Cancer patients are at risk to suffer from different cardiovascular diseases (CVD). Nevertheless, the impact of cardiovascular assessments on all-cause mortality (ACM) in cancer patients who are suspected of coronary heart disease (CHD) in a clinical setting is still unclear.

We collected data from 40,329 patients who were subjected to cardiac catherization from 01/2006 to 12/2017 at University Hospital Heidelberg suspected of having CHD. In this analysis, we concentrated on 3,666 patients with suspected CHD and a diagnosis of cancer prior to catherization and 3,666 propensity-score matched non-cancer patients according to age, gender, diabetes and hypertension.

ACM was higher in oncological patients (1442 deaths (39.2%) in non-cancer vs. 1998 deaths (54.5%) in cancer patients, p < 0.001). Cancer patients with a reduced left ventricular ejection fraction (LVEF) or cardiac biomarker elevation (high sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) showed higher rates of ACM compared to cancer patients without cardiac risk. Compared to non-cancer patients, NT-proBNP was found to be significantly higher (median NT-proBNP cancer, 881 ng/l vs. non-cancer, 668 ng/l; p < 0.001, Wilcoxon-rank sum test) and turned out to predict ACM more accurately than hs-cTnT (AUC: 0.74) in cancer patients. Risk factors for atherosclerosis, such as diabetes and age (>65 years) were significant predictors for increased ACM in cancer patients in a multivariate analysis (OR diabetes: 1.96 (1.39-2.75), p<0.001, OR age > 65 years: 2.95 (1.68-5.4), p<0.001). 

Our data support the notion, that overall outcome in cancer patients who are suspected of CHD depends on cardiovascular comorbidities. Therefore, particularly cancer patients could benefit from standardized cardiac care.