significantly worse survival following AMI. The adverse prognostic effect was most pronounced among patients with lung and hematological cancers and was observed in both STEMI and NSTEMI presentations.