P677Association between bleeding after acute coronary syndrome and newly diagnosed cancers
Authors: Munoz Pousa I , Raposeiras Roubin S , Abu-Assi E , Cespon Fernandez M , Caneiro Queija B , Cobas Paz R , Lopez Rodriguez E , Perez Casares L , Jamhour Chelh K , Castineiras Busto M , Fernandez Barbeira S , Bastos Fernandez G , Bilbao Quesada R , Iniguez Romo A 
Published: October 2019

Abstract

Introduction
There is a growing body of evidence on the incidence and negative prognostic impact of post-discharge hemorrhagic complications after acute coronary syndrome (ACS). The aim of this study was to assess the association of post-discharge bleeding with new cancer diagnosis after ACS.

Methods
Data from a single-center registry of 3,644 ACS patients discharged with dual antiplatelet therapy (DAPT) were used to investigate the association between post-discharge bleeding and diagnosis of cancer. The adjusted effect of bleeding as time-varying covariate on subsequent cancer diagnosis was assessed using Cox regression models. Positive predictive values (PPVs) of bleeding for cancer diagnosis were calculated.

Results
During a median follow-up of 56.2 months, bleeding events were documented in 1,215 patients and new cancers in 227 patients. After multivariable adjustment, post-discharge bleeding was associated with cancer diagnosis (adjusted HR 3.43, 95% CI 2.62–4.50), but only spontaneous bleeding (adjusted HR=4.38, 95% CI 3.31–5.79). This association was stronger as the severity of the bleeding increased (HR= 1.52, 4.88, 7.30, and 12.29, for BARC type 1, 2, 3a, and 3b bleeding, respectively). With respect to the specific location of bleeding for diagnosis of cancer, only gastrointestinal, genitourinary and bronchopulmonary bleeding result strongly associated with site-specific cancers [Table]. No differences in the adjusted risk of cancer were found for those post-discharge bleedings that happened on-DAPT versus off-DAPT (HR for on-DAPT bleeding vs off-DAPT bleeding: 1.05, 95% CI 0.69–1.62; p=0.832). PPV for cancer diagnosis of post-discharge bleeding was 7.7%. (21.9% for genitourinary bleeding, 18.6% for bronchopulmonary bleeding, 5.8% for gastrointestinal bleeding, and 2.3% for other bleedings). Median time from bleeding to cancer was 4.6 months.
Variables HR 95% CI P Any bleeding 3.43 2.62–4.50 <0.001 Bleeding severity BARC 1 (n=622) 1.52 0.96–2.43 0.074 BARC 2 (n=436) 4.88 3.48–6.85 <0.001 BARC 3A (n=71) 7.30 3.68–14.46 <0.001 BARC 3B (n=46) 12.29 5.59–26.98 <0.001 BARC 3C (n=37) 3.07 0.73–12.84 0.125 Bleeding spontaneity Spontaneous (n=827) 4.38 3.31–5.79 <0.001 Traumatic bleeding (n=389) 1.29 0.69–2.41 0.418 Bleeding location Gastrointestinal (GI; n=327) 3.78 2.51–5.71 <0.001 Genitourinary (GU; n=228) 8.63 5.91–12.59 <0.001 Bronchopulmonary (BP; n=56) 4.26 1.85–9.84 0.001 Others (No GI, no GU, no BP; n=605) 1.32 0.81–2.18 0.264 Bleending with DAPT Bleeding ON-DAPT 3.50 2.56–4.80 <0.001 Bleeding OF-DAPT 3.34 2.29–4.89 <0.001

Conclusions
Spontaneous post-discharge bleeding in ACS patients is strongly associated with subsequent cancer diagnosis within the first 6 months. A prompt evaluation of bleeding could be useful for enabling an early detection of cancer in these patients.