Major adverse cardiovascular events during elective chemotherapy admissions: Incidence, predictors, and in-hospital outcomes.

Abstract

e24020 Background: Cardiovascular complications represent a major source of morbidity among patients receiving systemic chemotherapy, yet contemporary data describing acute cardiovascular events during elective chemotherapy hospitalizations are limited. While prior studies have focused on long-term cardiotoxicity, the incidence, predictors, and short-term clinical impact of major adverse cardiovascular events (MACE) occurring during planned inpatient chemotherapy admissions remain poorly characterized. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS). Adult elective hospitalizations involving chemotherapy administration were identified using ICD-10-PCS codes. MACE was defined as a composite of acute MI, ischemic stroke, acute heart failure, or malignant arrhythmias. Multivariable survey-weighted logistic regression models were used to identify predictors of MACE and to evaluate associations with in-hospital mortality and resource utilization, adjusting for demographics, comorbidities, metastatic disease, and hospital characteristics. Results: Among 7,874,281 elective chemotherapy hospitalizations, 5.8% experienced at least one MACE. Patients with MACE were older (65.4 vs 38.8 years, p < 0.001) and more frequently male (55.1% vs 44.8%, p < 0.001). Independent predictors of MACE included older age (aOR 1.03), African American race versus White (aOR 1.21), obesity (aOR 1.30), obstructive sleep apnea (aOR 1.42), coronary artery disease (aOR 3.48), hyperlipidemia (aOR 1.47), peripheral vascular disease (aOR 1.35), sepsis (aOR 3.26), and anemia (aOR 1.31) (all p < 0.001). Female sex was independently protective (aOR 0.92). Solid tumors were associated with lower odds of MACE compared with hematologic malignancies (aOR 0.17). Metastatic disease and tumor lysis syndrome were not independently associated with MACE. MACE was strongly associated with increased in-hospital mortality (aOR 4.83), higher total hospitalization costs (+$78,844), and longer length of stay (+2.85 days) (all p < 0.001). Conclusions: MACE occurs in nearly 1 in 17 elective chemotherapy hospitalizations and is associated with substantial increases in mortality, length of stay, and healthcare costs. Patients with hematologic malignancies and pre-existing cardiovascular comorbidities are at particularly high risk. These findings highlight the need for improved cardiovascular risk stratification and inpatient monitoring strategies during elective chemotherapy admissions.