Contemporary invasive management and in-hospital outcomes of acute myocardial infarction in patients with active or prior cancer: insights from the EYESHOT-2 registry.

BACKGROUND: The coexistence of cancer and acute myocardial infarction (AMI) is increasingly common, yet contemporary real-world evidence on management and outcomes remains limited. We compared AMI characteristics, treatment, and in-hospital outcomes according to cancer status. METHODS: We analysed EYESHOT-2, a nationwide prospective registry of consecutive patients admitted to Italian cardiac care units with confirmed STEMI or NSTEMI. Patients were classified as having active cancer, prior cancer, or no cancer. Clinical characteristics, coronary angiography, revascularization, and in-hospital outcomes were compared across groups. RESULTS: Among 2797 patients with cancer-status data, 98 (3.5%) had active cancer and 135 (4.8%) had prior cancer. In STEMI, PCI was performed in 95.6%, 97.1%, and 94.0% of patients with active, prior, and no cancer, respectively (p = 0.65); corresponding NSTEMI rates were 69.8%, 73.8%, and 73.3% (p = 0.84). After adjustment, cancer status was not significantly associated with non-performance of PCI in STEMI (global p = 0.42) or NSTEMI (global p = 0.78). Unadjusted in-hospital mortality did not differ significantly across groups. Major bleeding was more frequent across cancer-status groups in NSTEMI (5.7%, 4.6%, and 1.7%; p = 0.03), but not in STEMI. CONCLUSIONS: Among AMI patients admitted to participating Italian cardiac care units, cancer status was not significantly associated with non-performance of PCI after multivariable adjustment in either STEMI or NSTEMI. Mortality and bleeding comparisons were unadjusted and limited by small cancer subgroups and few events. The findings should not be interpreted as demonstrating equivalent management or prognosis, or causal treatment effects.