Association of cancer on coronary atherosclerotic burden and plaque rupture: Insights from the BRAVADO study

Cardiovascular diseases and cancer represent leading global causes of mortality, sharing common risk factors. However, the specific impact of cancer on atherosclerotic plaque burden and coronary lesion complexity in acute coronary syndrome (ACS) remains understudied. We aim to compare coronary atherosclerotic burden as assessed by coronary angiography in cancer patients with ACS to those without cancer, including ACS and chronic disease.

This was a multicenter, ambispective observational study conducted between September 2016 and December 2022, involving detailed analysis of clinical records and invasive coronary angiograms. Patients were classified into three cohorts: (1) individuals presenting with acute coronary syndrome (ACS) and a prior history of cancer (ACSC), (2) ACS patients without any history of malignancy (ACSNC), and (3) patients with stable chronic coronary artery disease (CCAD). To reduce confounding, propensity score matching was applied to balance baseline characteristics between the ACSC and ACSNC groups. Comparative assessments focused on the presence of plaque rupture, angiographic complexity, and overall coronary atherosclerotic burden across the three cohorts.

618 patients were included, comprising 206 individuals each in the ACSC, ACSNC, and CCAD groups. A total of 3752 coronary lesions were analyzed. The most common types of cancer were prostate, hematological, and colorectal cancer. Patients with acute presentation had more eccentric and ulcerated lesions, involving bifurcations, and resulted in worse SYNTAX and Leaman scores when compared to chronic coronary artery disease (p values < 0.01 for all). Post-matching, 234 ACSC and ACSNC patients were compared, revealing higher anatomical complexity in ACSC, evidenced by elevated SYNTAX scores (p = 0.02), B2/C lesions (p < 0.01), and plaque rupture (p = 0.03). ACSC also showed a higher prevalence of plaque rupture in the proximal segments of the vessels (p < 0.01).

Among patients with acute coronary syndrome undergoing invasive coronary angiography, those with a history of cancer more frequently exhibited plaque rupture and greater anatomical complexity compared to non-cancer counterparts.

ClinicalTrials.gov Identifier: NCT04222608.