Temporal Changes in Treatments and Outcomes After Acute Myocardial Infarction Among Cancer Survivors and Patients Without Cancer, 1995 to 2013

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 beta-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. (C) 2017 American Cancer Society.