Coronary revascularization and mortality in men with congestive heart failure or prior myocardial infarction who receive androgen deprivation.
BACKGROUND
A study was undertaken to determine the impact of prior coronary revascularization (angioplasty, stent, or coronary artery bypass graft) on the risk of all-cause mortality after neoadjuvant hormonal therapy (HT) for prostate cancer (PC) in men with a history of coronary artery disease (CAD)-induced congestive heart failure (CHF) or myocardial infarction (MI).


METHODS
Among 7839 men who received radiation with or without a median of 4 months of HT for PC from 1991 to 2006, 495 (6.3%) had CAD-induced CHF or MI and formed the study cohort. Of these men, 250 (50.5%) had been revascularized before treatment for PC. Cox regression was used to determine whether HT increased the risk of all-cause mortality, and whether revascularization altered this risk, after adjusting for known PC prognostic factors and a propensity score for revascularization.


RESULTS
Median follow-up was 4.1 years. Neoadjuvant HT was associated with an increased risk of all-cause mortality (28.9% vs 15.7% at 5 years; adjusted hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.13-2.64; P = .01). Men who received HT without revascularization had the highest risk of all-cause mortality (33.3%; adjusted HR, 1.48; 95% CI, 1.01-2.18; P = .047), whereas men who were revascularized and did not receive HT had the lowest risk of all-cause mortality (9.4%; adjusted HR, 0.51; 95% CI, 0.28-0.93; P = .028). The reference group had an intermediate risk of all-cause mortality (23.4%) and was comprised of men in whom HT use and revascularization were either both given or both withheld.


CONCLUSIONS
In men with a history of CAD-induced CHF or MI, neoadjuvant HT is associated with an excess risk of mortality, which appears to be reduced but not eliminated by prior revascularization.
Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. pnguyen@LROC.harvard.edu
Paul L
PL
Nguyen
Ming H
MH
Chen
Samuel Z
SZ
Goldhaber
Neil E
NE
Martin
Clair J
CJ
Beard
Daniel E
DE
Dosoretz
Michael J
MJ
Katin
Rudi
R
Ross
Sharon A
SA
Salenius
Anthony V
AV
D'Amico
D000726:Androgen Antagonists / Q000009:adverse effects*; D017130:Angioplasty / Q000009:adverse effects; D001918:Brachytherapy; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000601:surgery*; D020360:Neoadjuvant Therapy; D011471:Prostatic Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D012306:Risk; D015607:Stents
D000726:Androgen Antagonists