OBJECTIVES: Cancer survivorship status among patients evaluated for chest pain 
at the emergency department (ED) warrants high degree of suspicion. However, it 
remains unclear whether cancer survivorship is associated with different risk of 
major adverse cardiac events (MACE) compared to those with no history of cancer. 
Furthermore, while HEART score is widely used in ED evaluation, it is unclear 
whether it can adequately triage chest pain events in cancer survivors. We 
sought to compare the rate of MACE in patients with a recent history of cancer 
in remission evaluated for acute chest pain at the ED to those with no history 
of cancer, and compare the performance of a common chest pain risk 
stratification score (HEART) between the two groups.
METHODS: We performed a secondary analysis of a prospective observational cohort 
study of chest pain patients presenting to the EDs of three tertiary care 
hospitals in the USA. Cancer survivorship status, HEART scores, and the presence 
of MACE within 30 days of admission were retrospectively adjudicated from the 
charts. We defined patients with recent history of cancer in remission as those 
with a past history of cancer of less than 10 years, and currently cured or in 
remission.
RESULTS: The sample included 750 patients (age: 59 ± 17; 42% females, 40% 
Black), while 69 patients (9.1%) had recent history of cancer in remission. A 
cancer in remission status was associated with a higher comorbidity burden, 
older age, and female sex. There was no difference in risk of MACE between those 
with a cancer in remission and their counterparts in both univariate [17.4 vs. 
19.5%, odds ratio (OR) = 0.87 (95% confidence interval (CI), 0.45-1.66], P = 
0.67] and multivariable analysis adjusting for demographics and comorbidities 
[OR = 0.62 (95% CI, 0.31-1.25), P = 0.18]. Patients with cancer in remission had 
higher HEART score (4.6 ± 1.8 vs. 3.9 ± 2.0, P = 0.006), and a higher proportion 
triaged as intermediate risk [68 vs. 56%, OR = 1.67 (95% CI, 1.00-2.84), P = 
0.05]; however, no difference in the performance of HEART score existed between 
the groups (area under the curve = 0.86 vs. 0.84, P = 0.76).
CONCLUSIONS: There was no difference in rate of MACE between those with recent 
history of cancer in remission compared to their counterparts. A higher 
proportion of patients with cancer in remission was triaged as intermediate risk 
by the HEART score, but we found no difference in the performance of the HEART 
score between the groups.