Abstract 4368574: Cardiovascular Events in Hospitalized Patients with Malignant Neuroendocrine Tumors: A Nationwide Analysis

Background: Malignant neuroendocrine tumors (NET) are associated with systemic effects that may predispose patients to cardiovascular complications. However, the burden and outcomes of cardiac events in this population remain poorly defined. Methods: We analyzed 148,860 hospitalizations with a diagnosis of malignant NET from the 2016–2021 National Inpatient Sample. Cardiovascular events included acute coronary syndromes (ACS), heart failure (HF), cardiac dysrhythmias, ischemic and hemorrhagic stroke. Multivariable survey-weighted logistic regression was used to identify predictors of cardiac events and their impact on in-hospital mortality and length of stay (LOS). Results: Cardiac events occurred in 23.7% of NET hospitalizations: ACS in 1.7%, HF in 11.1%, dysrhythmias in 16.2%, ischemic stroke in 0.9%, hemorrhagic stroke in 0.1%, and cardiovascular death in 9.9%. The cohort was 54.5% male, and males had 30% higher odds of cardiac events compared to females (p<0.001). The mean age among those with cardiac events was 64 years; each additional year of age increased the odds of cardiac events by 6.2% (p<0.001). White patients (73.6%) had the highest predicted probability of cardiac events (25.1%), and patients in the lower two income quartiles had similarly elevated risk (24%). Cardiac events were associated with an average increase of 1.7 days in LOS (p<0.001). The odds of in-hospital mortality were 74% higher among patients with cardiac events (OR 1.74, p<0.001). ACS was associated with the highest mortality risk (OR 2.34), followed closely by hemorrhagic stroke (OR 2.32), both doubling the odds of death. There was no significant change in mortality risk over time (2016–2021). Conclusion: Cardiovascular events affect nearly one in four hospitalized patients with malignant NET and are independently associated with longer hospitalization and higher in-hospital mortality. Male sex, older age, White race, and lower income were significant predictors of cardiac events. ACS, though infrequent, conferred the greatest mortality burden. These findings highlight the importance of cardiovascular surveillance and early intervention in patients with malignant NET.