Background: The advances in the management of cancer in children, adolescents, and young adults (CAYAs) over recent decades have greatly improved prognosis. However, the risk of long-term complications persists. (1,2) It is known that cancer treatment such as chemotherapy and radiotherapy as well as conventional cardiovascular risk factors increase the risk of ischemic heart disease (IHD). (3)

Purpose: The aim was to study IHD among CAYAs and investigate mortality and revascularization compared to controls.

Method: This study utilizes the Rebuc study, a retrospective matched cohort study that includes all young (<25 years) cancer patients in Sweden between 1958 and 2021, comprising a total of 65,173 CAYAs and 312,935 controls. From the Rebuc study population, 1,486 CAYAs and 6,258 controls with IHD (ICD-10: I20-I25) were identified and compared regarding all-cause mortality, cardiovascular mortality, and revascularization (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)).

Results: The median age at index was 22 years (IQR 19–23), and at the end of the study 66 years (IQR 59–72). 801 CAYAs (54%) and 3,265 controls (52%) had myocardial infarction (ICD-10: I21)

The risk for all-cause mortality after diagnosis of IHD was 1.26-fold higher for CAYAs (Hazard ratio (HR) 95% CI 1.14-1.40, p<0.0001) and 1.20-fold higher for cardiovascular mortality (HR 95% CI 1.06-1.37, p<0.001) compared to controls. Revascularisation of any kind was registered among 47% of CAYAs and 48% of controls (p = 0.8). PCI was registered among 39% of CAYAs and 42% of controls (p = 0.045), while CABG was registered among 14% of CAYAs and 11% of controls (p = 0.001).

Conclusion: CAYAs with IHD had a higher risk of all-cause and cardiovascular mortality compared to controls. There was no difference regarding revascularization between the groups, however, CABG was more common among CAYAs while PCI was more common among controls.