Global Incidence and Mortality of Myocardial Infarction in Multi-Modality Head and Neck Cancer Treatment: A Systematic Review and Meta-analysis

Abstract

INTRODUCTION: Myocardial infarction (MI) incidence and mortality vary following multi-modality treatment for head and neck cancer (HNC). This systematic review and meta-analysis evaluate these rates. METHODS: We searched PubMed, Embase, ScienceDirect, and Web of Science (inception to March 2025) for studies reporting MI incidence or mortality after HNC treatment. A random-effects meta-analysis yielded pooled proportions. Subgroup analyses examined variations by treatment modality, time period (pre-/post-2010), and geography. RESULTS: Of 680 studies, 53 were included, encompassing 85,948 patients with HNC. The global pooled MI incidence was 1.7% (95% CI 1.2-2.3%), decreasing from 2.6% (pre-2010) to 1.5% (post-2010). Incidence was lowest with upfront surgery alone (1.2%) and higher with surgery plus adjuvant therapy (2.7%), primary chemoradiotherapy (CRT) (2.3%), radiotherapy (RT) alone (2.4%), or chemotherapy (CT) alone (2.1%). Global pooled MI mortality was 42.1% (95% CI 15.3-74.6%), declining from 49.8% (pre-2010) to 36.0% (post-2010). Male sex (p = 0.01) and longer follow-up in the RT group (p = 0.01) were associated with higher MI incidence via meta-regression; longer follow-up was also linked to higher mortality (p = 0.028). CONCLUSION: This systematic review (PROSPERO: CRD420251040579) estimated the global MI incidence post-HNC treatment to be 1.7%, with the lowest after surgery alone and no significant geographic variation. MI mortality is high (42.1%) but has decreased over time. These findings demonstrate significant cardiovascular burden associated with HNC treatment, particularly non-surgical modalities, highlighting the need for targeted cardiovascular surveillance strategies.