Prediction of mortality, bleeding, and ischaemic events in patients with cancer and acute coronary syndrome: a model development and validation study
Authors' conclusion
The ONCO-ACS score provides a validated practical tool for predicting mortality, bleeding, and ischaemic risk in patients with cancer and acute coronary syndrome.
Study context
- Population
- Patients with cancer and ACS in England, UK, Sweden and Switzerland, Jan 1, 2004–Aug 8, 2023ACS
- Participants
- 1,017,759 patients
- Comparison
- Internal validation vs English Midlands vs Sweden vs Switzerland
- Swedenn = 194,059
- Switzerlandn = 8,530
- Outcome
- Prediction of all-cause mortality, major bleeding and ischaemic events (CV death, MI, ischaemic stroke) by the ONCO-ACS score
- Follow-up
- 6 months
Methodological detailsmachine learning, competing risks framework, external validation, multinational
- Machine learning
- Competing risks framework
- External validation
- Multinational
Performance
As reported in the abstract
tAUC at 6 months
| Test or model | tAUC all-cause mortality | tAUC major bleeding | tAUC ischaemic events |
|---|---|---|---|
| Internal validation | 0.84 (0.83-0.85) | 0.70 (0.68-0.73) | 0.79 (0.78-0.81) |
| English Midlands | 0.84 [0.82-0.85] | 0.70 [0.67-0.74] | 0.76 [0.74-0.78] |
| Sweden | 0.80 [0.79-0.82] | 0.67 [0.65-0.70] | 0.70 [0.69-0.72] |
| Switzerland | 0.83 [0.76-0.91] | 0.74 [0.57-0.91] | 0.73 [0.61-0.86] |
tAUC all-cause mortality
Internal validation0.84 (0.83-0.85)
English Midlands0.84 [0.82-0.85]
Sweden0.80 [0.79-0.82]
Switzerland0.83 [0.76-0.91]
tAUC major bleeding
Internal validation0.70 (0.68-0.73)
English Midlands0.70 [0.67-0.74]
Sweden0.67 [0.65-0.70]
Switzerland0.74 [0.57-0.91]
tAUC ischaemic events
Internal validation0.79 (0.78-0.81)
English Midlands0.76 [0.74-0.78]
Sweden0.70 [0.69-0.72]
Switzerland0.73 [0.61-0.86]
Further findings
Cumulative incidence in patients with cancer and ACS
- All-cause mortality
- 27.8% [95% CI 27.3-28.3]
- Major bleeding
- 7.3% [7.0-7.5]
- Ischaemic events
- 16.1% [15.7-16.4]
Original publication
Prediction of mortality, bleeding, and ischaemic events in patients with cancer and acute coronary syndrome: a model development and validation study. Lancet. Published 31 January 2026. doi:10.
Summarised from the published abstract; every number is checked against it