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. 2011 Mar 8;183(4):430-6.
doi: 10.1503/cmaj.100463. Epub 2011 Feb 7.

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction

Mark J Eisenberg  1 , Jonathan Afilalo, Patrick R Lawler, Michal Abrahamowicz, Hugues Richard, Louise Pilote
Affiliations

Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction

Mark J Eisenberg et al. CMAJ. .

Abstract

Background: Patients exposed to low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction may be at increased risk of cancer.

Methods: Using an administrative database, we selected a cohort of patients who had an acute myocardial infarction between April 1996 and March 2006 and no history of cancer. We documented all cardiac imaging and therapeutic procedures involving low-dose ionizing radiation. The primary outcome was risk of cancer. Statistical analyses were performed using a time-dependent Cox model adjusted for age, sex and exposure to low-dose ionizing radiation from noncardiac imaging to account for work-up of cancer.

Results: Of the 82,861 patients included in the cohort, 77% underwent at least one cardiac imaging or therapeutic procedure involving low-dose ionizing radiation in the first year after acute myocardial infarction. The cumulative exposure to radiation from cardiac procedures was 5.3 milliSieverts (mSv) per patient-year, of which 84% occurred during the first year after acute myocardial infarction. A total of 12 020 incident cancers were diagnosed during the follow-up period. There was a dose-dependent relation between exposure to radiation from cardiac procedures and subsequent risk of cancer. For every 10 mSv of low-dose ionizing radiation, there was a 3% increase in the risk of age- and sex-adjusted cancer over a mean follow-up period of five years (hazard ratio 1.003 per milliSievert, 95% confidence interval 1.002-1.004).

Interpretation: Exposure to low-dose ionizing radiation from cardiac imaging and therapeutic procedures after acute myocardial infarction is associated with an increased risk of cancer.

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Figures

Figure 1:
Figure 1:
Relation between cumulative exposure to low-dose ionizing radiation (measured in milliSieverts) from cardiac imaging and therapeutic procedures after acute myocardial infarction and the risk of cancer during a mean follow-up period of 5.0 years. Hazard ratios (HRs) above 1.0 indicate an increased risk of cancer. Adjusted HRs were derived from models adjusted for age, sex and exposure to low-dose ionizing radiation from noncardiac procedures. *Among patients who were exposed to more than 0 mSv of radiation. Note: CI = confidence interval, mSv = milliSieverts.
See this image and copyright information in PMC

Comment in

  • Radiation exposure from medical imaging: a silent harm?
    Mercuri M, Sheth T, Natarajan MK. Mercuri M, et al. CMAJ. 2011 Mar 8;183(4):413-4. doi: 10.1503/cmaj.101885. Epub 2011 Feb 7. CMAJ. 2011. PMID: 21324851 Free PMC article. No abstract available.
  • Risks of cardiac imaging.
    Toms DA. Toms DA. CMAJ. 2011 Nov 8;183(16):1885; author reply 1885. doi: 10.1503/cmaj.111-2086. CMAJ. 2011. PMID: 22065667 Free PMC article. No abstract available.
  • Latency period of radiation-induced cancer.
    Fraser DK. Fraser DK. CMAJ. 2011 Nov 22;183(17):2017; author reply 2017. doi: 10.1503/cmaj.111-2088. CMAJ. 2011. PMID: 22106106 Free PMC article. No abstract available.

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