Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex

Abstract

A number of cardiac fluoroscopic interventions have increased rapidly worldwide over the past decade. Percutaneous transluminal coronary angioplasty (PTCA) and stent implantation have become increasingly popular, and these advancements have allowed patients to receive repetitive treatments for restenosis. However, these advancements also significantly increase radiation exposure that may lead to higher cumulative doses of radiation. In the present study, a nationwide population-based case-controlled study was used to explore the risk of leukemia after cardiac angiographic fluoroscopic intervention.A total of 5026 patients with leukemia and 100,520 control patients matched for age and sex (1:20) by a propensity score method without any cancer history were enrolled using the Registry Data for Catastrophic Illness and the National Health Insurance Research Database (NHIRD) of Taiwan between 2008 and 2010. All subjects were retrospectively surveyed (from year 2000) to determine receipt of cardiac fluoroscopic interventions. Data were analyzed using conditional logistic regression models, and estimated crude and adjusted odds ratios (95% confidence interval).After adjusting for age, gender, and comorbidities, PTCA was found to be associated with an increased risk of leukemia with an adjusted OR of 1.566 (95% CI, 1.282–1.912), whereas coronary angiography alone without PTCA and cardiac electrophysiologic study were not. Our results also showed that an increased frequency of PTCA and coronary angiography was associated with a higher risk of leukemia (adjusted OR: 1.326 to 1.530 [all P < 0.05]). Gender subgroup analyses demonstrated that men were associated with a higher risk of leukemia compared with women.These results provide additional data in the quantification of the long-term health effects of radiation exposure derived from the cardiac fluoroscopic diagnostic and therapeutic intervention. PTCA alone or PTCA with coronary angiography was associated with an elevated risk of leukemia. Continued follow-up of existing cohorts will be valuable to help assess lifetime risks of cancer.

Stress Echocardiography Positivity Predicts Cancer Death

“…Cancer and ischemic heart disease share many risk factors (eg, obesity and diabetes mellitus), 18 underlying biology (eg, chronic inflammation, somatic DNA instability), 19,20 and possibly iatrogenic links (since radiation widely used in CAD diagnosis and treatment is also a risk factor for cancer, in the same wayconceptually-as radiation and drugs used for diagnosis and treatment of cancer are an established risk factor for ischemic heart disease). [21][22][23] The interaction analysis established that the relationship between SE result and cancer risk was valid both in smokers and in nonsmoker patients, which ruled out the smoking history influence on the relation between SE result and cancer.…”

“…24 For men and women aged at least 60 years at the time of the first PCI, excess risk of potentially fatal cancers attributable to radiation ranged from 0.4% to 4%. 26,27 The number of PCIs is a risk factor for subsequent development of lung cancer 28 and leukemia, 23 and contributes to the majority of the significant radiological exposure of the adult cardiology patient. 29 In a previous study in a much larger population of 16 311 inhospital cardiac patients admitted to our institution over the past 40 years, we showed that the cumulative estimated effective radiation dose from cardiologic testing was a significant predictor of cancer death and for (fatal and nonfatal) cancer onset.…”

Radiation exposure during TACE procedures using additional cone-beam CT (CBCT) for guidance: safety and precautions

“…Therefore, the number of acquisitions needs to be kept as low as reasonably necessary. Stochastic and deterministic effects such as local skin injuries or induction of leukemia due to interventional procedures needs to be considered (10,11). Hidajat et al could show that threshold doses for local transient erythema and depression of hematopoiesis are easily reachable during typical TACE sessions (12).…”

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study

“…The major characteristic of this database is its high coverage rate of medical care in a national population (ie, >99% Taiwanese). 35 Thus, results obtained from this population-based database largely represented an actual condition in a real medical world setting.…”

“…Design and conduct of the present study were approved by the Institution Review Board (IRB) of the Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (approved number, B10001019). As mentioned previously, 35–37 the IRB waived a requirement of written informed consents because permanent de-identification was conducted by the National Health Research Institute before data analysis. 36 38 39 …”