Women with breast implants had a significantly higher rate of abnormal cardiac functional test results than those without implants, a recent retrospective analysis has found. They also had an increased rate of cardiac catheterisation and a lower rate of PCI (percutaneous coronary intervention).
Researchers also concluded the reliability and validity of non-invasive cardiac tests in assessing cardiac ischaemia was hampered by the implants.
The team, led by the University of Arizona, recommended women should be thoroughly informed of the potential impact of implants on abnormal outcomes of any cardiac diagnostic test, which may lead to an increase in invasive cardiac procedures.
Challenges
They said a major challenge lies in the absence of reliable population-based estimates of implant prevalence rates because of the lack of historical registries and the availability of incomplete sales data, which have prevented reliable absolute risk assessments.
Recent studies based on routine chest X-rays have estimated the prevalence implants in the general population to be around 3% in The Netherlands and 4% in Italy, reports Medscape.
Coronary artery disease (CAD) in women tends to have a worse short- and long-term prognosis than in men and remains the leading cause of mortality globally.
Both clinical symptoms and diagnostic approaches can be challenging in women because of their lower likelihood of presenting with classic anginal symptoms and the poor performance of conventional stress tests.
Moreover, women with ischaemic signs and symptoms are more likely to have non-obstructive CAD, necessitating additional imaging and therapeutic considerations compared with men.
Recommendations for non-invasive cardiac diagnostic testing in women with suspected CAD are primarily based on evidence derived from cohort studies conducted on middle-aged men.
Most diagnostic and prognostic evidence in cardiac imaging in women and men has been derived from observational registries and reference populations, which are subject to selection bias and other biases.
A deeper understanding of gender differences and their impact on non-invasive cardiac testing in women could greatly improve clinical decision-making.
Recommendations for non-invasive cardiac diagnostic testing in women with suspected CAD are primarily based on evidence derived from cohort studies conducted on middle-aged men.
Hindrances
The interference of breast implants with cardiac diagnostic procedures is a challenge. The increasing use of these procedures in ageing women and the higher prevalence of atypical presentations of cardiac ischaemia often prompt greater reliance on cardiac diagnostic assessments.
Common methods for identifying haemodynamically significant CAD include radionuclide myocardial perfusion imaging using single-photon emission computed tomography (SPECT) and PET.
Echocardiography is also routinely employed to evaluate cardiac structures and functions, along with stress echocardiography, to assess coronary ischaemia.
The presence of silicone or saline breast implants can, however, significantly increase attenuation artefacts during both echocardiography and SPECT imaging, resulting in false-positive rates in this population.
False positives
The elevated false-positive rates in cardiac tests have prompted researchers to assess the hypothesis that women with implants experience a higher incidence of positive cardiac tests and coronary angiography associated with lower rates of percutaneous coronary interventions (PCI) than women without implants.
During the retrospective analysis using the National Inpatient Sample (NIS) database, 1 871 335 women aged 18 or older underwent coronary angiography, of whom 865 020 underwent PCI.
Those with breast implants with abnormal cardiac functional tests were 10 years younger (55.06 years vs 65.06 years; P < .001).
Additionally, the breast implant cohort had a higher adjusted abnormal cardiac functional study, even after adjusting for age, ethnicity, diabetes, hypertension, hyperlipidaemia, ST-elevation myocardial infarction, non–ST-elevation myocardial infarction, chronic kidney disease, breast cancer, and smoking (odds ratio [OR], 1.78; 95% CI, 1.22-2.68; P = .02).
Adult women with breast implants also had a significantly higher rate of adjusted coronary angiography (OR, 1.3; P < .001) but a lower rate of PCI (35.7% vs 46.2%; P < .001; unadjusted OR, 0.65; adjusted OR, 0.79; P = .01).
Key findings:
• Women with breast implants had a higher rate of abnormal cardiac functional test results than those without implants, and an increased rate of cardiac catheterisation and a lower rate of PCI.
• Breast implants interfered, significantly, with the reliability and validity of non-invasive cardiac tests in assessing cardiac ischaemia.
• Women should be thoroughly informed of the potential impact of implants on abnormal outcomes of any cardiac diagnostic test, which may lead to an increase in invasive cardiac procedures.
Study details
Women with Breast Implants Have Higher Adjusted Abnormal Cardiac Testing and Coronary Angiography but Lower Coronary Intervention
Mohammad Reza Movahed, Kyvan Irannejad, Emma Venard et al.
Published in The American Journal of Medicine in April 2025
Abstract
Background
Breast implants interfere with myocardial perfusion imaging (single photon emission computed tomography) and echocardiographic windows, leading to increased false-positive results. To validate this concept, we hypothesised that patients with breast implants should have higher positive cardiac testing and coronary angiogram with lower percutaneous coronary intervention (PCI) rates compared with women without a breast implant.
Methods
Using International Classification of Diseases, 10th Revision codes for breast implants, abnormal results of cardiac functional study, coronary angiogram, and PCIs, we evaluated any association between these parameters in adult women with breast implants utilising the National Inpatient Sample database.
Results
A total of 45,015 women had abnormal cardiac functional studies. A total of 1,871,335 women ages 18 years or older underwent coronary angiography. From those, 865,020 underwent PCI. Women with breast implants with abnormal cardiac functional tests were 10 years younger (55.06 vs 65.06 years, P < .001). Furthermore, the breast implant cohort had a higher adjusted abnormal cardiac functional study (odds ratio [OR] 1.78; 95% confidence interval [CI], 1.11-2.26; P = .02). Adult women with breast implants also had a significantly higher rate of adjusted coronary angiography (OR 1.3; 95% CI, 1.17-1.44; P < .001) but a lower rate of PCI (35.7% vs 46.2%, P < .001, unadjusted OR 0.65; 95% CI, 0.54-0.78; adjusted OR 0.79; 95% CI, 0.65-0.98; P = .01).
Conclusions
Women with breast implants had higher adjusted positive cardiac functional studies, and a higher adjusted rate of coronary angiography but lower rates of PCI, consistent with our hypothesis that breast implant interference can increase abnormal cardiac testing, leading to an increase in the utilization of coronary angiography.
Medscape article – Breast Implants Linked to Unexpected Cardiac Risks in Women (Open access)
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