9 February 2026
A new tool, known as ONCO-ACS score, has been developed following a study coordinated by clinicians at Royal Brompton Hospital. The tool is designed to help estimate the risk of death, bleeding and other complications in patients with acute coronary syndrome (ACS) who also have a history of cancer.
The study was published in the Lancet and led by Professor Thomas Lüscher, consultant cardiologist and director of research, education and development.
ACS refers to a group of diseases in which blood flow to the heart is decreased. In patients who have a history of cancer, additional risk factors such as cancer-related tissue damage or changes to how their blood clots, can further increase their risk. This makes the management of patients with both cancer and ACS challenging.
The standard care for ACS is rapidly restoring blood flow to the heart. However, individuals with cancer related characteristics require careful management, particularly with respect to secondary prevention measures and blood clotting therapy. Until recently, clinicians lacked a reliable way to make accurate assessment of risks, making it difficult to inform on personalised treatment strategies for these patients.
This study aimed to change this by developing the ONCO-ACS score, a reliable prediction tool that could inform treatments. Data was obtained from 1,017,759 patients in the UK, Sweden and Switzerland, who presented with ACS between 2004 and 2023, of whom 47,236 had cancer.
With this data, a machine-learning based approach was used to develop prediction models when determining links between characteristics of each patient and their outcomes. Prediction models were separately trained on data for patients with, and without, cancer, to enable the individual importance of each variable to be evaluated.
The output was the generation of a prediction score for a patient covering; mortality, major bleeding and ischaemic (less blood flow) events, based on key patient data points. It provides a clear risk rating, from ‘Low’ to ‘Very High’, for each outcome. The scores were externally validated using data from additional regions across the 3 countries which had not been included in the original data set.
A calculator for the ONCO-ACS score, which uses 11 routinely collected clinical variables, is available online.
When commenting on the study Professor Lüscher stated:
“We are proud to provide such a tool for a rapidly expanding patient population as cancer, due to novel treatment strategies, becomes a chronic condition. Such patients more and more also are prone to cardiovascular risk, in part due to the cancer treatment itself. The ONCO-ACS score will help physicians to provide personalised management to these patients.”
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