ESC Congress 2026 Abstract · Oct 26, 2026

Acute myocardial infarction in lung cancer patients: a nationwide population-based cohort study

By Wong HJ, Low CE, Yau CE et al.

Background: Cardiovascular disease is a major competing cause of death in patients with cancer, yet the burden and timing of acute myocardial infarction (AMI) after lung cancer diagnosis remain inadequately defined. Quantifying this risk is essential for informing treatment decisions and survivorship care. Methods: We conducted a cohort study using linked data from a nationwide cancer and myocardial infarction registry. Adults diagnosed with primary lung cancer from January 1, 2007, to December 31, 2021, were included. Patients with prior AMI were excluded. Incident AMI after cancer diagnosis was the primary outcome. Age-standardized incidence rate ratios (SIRRs) and standardized incidence rate differences (SIRDs) were estimated relative to the general population. Competing-risk methods were used to calculate cumulative incidence, with subgroup analyses by demographic, tumor, and treatment characteristics. Results: Among 19,529 patients with lung cancer (median age 70 years [IQR 61–78]; 64% male), 828 developed AMI over a median follow-up of 0.85 years. Cumulative AMI incidence was 4.4% at 5 years and 5.1% at 10 years. Compared with the general population, lung cancer was associated with markedly increased AMI risk (SIRR 3.63, 95% CI 3.39–3.89; SIRD 22.6 per 1000 person-years, 95% CI 20.93–24.28). Excess risk was concentrated within the first 5 years (SIRR 5.04, 95% CI 4.69–5.41) and not elevated thereafter. Risk was highest for small cell carcinoma (SIRR 7.27, 95% CI 5.73–9.23) and large cell carcinoma (SIRR 6.00, 95% CI 3.83–9.40). Patients receiving radiotherapy alone (SIRR 4.68, 95% CI 3.86–5.68) or chemoradiotherapy (SIRR 4.35, 95% CI 3.57–5.31) had greater risk than those treated with a primary surgical approach (SIRR 1.64, 95% CI 1.36–1.99). AMI presentations were frequently atypical with only 34% reporting chest pain. Conclusion: Lung cancer is associated with a substantial, early excess risk of AMI, particularly among patients with aggressive histology and those receiving radiotherapy-based treatment. These findings support routine integration of cardiovascular risk assessment and preventive strategies into early lung cancer care.Cumulative incidence of AMISIRR and SIRD of AMI

doi.org/10.1093/eurheartj/ehag785.3829 Open access Populations