title: Long-term outcome and medical radiation exposure in patients hospitalized for cardiovascular disease.
abstract: BACKGROUND
  Low radiation doses from diagnostic and therapeutic procedures may increase cancer incidence after decades in cardiac patients. The aim of the study was to evaluate the long-term outcome and the prognostic effect of radiological exposure.
  
  
  METHODS
  A retrospective cohort study examined 16,311 Italian cardiac patients without cancer consecutively hospitalized between 1970 and 2009 and followed-up for a median of 10 years. Cumulative estimated effective dose was calculated for the imaging procedures. Main causes of death and primary cancer onset were the end points and their relation with radiation exposure was analyzed by Cox model.
  
  
  RESULTS
  Over the years, there was an increasing trend of cancer, a decreasing trend of cardiovascular, with stability of other-causes death. Cumulative estimated effective radiation dose was higher in patients who died for cancer (20 ± 19 mSv) compared to cardiovascular (17 ± 17, P < 0.001) and other-causes deaths (15 ± 17, p < 0.001). The cumulative estimated effective dose adjusted HR was 1.004 (95% CI 1.000-1.009, p = 0.045) for cancer death and 1.008 (95% CI 1.005-1.011, p < 0.001) for (fatal and non-fatal) cancer onset. Radiation effective dose was not predictive of cardiovascular mortality (HR = 0.991), nor it was of other types of deaths (HR = 0.995). Smoking was a predictor for cardiovascular mortality, but it was not of other types of deaths.
  
  
  CONCLUSIONS
  Non-cardiovascular causes of death are responsible for almost half of later deaths in cardiac patients. The radiological exposure from medical imaging procedures is predictive of cancer risk and cancer death.
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy. Electronic address: clara@ifc.cnr.it.
authors.forename: Clara
authors.initials: C
authors.lastname: Carpeggiani
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Landi
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Michelassi
authors.affiliation: Medical Physics Department, University Hospital 'Maggiore della Carità', Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Brambilla
authors.affiliation: Cardiology Division, Campo di Marte Hospital, Lucca, Italy.
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.affiliation: CNR Institute of Clinical Physiology, Pisa, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057791:Cardiac Imaging Techniques / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D000067562:Late Onset Disorders / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000209:etiology / Q000401:mortality*; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors
keywords: Cancer; Death; Imaging; Radiation