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. Cancer 2011. © 2010 American Cancer Society. In men with a history of coronary artery disease‐induced congestive heart failure or myocardial infarction, neoadjuvant hormonal therapy is associated with an excess risk of mortality, which appears to be reduced but not eliminated by prior revascularization. Hormonal therapy must be used cautiously in such men, even if they have been revascularized.