Risk of Hematologic Malignancies in Patients With Acute Myocardial Infarction: A Nationwide Population-Based Cohort Study

Abstract

Background: Acute myocardial infarction (AMI) and cancer are leading causes of death worldwide. However, the relationship between AMI and hematologic malignancies remains unclear.

Objectives: The authors aimed to investigate the association between AMI and the subsequent risk of incident hematologic malignancies.

Methods: This retrospective cohort study included 103,686 patients with AMI and no history of hematologic malignancies, and 103,686 age- and sex-matched individuals with no history of AMI or hematologic malignancies, diagnosed between January 1, 2003, and December 31, 2021. Data were obtained from the Korean National Health Insurance claims database. We compared the cumulative incidence of hematologic malignancies between groups using Gray's method. HRs and 95% CIs were calculated using Gray's competing risk regression model, with death treated as a competing risk.

Results: During follow-up (AMI, 7.9 years [Q1-Q3: 5.2-11.4 years]; control group, 17.8 years [Q1-Q3: 14.8-17.9 years]), 1,043 and 1,479 individuals in the AMI and control groups, respectively, were newly diagnosed with hematologic malignancies (incidence rate per 1,000 person-years: 1.21 vs 0.93). Competing risk analysis revealed that the AMI group had a higher risk of hematologic malignancy than the control group (HR: 1.49; 95% CI: 1.31-1.69). Findings were consistent in sensitivity and standardized incidence ratio analyses.

Conclusions: Patients with AMI had a higher risk of hematologic malignancies than those without AMI. These findings suggest an association between AMI and hematologic malignancies, and underscore the importance of considering hematologic malignancy development in patients with AMI.

Keywords: acute coronary syndrome; bi-directional cardio-oncology; epidemiology; hematologic malignancy; myocardial infarction; outcomes; reverse cardio-oncology.

Graphical abstract

Figure 1

Participants Selection and Follow-Up Flow Chart Patients newly diagnosed with acute myocardial infarction (AMI) between 2003 and 2016 who had a health examination within 2 years before diagnosis were included. Age- and sex-matched controls without a history of AMI or hematologic malignancies were also selected. Incident hematologic malignancies were tracked through December 2021.

Figure 2

Cumulative Incidence of Hematologic Malignancies by AMI Status The acute myocardial infarction (AMI) group had a 49.0% higher risk of hematologic malignancies compared with those without a history of AMI (HR: 1.49; 95% CI: 1.31-1.69; P < 0.0001). A multivariable Gray’s subdistribution hazard model was used to account for competing risks, adjusting for age, sex, smoking status, drinking status, regular exercise, low-income status, residential area, diabetes mellitus, hypertension, ischemic stroke or transient ischemic attack, chronic obstructive pulmonary disease, chronic liver disease, obesity (body mass index ≥25 kg/m²), and chronic kidney disease.

Central Illustration

Risk of Hematologic Malignancies in Patients With Acute Myocardial Infarction A total of 103,686 patients diagnosed with acute myocardial infarction (AMI) from the Korean National Health Insurance Service database between 2003 and 2016 were compared to 103,686 age- and sex-matched non-AMI control subjects. The incidence rate of hematologic malignancies was higher in the AMI group than in the control group (1.21% vs 0.93% per 1,000 person-years). After adjusting for all potential confounding variables, the risk of hematologic malignancies in the AMI group was 49.0% higher than that in the control group (HR: 1.49; 95% CI: 1.31-1.69).

Figure 3

Association Between AMI and Incidence of Specific Hematologic Malignancies A Gray’s competing risk regression model adjusted for age, sex, smoking status, and alcohol consumption status, regular exercise, low-income status, residential area, diabetes mellitus, hypertension, ischemic stroke or transient ischemic attack, chronic obstructive pulmonary disease, chronic liver disease, obesity (body mass index ≥25 kg/m²), and chronic kidney disease was used. AMI = acute myocardial infarction.

Figure 4

Subgroup Analysis of Hematologic Malignancy Risk in Patients With AMI A Gray’s competing risk regression model adjusted for age (years), sex, smoking status, alcohol consumption status, regular exercise, low-income status, residential area, diabetes mellitus (DM), hypertension, ischemic stroke or transient ischemic attack, chronic obstructive pulmonary disease, chronic liver disease, obesity (body mass index [BMI] ≥25 kg/m²), and chronic kidney disease was used. AMI = acute myocardial infarction.