title: Leukemia Risk After Cardiac Fluoroscopic Interventions Stratified by Procedure Number, Exposure Latent Time, and Sex: A Nationwide Population-Based Case-Control Study.
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.
authors.affiliation: From the Department of Dermatology (K-CW, C-SW), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Clinical Medicine (K-CW), College of Medicine, National Cheng Kung University, Tainan; Faculty of Yuhing Junior College of Health Care and Management (K-CW), Kaohsiung; Department of Radiation Oncology (H-YL, S-KH, M-SL, BJS, S-JT, W-TT, L-CC, W-YC), Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; School of Medicine (H-YL, S-KH, M-SL, B-JS, Y-CS, W-YC), Tzu Chi University, Hualien; Master Degree Program in Aging and Long-Term Care (Y-TH), College of Nursing, Kaohsiung Medical University; Department of Cardiology (W-HW), Kaohsiung Veterans General Hospital, Kaohsiung; Division of Hematology Oncology (Y-CS), Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; Department of Biomedical Imaging and Radiological Sciences (W-TT), National Yang-Ming University, Taipei; Department of Public Health (C-YL, W-YC), College of Medicine, National Cheng Kung University, Tainan; and Department of Public Health (C-YL), China Medical University, Taichung, Taiwan.
authors.forename: Kai-Che
authors.initials: KC
authors.lastname: Wei
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Shih-Kai
authors.initials: SK
authors.lastname: Hung
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Huang
authors.forename: Moon-Sing
authors.initials: MS
authors.lastname: Lee
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Wang
authors.forename: Chieh-Shan
authors.initials: CS
authors.lastname: Wu
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.forename: Bing-Jie
authors.initials: BJ
authors.lastname: Shen
authors.forename: Shiang-Jiun
authors.initials: SJ
authors.lastname: Tsai
authors.forename: Wei-Ta
authors.initials: WT
authors.lastname: Tsai
authors.forename: Liang-Cheng
authors.initials: LC
authors.lastname: Chen
authors.forename: Chung-Yi
authors.initials: CY
authors.lastname: Li
authors.forename: Wen-Yen
authors.initials: WY
authors.lastname: Chiou
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D007938:Leukemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012737:Sex Factors; D013997:Time Factors