Neoplastic mortality long after acute coronary syndrome in selected urban and rural areas: The abc-7∗ study on heart disease. (∗abc is the acronym for adria, bassano, conegliano, and padova hospitals)

Introduction: We reported an increased cancer onset risk in patients with acute coronary syndrome (ACS) (1), and a significant geographic difference, with the highest risk in the north-rural area of Veneto region Italy (2). Purpose: To investigate the possible difference in neoplastic mortality in these geographic areas. Methods: The present prospective study includes 541 patients admitted with ACS to intensive coronary care units of hospitals in three provinces in the Veneto region of Italy, and discharged alive. They completed 22 years of follow-up virtually without drop-outs. Patient's residency was classified into three urban and three nearby rural areas. Results: The total person-years of follow-up was 5748 years and 292 patients (54%) were living in rural areas of the three provinces. Urban and rural residents shared most of the clinical characteristics. Fifteen patients had a pre-existed malignancy and 106 patients developed the disease during follow-up. A total of 99 patients died due to cancer. The incidence rate of neoplastic death was lower in urban than in rural areas (15 and 19/1000 person-years, respectively. In unadjusted multinomial logistic regression analysis, cancer death risk increased from urban to rural areas (Relative risk ratio [RRR] 3.5;95% confidence interval [CI] 1.3-9.9;p=0.02), with little change from north to south provinces (RRR 1.2;95% CI 0.7-2.0;p=0.46). Yet, we found a strong positive interaction between urban-rural areas and provinces (RRR 0.4;95% CI 0.2-0.8;p=0.007). These results kept true in the fully adjusted model (figure 1). Conclusion: We observed a significant difference in cancer death in different geographic areas of the Veneto region, with the highest risk in the north-rural area and the lowest risk in the north-urban area, among lifelong ACS patients. References: 1. Berton G, Cordiano R, Cavuto F, et al Neoplastic disease after acute coronary syndrome: incidence, duration, and features: the ABC-4∗ Study on Heart Disease. J Cardiovasc Med (Hagerstown). 2018;19(10):546-53. 2. Berton G, Mahmoud H, Cordiano R, et al. Malignancy Onset After Acute Coronary Syndrome: Geographic Distribution. (The Abc-7∗ Study on Heart Disease). (∗ABC Is the Acronym for Adria, Bassano, Conegliano, and Padova Hospitals). The 51st Congress of the Italian Association of Hospital Cardiologists (ANMCO) and ANMCO in times of COVID-19;27 August 2020;Rimini, Italy.: European Heart Journal Supplements;2020. p. G164, G5.