Characteristics and outcome of chest pain among patients with and without a history of cancer

Abstract

Abstract Background Progress in medical oncology has led to remarkable contributions and prolonged life expectancy among cancer patients. Despite the improved prognosis, cancer treatment is associated with adverse cardiovascular outcomes in the oncologic population. This study aims to investigate the clinical characteristics and outcomes of cancer survivors presenting to the emergency department with chest pain. Methods We included consecutive adult patients (18 years and older) who presented at a large tertiary medical center, with chest pain between 2007 and 2022 and were hospitalized for further investigation. All-cause mortality and cancer data were available for all patients from national registries. Patients with active cancer were excluded. Patients were divided into two groups; (1) past cancer (defined as no oncologic therapy in the previous 6 months) and (2) no cancer history. A binary logistics regression model was used to identify patients diagnosed with non-ST-segment elevation myocardial infarction (NSTEMI), pulmonary embolism, new-onset atrial fibrillation, or death within 30 days of presentation. Results Final study population included 37,633 patients with a median age of 65 (IQR, 55-75), of whom 13,089 (34.8%) were women. There were 1807 (5%) patients with a history of cancer and 35,829 (95%) with no oncologic background. Patients with a cancer history were older (65 vs. 64, p<0.001) and were less likely to be men (50% vs. 66%, P<0.001). Univariate binary logistic regression demonstrated that cancer survivors were almost three times more likely to meet the study end-point and to have a cardiovascular diagnosis during hospitalization (OR 2.55, 95% CI 2.24-2.91, p<0.001). The association was consistent in a multivariate model (OR 1.7, 95% CI 1.46-1.96, p<0.001) and was more pronounced among females. During a median follow-up of 5.8 years (IQR, 2.4-8.1), 6,987 patients died. Kaplan-Meier survival analysis demonstrated that cancer survivors were more likely to die during follow-up (7.2% vs. 2.2%, respectively, log-rank P<0.001). A propensity score matching model demonstrated that cancer survivors were twice more likely to meet the study end-point of in-hospital cardiovascular diagnosis or mortality within 30 days (17% vs. 8%, p<0.001). Conclusions Among patients hospitalized with chest pain, those with an oncologic background are twice more likely to have a cardiovascular diagnosis that can explain their symptoms. In addition, these patients are at risk for short and long-term mortality. Our results support including a history of cancer in risk stratification models of patients presenting with chest pain.Kaplan-Meier curve by oncologic historyCardiovascular endpoints (log. scale)