Survival of Patients with Acute Coronary Syndrome and Hematologic Malignancies—A Real-World Analysis

SIMPLE SUMMARY: The impact of the co-occurrence of coronary artery disease and hematologic malignancies (HM) remains poorly understood. Therefore, the aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). To this end, we analyzed 439,716 patients hospitalized for ACS between 2010 and 2018, matched by age, sex, and all comorbidities for short- and long-term survival and adverse cardiac events. The incidence of ACS and HM was only 0.5%. In these patients, myelodysplastic/myeloproliferative disorders, lymphocytic leukemias, and multiple myelomas predominated. These patients were older and less likely to have an ST-segment elevation myocardial infarction. With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to receive coronary angiography and percutaneous coronary intervention, although bleeding events were not significantly increased. After an adjustment for risk profile, HM was associated with lower long-term but not short-term survival. ABSTRACT: Background: The impact of the encounter between coronary heart disease (CHD) and cancer, and in particular hematologic malignancies (HM), remains poorly understood. Objective: The aim of this analysis was to clarify how HM affects the prognosis of acute coronary syndrome (ACS). We analyzed German health insurance data from 11 regional Ortskrankenkassen (AOK) of patients hospitalized for ACS between January 2010 and December 2018, matched by age, sex and all comorbidities for short- and long-term survival and major adverse cardiac events (MACE). Results: Of 439,716 patients with ACS, 2104 (0.5%) also had an HM. Myelodysplastic/myeloproliferative disorders (27.7%), lymphocytic leukemias (24.8%), and multiple myeloma (22.4%) predominated. These patients were about 6 years older (78 vs. 72 years *). They had an ST-segment elevation myocardial infarction (STEMI, 18.2 vs. 34.9% *) less often and more often had a non-STEMI (NSTEMI, 81.8 vs. 65.1% *). With the exception of dyslipidemia, these patients had more concomitant and previous cardiovascular disease and a worse NYHA stage. They were less likely to undergo coronary angiography (65.3 vs. 71.6% *) and percutaneous coronary intervention (PCI, 44.3 vs. 52.0% *), although the number of bleeding events was not relevantly increased (p = 0.22). After adjustment for the patients’ risk profile, the HM was associated with reduced long-term survival. However, this was not true for short-term survival. Here, there was no difference in the STEMI patients, * p < 0.001. Conclusion: Survival in ACS and HM is significantly lower, possibly due to the avoidance of PCI because of a perceived increased risk of bleeding.