Association between prostate cancer and myocardial infarction management and post-infarction outcomes: A Norwegian registry study

Background and aims Prostate cancer (PCa) is the most frequently diagnosed cancer in men in Norway and as survival rates improve cardiovascular disease (CVD) has emerged as a primary cause of morbidity and mortality, including acute myocardial infarction (AMI). Cancer and CVD share some important risk factors and PCa treatment may increase the risk of CVD. The aim of this study was to compare rates of invasive management, in-hospital complications, major adverse cardiovascular events (MACE), re-infarction and death, as well as prescription of guideline recommended secondary pharmacological prevention after an AMI between PCa patients and the general male AMI population. Methods Data included nation-wide registry data to identify all males 40-85 years in Norway who had their first AMI during 2013-2019. We compared outcomes after AMI between those diagnosed with localized PCa between 2004-2019 and the general AMI population using logistic and cause-specific Cox regression. Results 34,362 AMI patients were included, of whom 1405 (4.1%) had PCa. No differences were observed in invasive management or secondary medical treatment post-AMI between PCa patients and non-cancer patients. While PCa patients had a lower risk of overall complications (OR 0.77; 0.64-0.92), they experienced an increased risk of serious bleeding (OR 1.66; 1.08-2.44) and no difference in MACE or re-infarction events. PCa patients had better 1-year survival (HR 0.82; 0.69-0.98). Conclusions There was no evidence of reduced quality of AMI care for PCa patients in Norway. These findings support treatment of AMI as usual for localized PCa patients, but with attention to increased bleeding risk. Key learning points What is known Evidence from studies evaluating quality of care and outcomes of cancer patients after an acute myocardial infarction have found that those with cancer are more likely to receive poorer quality of care and have worse outcomes, compared to non-cancer patients. Prostate cancer is one of the most frequently diagnosed cancers in men, and as survival rates improve, cardiovascular disease has emerged as a primary cause of morbidity and mortality, including acute myocardial infarction. What the study adds There was no evidence that non-metastatic prostate cancer patients receive reduced quality of care when they experienced an acute myocardial infarction or that they were at higher risk of adverse outcomes in the following year. Overall, risk of in-hospital complications was lower in prostate cancer patients, except for serious bleeding, which was more likely. Non-metastatic prostate cancer patients should receive usual treatment for a myocardial infarction but with individualized consideration of their higher risk of bleeding. Non-standard abbreviations and acronyms ADT = androgen deprivation therapy; CCI = Charlson comorbidity index; NorPD = Norwegian Prescription Database; NORMI = Norwegian Myocardial Infarction Quality Registry PCa = prostate cancer