Patients with current or past cancer have a higher prevalence of acute myocardial infarction (AMI) as the cause of chest pain than patients without cancer, according to research published in JACC: CardioOncology.

The study also showed that, among patients who visited the emergency department (ED) for chest pain, cancer patients stayed longer and required hospitalization more often than patients without cancer.

For this study (APACE; Identifier: NCT00470587), the researchers assessed the prevalence of AMI and associated outcomes in 8267 patients presenting to an ED with acute chest pain.

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A total of 711 patients (8.6%) had active cancer or a history of cancer. The cancer patients had solid tumors (83.3%), hematologic malignancies (13.8%), or both (1.8%).

Compared to non-cancer patients, the cancer patients were older, were more likely to have preexisting cardiac disease, had a higher burden of cardiovascular risk factors, and were more likely to have comorbidities such as chronic kidney disease and obstructive lung disease (P <.001 for all).  

A final diagnosis of AMI was made in 26.8% of cancer patients and 21.1% of patients without cancer (P <.001). This difference was driven primarily by non–ST-segment elevation myocardial infarction, which occurred in 23.8% of patients with cancer and 16.9% of those without cancer (P <.001).

The median time spent in the ED was 5.2 hours among cancer patients and 4.3 hours among non-cancer patients (P <.001). Cancer patients were more likely to be hospitalized than non-cancer patients (49.8% and 34.3%, respectively; P <.001).

The rate of all-cause death at 5 years was 34.4% in cancer patients and 8.9% in those without cancer (P <.001). The 5-year cumulative incidence of cardiovascular death was 15.0% in patients with cancer and 7.6% in those without it (P <.001).

“[H]igh awareness for the presence of AMI is needed in patients with active or past cancer presenting with acute chest pain or discomfort to the ED,” the researchers concluded. “Future studies will need to elucidate whether the observed differences between patients with and those without cancer are due to cancer or a result of other risk factors rather than cancer.”

Disclosures: This research was partly supported by Abbott, Beckman Coulter, Roche, Ortho Clinical Diagnostics, Quidel, Siemens, and Singulex. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Bima P, Lopez-Ayala P, Koechlin L, et al. Chest pain in cancer patients: Prevalence of myocardial infarction and performance of high-sensitivity cardiac troponins. JACC: CardioOncol. Published online August 26, 2023. doi:10.1016/j.jaccao.2023.08.001