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Estimating incidence of organ cancer related to PCI radiation exposure in patients treated for acute and chronic total occlusions.

BACKGROUND
Minimal data exist on the number of additional cancer cases related to radiation exposure following percutaneous coronary intervention (PCI). The aim of this study is to estimate the lifetime attributable risk (LAR) of cancer incidence for individual organs following radiation exposure during PCI in the context of two opposite sides of the angiographic spectrum of coronary occlusive disease: ST-elevation myocardial infarction (STEMI) and chronic coronary total occlusion (CTO).


METHODS AND RESULTS
We identified all consecutive patients treated with PCI for STEMI (n = 555) and for CTO (n = 543) in a tertiary care center in 6 years. The LARs of cancer incidence for 6 organs were estimated using the Biological Effects of Ionizing Radiation (BEIR) VII model. The estimated LAR of cancer incidence for individual organs was found to markedly increase as the age of the patient decreased and was significantly higher for the lung (additional risk up to 18/100,000 persons exposed in CTO and 9/100,000 persons exposed in STEMI patients, respectively; P<.0001) and for the red bone marrow (up to 3.5/100,000 persons exposed and 1.5/100,000 persons exposed, respectively; P<.0001).


CONCLUSION
In PCI procedures, the lung was the organ with the highest radiation absorbed. The number of additional estimated cancer cases for individual organs was on average two times higher in patients treated with PCI for CTO and the highest estimated LARs were for lung and red bone marrow cancers.