1995 年至 2013 年间，癌症幸存者和非癌症患者急性心肌梗死后治疗方法和结局的时间变化。
Temporal changes in treatments and outcomes after acute myocardial infarction among cancer survivors and patients without cancer, 1995 to 2013.
机构信息
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
出版信息
Cancer. 2018 Mar 15;124(6):1269-1278. doi: 10.1002/cncr.31174. Epub 2017 Dec 6.
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 < .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.
背景
癌症幸存者（CS）发生急性心肌梗死（AMI）后治疗和死亡率趋势的相关信息较为匮乏。
方法
在这项基于人群的研究中，作者通过使用逆概率治疗加权（IPTW）调整模型，比较了安大略省（加拿大）CS 和无癌症患者（非癌症患者 [NCP] 组）的治疗和结局（死亡率、非致命性心血管结局）的时间趋势。
结果
在 270089 例 AMI 患者（CS 22907 例，NCP 247182 例，1995-2013 年；中位随访时间分别为 10.1 和 11.0 年）中，CS 和 NCP 中侵入性冠状动脉策略和药物治疗的使用率均有所增加，死亡率均有所下降（均 P <.001）。在 AMI 后 30 天，CS 和 NCP 之间接受冠状动脉造影的情况没有差异（发生率风险比 [IRR]，0.98；95%置信区间 [CI]，0.96-1.01；P = .23）、经皮冠状动脉介入治疗（IRR，0.98；95% CI，0.94-1.02；P = .29）或旁路（IRR，0.93；95% CI，0.85-1.02；P = .11）。在 AMI 后 90 天，β-受体阻滞剂、氯吡格雷或硝酸盐的使用没有差异；但是 CS 较少使用血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂和他汀类药物。CS 在 30 天时全因死亡率更高（调整后的危险比 [HR]，1.12；95% CI，1.07-1.17；P < .001），1 年时（1.16；95% CI，1.12-1.20；P < .001）和长期（HR，1.21；95% CI，1.17-1.25；P < .001），心力衰竭风险更高（HR，1.08；95% CI，1.03-1.14；P = .001），但心肌再梗死（HR，0.98；95% CI，0.95-1.01；P = .22）或中风（HR，1.06；95% CI，0.97-1.16；P = .18）的风险无差异。
结论
在安大略省的 CS 和 NCP 中，1995 年至 2013 年间，死亡率和治疗方法的改善情况相似。然而，与 NCP 相比，CS 的死亡率和心力衰竭风险更高。癌症 2018；124：1269-78。© 2017 美国癌症协会。
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