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Temporal changes in treatments and outcomes after acute myocardial infarction among cancer survivors and patients without cancer, 1995 to 2013
Author(s) -
Gong Inna Y.,
Yan Andrew T.,
Ko Dennis T.,
Earle Craig C.,
Cheung Winson Y.,
Peacock Stuart,
Hall Marlous,
Gale Chris P.,
Chan Kelvin K. W.
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31174
Subject(s) - medicine , myocardial infarction , cancer
BACKGROUND There is a paucity of information about treatment and mortality trends after acute myocardial infarction (AMI) for cancer survivors (CS). METHODS In this population‐based study, the authors compared temporal trends of treatments and outcomes (mortality, nonfatal cardiovascular outcomes), among CS and patients without cancer (the noncancer patient [NCP] group) with AMI in Ontario (Canada) using inverse probability treatment weight (IPTW)‐adjusted modeling. RESULTS Of 270,089 patients with AMI (22,907 CS, 247,182 NCP, 1995‐2013; median follow‐up, 10.1 and 11.0 years, respectively), the use of invasive coronary strategies and pharmacotherapies increased and mortality declined for CS and NCP (all P trend < .001). At 30 days after AMI, there was no difference between CS and NCP in the receipt of coronary angiography (incidence risk ratio [IRR], 0.98; 95% confidence interval [CI], 0.96‐1.01; P = .23), percutaneous coronary intervention (IRR, 0.98; 95% CI, 0.94‐1.02; P = .29), or bypass (IRR, 0.93; 95% CI, 0.85‐1.02; P = .11). At 90 days after AMI, there was no difference in the receipt of β‐blockers, clopidogrel, or nitrates; but CS were less often prescribed angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers and statins. CS had higher all‐cause mortality at 30 days (adjusted hazard ratio [HR] 1.12; 95% CI, 1.07‐1.17; P < .001), at 1 year (1.16; 95% CI, 1.12‐1.20; P < .001), and long term (HR, 1.21; 95% CI, 1.17‐1.25; P < .001) and had a greater risk of heart failure (HR, 1.08; 95% CI, 1.03‐1.14; P = .001), but not myocardial re‐infarction (HR, 0.98; 95% CI, 0.95‐1.01; P = .22) or stroke (HR, 1.06; 95% CI, 0.97‐1.16; P = .18). CONCLUSIONS Among CS and NCP with AMI in Ontario, similar improvements in mortality and receipt of treatments were observed between 1995 and 2013. However, compared with NCP, CS had a higher risk of mortality and heart failure. Cancer 2018;124:1269‐78. © 2017 American Cancer Society .