Abstract Body (Do not enter title and authors here): Background: The interaction between cancer and coronary artery disease (CAD) significantly impacts cardiovascular outcomes and disease progression. However, the impact of cancer on atherosclerotic plaque burden and coronary lesion complexity in acute coronary syndrome (ACS) have not yet been studied.

Objective: The aim of this study is to correlates the presence of cancer e atherosclerotic plaque burden

Methods: This is a multicenter, ambispective, observational study, based on the analysis of coronary angiographies. Data was collected between September 2016 to December 2022. Patients were categorized into three study groups: ACSC (ACS with a history of cancer), ACSNC (ACS without a history of cancer), and CCAD (chronic coronary artery disease). Patients with ACS were consecutively included while those with CCAD were randomly included. Propensity score matching between ACSC and ACSNC groups was performed.

Results: 618 patients were included, and 3,752 coronary lesions were analyzed. The mean age of the patients was 68 years, with more than 74% diagnosed with hypertension. The most common types of cancer were prostate, hematological, and colorectal cancer (Figure 1). Patients with acute presentations had more eccentric and ulcerated lesions, with lumen obstructions greater than 90%, involving bifurcations and resulting in worse SYNTAX and Leaman scores compared to chronic coronary artery disease (p values < 0.01 for all). Post-matching, 234 ACSC and ACSNC patients were compared, revealing heightened atherosclerotic burden in ACSC, evidenced by elevated SYNTAX scores and complex lesions (p < 0.01). This group also showed a higher prevalence of complex lesions in the proximal thirds of the vessels, with statistical correlation (p = 0.003), as shown on Figure 2.

Conclusion: Cancer was associated with a greater atherosclerotic burden and greater complexity of coronary lesions in patients with ACS when compared to those without history of cancer. These findings underscore the impact of cancer on exacerbating cardiovascular complexity in ACS individuals, emphasizing the need for comprehensive management strategies in this population.