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Temporal changes in treatments and outcomes after acute myocardial infarction among cancer survivors and patients without cancer, 1995 to 2013.
- Source :
-
Cancer [Cancer] 2018 Mar 15; Vol. 124 (6), pp. 1269-1278. Date of Electronic Publication: 2017 Dec 06. - Publication Year :
- 2018
-
Abstract
- Background: There is a paucity of information about treatment and mortality trends after acute myocardial infarction (AMI) for cancer survivors (CS).<br />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.<br />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 <subscript>trend</subscript> < .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).<br />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.<br /> (© 2017 American Cancer Society.)
- Subjects :
- Acute Disease
Adrenergic beta-Antagonists therapeutic use
Aged
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Case-Control Studies
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Male
Middle Aged
Myocardial Infarction drug therapy
Myocardial Infarction etiology
Survival Rate
Time Factors
Treatment Outcome
Cancer Survivors statistics & numerical data
Cardiovascular Agents therapeutic use
Myocardial Infarction mortality
Neoplasms complications
Subjects
Details
- Language :
- English
- ISSN :
- 1097-0142
- Volume :
- 124
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 29211307
- Full Text :
- https://doi.org/10.1002/cncr.31174