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 Ptrend < .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.