Aim To investigate the clinical features and incidence ofmalignant neoplasia during 17 years of follow-up in anunselected sample of patients with acute coronarysyndrome (ACS).

Methods The Adria, Bassano, Conegliano, and PadovaHospital-4 Study on Heart Disease is an ongoing,prospective study of an unbiased population of patientswith ACS. Baseline clinical and laboratory data wereobtained during the first 7 days of hospitalization at threedifferent intensive coronary care units. The current study included data from 589 patients with ACS.

Results At enrollment, 19 patients had confirmed neoplasia.During follow-up, 99 additional patients developedmalignant neoplastic disease. The incidence rate was 17.8cases per 1000 person-years, which was about three timeshigher than that observed in the general population.Patients had a shorter duration of neoplasia when theydeveloped it after enrollment compared with those withpreexisting neoplasia [hazard ratioU2.0 (1.5–2.6),PU0.001]. Patients with neoplasia who died during follow-up had an earlier onset of neoplasia [hazard ratioU1.8(1.1–2.9),PU0.01] and shorter duration than survivors[hazard ratioU4.1 (2.4–7.0),P<0.0001]. The estimated time to diagnosis of neoplasia indicated elderly patientshad a significantly higher risk than younger people duringthe 17 years of follow-up. After the onset of neoplasia,survival time declined more sharply in the elderly thanyounger people.

Conclusion The long-term prospective study showed thatpatients with ACS have a higher incidence of malignancythan the general population. Those who develop neoplasmafter being diagnosed with ACS have a worse prognosisthan patients with a preexisting neoplasia.

Keywords: acute coronary syndrome, long-term follow-up, neoplasia,outcomes, survival analysis