Radiation-Linked Heart Disease Ups Death in Cardiothoracic Sx
Increasing Euro score and lack of beta-blockers also independently tied to higher mortality
TUESDAY, April 9 (HealthDay News) -- Radiation-associated heart disease (RAHD) correlates with an increased risk of death in patients undergoing cardiothoracic surgery (CTS), according to a study published online April 8 in Circulation.
Willis Wu, M.D., from the Cleveland Clinic in Ohio, and colleagues conducted a retrospective, observational study involving 173 RAHD patients (75 percent women, 63 ±14 years) and 305 age-, gender-, and time/type of CTS-matched comparison patients (74 percent women, 63 ±4 years) undergoing CTS. Clinical and surgical parameters, preoperative Euro scores, and all-cause mortality were evaluated.
The researchers found that most RAHD patients had prior breast cancer (53 percent) and Hodgkin's lymphoma (27 percent), with a mean of 18 ± 12 years from radiation. The RAHD and comparison groups had similar mean Euro scores (7.8 versus 7.4; P = 0.1). In both groups, about two-thirds of the patients had combination surgical procedures. In the RAHD group, proximal coronary artery disease was higher (45 versus 38 percent; P = 0.09), while redo CTS was significantly lower in the RAHD group (20 versus 29 percent; P = 0.02). The proportion of patients who died during a mean follow-up of 7.6 years was significantly higher in the RAHD than the comparison group (55 versus 28 percent). In multivariate analysis, increased mortality correlated with RAHD (hazard ratio [HR], 2.47), increasing Euro score (HR, 1.22), and lack of beta-blockers (HR, 0.66).
"Upon undergoing cardiothoracic surgery, despite having good procedural success, presence of radiation heart disease is independently associated with significantly worse long-term survival, as opposed to a comparison group," write the authors.