Association Between Prostate Cancer and Myocardial Infarction Management and Postinfarction Outcomes: A Norwegian Registry Study

BACKGROUND: Prostate cancer (PCa) is the most frequently diagnosed cancer in men in Norway. With improving survival rates, cardiovascular disease, including acute myocardial infarction (AMI), has emerged as a leading cause of morbidity and death among patients with PCa. PCa and cardiovascular disease have several important overlaps, including shared risk factors, and certain PCa treatments may increase the risk of cardiovascular disease. The aim of this study was to compare rates of invasive management, in-hospital complications, major adverse cardiovascular events, reinfarction, and death, as well as prescription of guideline-recommended secondary prevention following an AMI, between patients with PCa and the general male population with AMI. METHODS: Nationwide registry-based data were used to identify all men aged 40 to 85 years in Norway who had their first AMI during 2013 to 2019. We compared outcomes after AMI between those diagnosed with localized PCa between 2004 and 2019 and the general AMI population using logistic and cause-specific Cox regression. RESULTS: A total of 34 362 patients with AMI were included, of whom 1405 (4.1%) had PCa. There were no significant differences in rates of invasive management or secondary medical treatment after AMI between patients with PCa and patients without cancer. Patients with PCa had a lower risk of overall in-hospital complications (odds ratio, 0.77 [95% CI, 0.64-0.92]) but a higher risk of serious bleeding (odds ratio, 1.66 [95% CI, 1.08-2.44]). Major adverse cardiovascular event and reinfarction rates were similar between the groups. One-year survival was better in patients with PCa (hazard ratio, 0.82 [95% CI, 0.69-0.98]). CONCLUSIONS: Standard AMI treatment protocols can be applied to patients with localized PCa, although increased attention to bleeding risk is warranted.