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. 2022 Jul;198(7):630-638.
doi: 10.1007/s00066-022-01927-0. Epub 2022 Apr 7.

Risk of coronary stenosis after adjuvant radiotherapy for breast cancer

A-K Wennstig  1   2 , H Garmo  3 , L Wadsten  4   5 , B Lagerqvist  6 , I Fredriksson  7   8 , L Holmberg  9   10 , C Blomqvist  11 , G Nilsson  12   13   14 , M Sund  4   15
Affiliations

Risk of coronary stenosis after adjuvant radiotherapy for breast cancer

A-K Wennstig et al. Strahlenther Onkol. 2022 Jul.

Abstract

Purpose: Adjuvant radiotherapy (RT) for breast cancer is associated with an increased risk of ischemic heart disease. We examined the risk of coronary artery stenosis in a large cohort of women with breast cancer receiving adjuvant RT.

Methods: A cohort of women diagnosed with breast cancer between 1992 and 2012 in three Swedish health care regions (n = 57,066) were linked to the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) to identify women receiving RT who subsequently underwent a percutaneous coronary intervention (PCI) due to coronary stenosis. Cox regression analyses were performed to examine risk of a coronary intervention and competing risk analyses were performed to calculate cumulative incidence.

Results: A total of 649 women with left-sided breast cancer and 494 women with right-sided breast cancer underwent a PCI. Women who received left-sided RT had a significantly higher risk of a PCI in the left anterior descending artery (LAD) compared to women who received right-sided RT, hazard ratio (HR) 1.44 (95% confidence interval [CI] 1.21-1.77, p < 0.001). For the proximal, mid, and distal LAD, the HRs were 1.60 (95% CI 1.22-2.10), 1.38 (95% CI 1.07-1.78), and 2.43 (95% CI 1.33-4.41), respectively. The cumulative incidence of coronary events at 25 years from breast cancer diagnosis were 7.0% in women receiving left-sided RT and 4.4% in women receiving right-sided RT.

Conclusion: Implementing and further developing techniques that lower cardiac doses is important in order to reduce the risk of long-term side effects of adjuvant RT for breast cancer.

Keywords: Ischemic heart disease; LAD (left anterior descending artery); PCI (percutaneous coronary intervention); Side effects; Survivorship.

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Conflict of interest statement

A.-K. Wennstig, H. Garmo, L. Wadsten, B. Lagerqvist, I. Fredriksson, L. Holmberg, C. Blomqvist, G. Nilsson, and M. Sund declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of coronary findings in women with breast cancer (BC), stratified by BC laterality and radiotherapy (RT). Left Main left main coronary artery
Fig. 2
Fig. 2
Risk of having a percutaneous coronary intervention (PCI) stratified by radiotherapy in women with breast cancer (BC) receiving left-sided radiotherapy (RT) compared to women with BC receiving right-sided RT. LAD left anterior descending artery, RCA right coronary artery, LMCA left main coronary artery, LCx left circumflex artery, HR hazard ratio, CI confidence interval
Fig. 3
Fig. 3
Risk of a percutaneous coronary intervention (PCI) stratified by a simultaneous intervention in the left anterior descending artery (LAD) in women with breast cancer (BC) receiving left-sided radiotherapy (RT) compared to women with BC receiving right-sided RT. RCA right coronary artery, LMCA left main coronary artery, LCx left circumflex artery, HR hazard ratio, CI confidence interval
See this image and copyright information in PMC

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