Women with breast implants have a higher rate of cardiac catheterization but a lower rate of percutaneous coronary intervention suggesting breast implant interference leads to higher false positive rates of cardiac stress imaging

Abstract

BackgroundBreast implants cause attenuation during myocardial perfusion imaging (SPECT) and interfere with echocardiographic acoustic windows, which may cause false positive results. We hypothesized that false positive cardiac testing would lead to a lower rate of percutaneous intervention (PCI) in patients with breast implants who underwent cardiac catheterization.MethodsUsing ICD 10 codes for breast implants, cardiac catheterization, and percutaneous coronary interventions, we evaluated any association between these cardiac procedures and older adult women with breast implants.ResultsA total of 1,681,135 women 50 or older underwent cardiac catheterization and 792,760 of them underwent PCI. The total number of patients with breast implants who underwent cardiac catheterization was 1,980 (1.99%). The rate of cardiac catheterization was similar (2.99% vs 3.30%, p= 0.06). However, after multivariate adjustment, women with breast implants had a significantly higher rate of cardiac catheterization (OR: 1.12, CI: 1.00-1.25, P=0.05). Furthermore, women after undergoing cardiac catheterization had a lower unadjusted and adjusted rate of PCI (36.93% vs 47.08%, <0.001, unadjusted OR: 0.66, CI: 0.54-0.80, adjusted OR:0.79, CI: 0.64-0.97, p=0.02). Sensitivity analyses using different age cutoffs showed a similar pattern of findings.ConclusionsWomen with breast implants who underwent cardiac catheterization had significantly lower adjusted rates for PCI consistent with our hypothesis that breast implants may lead to higher false positive rates during cardiac ischemia testing. Therefore, women who consider breast implants should be informed about interference with cardiac diagnostic procedures.