Risk of cancer after ST-segment-elevation myocardial infarction

Q: Does STEMI increase cancer incidence compared with the general population over 5 years?

Over 5-year follow-up, cancer incidence was not significantly different between STEMI patients and the general population (HR 0.96, 95% CI 0.78–1.19).

Q: When is the cancer risk most elevated after STEMI?

Cancer incidence was markedly higher during the first 3 months after STEMI (HR 2.45, 95% CI 1.13–5.30) and then gradually diminished over follow-up.

Q: Which STEMI patient factors were associated with cancer incidence in the first year?

Higher C-reactive protein, higher platelet counts, and lower hemoglobin were associated with cancer incidence during the first year after STEMI (reported HRs for CRP >10 mg/dL, platelets >300, and hemoglobin <7.5 mmol/L).

Sep 24, 2026

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Analyses from administrative databases suggest increased cancer incidence after myocardial infarction, particularly within the first 6 months, but the cause—biological link versus detection of pre-symptomatic cancers and shared risk factors—remains unclear. Cancer incidence among 1,809 survivors of thrombotic STEMI was compared with 10,052 participants from the general population (Rotterdam Study) using identical linkage to the Netherlands Cancer Registry. Cox models adjusted for shared atherosclerosis and cancer factors showed no 5-year difference overall (HR 0.96).

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

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European Journal of Epidemiology (2023) 38:853–858 [https://doi.org/10.1007/s10654-023-00984-8](https://doi.org/10.1007/s10654-023-00984-8) Risk of cancer after ST‑segment‑elevation myocardial infarction Maarten J. G. Leening1,2,3 · Nathalie I. Bouwer3,4 · M. Arfan Ikram2,5 · Maryam Kavousi2 · Rikje Ruiter2,6 · Eric Boersma1 · Ewout‑Jan van den Bos3 · Auke P. J. D. Weevers3 · Jaap W. Deckers1,2 · Mark‑David Levin4 Received: 7 September 2022 / Accepted: 28 February 2023 / Published online: 22 March 2023 © The Author(s) 2023 Abstract Analyses from administrative databases have suggested an increased cancer incidence among individuals who experienceda myocardial infarction, especially within the first 6 months. It remains unclear to what extent this represents an underlying biological link, or can be explained by detection of pre-symptomatic cancers and shared risk factors.Cancer incidence among 1809 consecutive patients surviving hospitalization for thrombotic ST-segment-elevation myocardial infarction (STEMI; mean age 62.6 years; 26% women; 115 incident cancers) was compared to the cancer incidence among 10,052 individuals of the general population (Rotterdam Study; mean age 63.1 years; 57% women; 677 incident cancers). Pathology-confirmed cancer diagnoses were obtained through identical linkage of both cohorts with the Netherlands Cancer Registry. Cox models were used to obtain hazards ratios (HRs) adjusted for factors associated with both atherosclerosis and cancer. Over 5-year follow-up, there was no significant difference in the incidence of cancer between STEMI patients and the general population (HR 0.96, 95% CI 0.78–1.19). In the first 3 months after STEMI, cancer incidence was markedly higher among STEMI patients compared to the general population (HR 2.45, 95% CI 1.13–5.30), which gradually dissolved during follow-up (P-for-trend 0.004). Among STEMI patients, higher C-reactive protein, higher platelet counts, and lower hemoglobin were associated with cancer incidence during the first year after STEMI (HRs 2.93 for C-reactive protein > 10 mg/dL, 2.10 for platelet count >300*109, and 3.92 for hemoglobin < 7.5 mmol/L) . Although rare, thrombotic STEMI might be a paraneoplastic manifestation of yet to be diagnosed cancer, and is hallmarked by a pro-inflammatory status and anemia. Trial registration Registered into the Netherlands National Trial Register and WHO International Clinical Trials Registry Platform under shared catalogue number NTR6831 . Keywords ST-segment-elevation myocardial infarction (STEMI) · Cancer · Paraneoplastic · Prognosis · Population-based · Epidemiology Maarten J. G. Leening and Nathalie I. Bouwer contributed equally. * Maarten J. G. Leening [m.leening@erasmusmc.nl](m.leening@erasmusmc.nl) 1 Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands 2 Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands 3 Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands 4 Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands 5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA 6 Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands Introduction Individuals diagnosed with cancer face increased short-term risks of cardiovascular events [1] which is often attributed to invasive procedures and chemotherapy. Conversely, analyses from large administrative databases have suggested an increased cancer incidence among individuals who experienced a myocardial infarction, especially during the first 6 months after hospital admission [2–4] . From these studies it remains unclear, however, to what extent this finding represents an underlying biological link, or can be explained by increased detection of pre-symptomatic cancers in a population receiving c

FAQs

Does STEMI increase cancer incidence compared with the general population over 5 years?

Over 5-year follow-up, cancer incidence was not significantly different between STEMI patients and the general population (HR 0.96, 95% CI 0.78–1.19).

When is the cancer risk most elevated after STEMI?

Cancer incidence was markedly higher during the first 3 months after STEMI (HR 2.45, 95% CI 1.13–5.30) and then gradually diminished over follow-up.

Which STEMI patient factors were associated with cancer incidence in the first year?

Higher C-reactive protein, higher platelet counts, and lower hemoglobin were associated with cancer incidence during the first year after STEMI (reported HRs for CRP >10 mg/dL, platelets >300, and hemoglobin <7.5 mmol/L).

Sep 24, 2026

Uploaded by Angel