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Cancer has a non-negligible prevalence in patients with acute coronary syndrome undergoing percutaneous coronary intervention, with a major risk of cardiovascular events and bleedings. Moreover, these patients are often undertreated from clinical despite medical therapy seems to be protective. Registration:The BleeMACS project (NCT02466854).

Background Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI‐AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow‐up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3‐fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient‐years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6–3.9]). Gastrointestinal bleeding was associated with a 13‐fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1–19.8); genitourinary bleeding was associated with an 18‐fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5–26.2); and bronchopulmonary bleeding was associated with a 15‐fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0–41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5–3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.

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Although the GRACE risk score is routinely used for stratification of patients with ACS, assessment of hsCRP may provide additional prognostic value in the follow-up of non-STEMI patients.

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Introduction Several studies have showed a substantial risk of death in patients with MINOCA. However, little is still known about the causes of death in these patients compared to patients with MI with significant coronary lesions. On the other hand, using statins treatment in MINOCA has demonstrated to have prognosis benefit in a recent observational. In this study, we aim to describe the previous aspects in a contemporary cohort of patients with AMI. Methods We analyzed retrospective data from 4,499 consecutive patients discharged with a confirmed diagnosis of AMI from January/2010 to December/2016. Patients with coronary lesions <50% were classified as MINOCA. Patients with Tako-Tsubo syndrome were excluded. The time to death in patients with MINOCA vs MI-OCA was analyzed and the causes of death (CV death and non-CV death) were compared. When the cause of death was unknown, it was classified as unknown. The log-rank test was used to find differences in death rate between both groups. The effect of statin treatment was tested. Results 643 patients (14.3%) were diagnosed with MINOCA. The prevalence of women was higher among patients with MINOCA (42.8% vs. 22.6%, p<0.01). The MINOCA were older (69±13 years vs. 66±13 years, p<0.01) with a higher prevalence of hypertension (70.85% vs. 65.3%, p=0.007), previous stroke (10.65 vs. 7.0%; p=0.001), COPD (14.0% vs. 9.95, p=0.002) and cancer history (9.2% vs. 7.6%, p=0.16). In contrast, the MINOCA patients had a lower prevalence of active smoking (19.9% vs. 35%, p<0.01), DM (33.0 vs. 29.4%, p=0.07), dyslipidemia (65.8% vs. 66.3%, p=0.81) and peripheral arteriography (7.3% vs. 8.3%, p=0.41). STEMI was the most frequent form of hospital presentation in the MINOCA cohort (41.95% vs. 19.1%). LVEF was higher in the MINOCA cohort (55% ± 11% vs. 52% ± 10%, p=0.006). At discharge, 86.5% of MINOCAs were treated with statin vs. 86.5% in MI-OCA. The statins prescribed at discharge were of higher potency at 78.2% in MINOCA vs. 88.1% in MI-OCA, moderate potency in 16.1% vs 9.5%, and lower potency in 5.7% vs. 2.4%, respectively (p=0.001). During a median follow-up of 15 months (IQR: 12.6–26.0 months), there were 383 deaths (8.5%), of which 314 occurred in the MI-OCA cohort (8.2%) and 69 occurred in MINOCA cohort (11.1%); p=0.001. 47.8% (n=33/69) were deaths of CV origin in the MINOCA group vs. 48.1% (n=151/314) in the MI-OCA group (p=0.61). The cause of death could not be determined in 6 patients (8.7%) with MINOCA and in 46 (14.7%) with MI-OCA (p=0.19). No benefit of the statin treatment of any potency was observed in MINOCA (HR=0.8 [95% CI: 0.4–1.6]) whether there was benefit in MI-OCA group (HR=0.7 [95% CI 0.5–0.98]). Conclusions There is a considerable difference in the comorbidities between MINOCA and MI-OCA, but a similar rate of death of CV origin in the medium term. The lack of benefit of statin treatment has to be confirmed in other larger studies.

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