Management patterns of acute coronary syndrome among patients with malignancy: a systematic review and meta-analysis

Patients presenting with acute coronary syndrome (ACS) and a history of cancer are high-risk. Prior studies suggest differences in acute treatment and discharge prescribing compared with non-cancer patients.

PubMed, Scopus, Embase, andClinicalTrials.gov were searched on 24 January 2025, for studies published between 2000 and 2025. Studies comparing ACS management and medication use in patients with versus without a history of malignancy were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model.

Seventeen studies were included. During hospitalization, cancer patients with ACS were significantly less likely to undergo percutaneous coronary intervention (PCI), receive drugeluting stents, or receive glycoprotein IIb/IIIa inhibitors (all p < 0.001), compared to non-cancer patients. No significant differences were observed in the administration of beta-blockers (p = 0.26) or P2Y12 inhibitors (p = 0.39). At discharge, cancer patients were less likely to be prescribed dual antiplatelettherapy (p = 0.02), aspirin (p < 0.001), beta-blockers (p = 0.03), and statins (p = 0.02). No significant differences were found in prescriptions for P2Y12 inhibitors, oral anticoagulants, nitrates, calcium channel blockers, or ACE inhibitors/ARBs.

Differences in treatment persist in both in-hospital management and discharge prescribing for cancer patients with ACS, underscoring the need for standardized, evidence-based protocols to ensure equitable care.

This meta-analysis was prospectively registered with PROSPERO (CRD420251275640.).