Breast implant is associated with higher positive cardiac testing leading to a higher utilization of coronary angiography despite lower presence of coronary disease

Background: Breast implants interfere with myocardial perfusion imaging (SPECT) and echocardiographic windows leading to increased false positive results. To validate this concept, we hypothesized that patients with breast implants should have higher positive cardiac testing and coronary angiogram with lower percutaneous coronary intervention (PCI) rates compared to women without a breast implant. Methods Using ICD 10 codes for breast implants, abnormal results of cardiac functional study, coronary angiogram, and percutaneous coronary interventions, we evaluated any association between these parameters in adult women with breast implants utilizing the National Inpatient Sample (NIS) database. Results A total of 45,015 women had abnormal cardiac functional studies. A total of 1,871,335 women 18 or older underwent coronary angiography and 865,020 of them underwent PCI. Women with breast implants were 10 years younger with abnormal cardiac functional tests (55.06 vs 65.06 years, p < 0.001). Furthermore, the breast implant cohort had a higher abnormal cardiac functional study which was significant after adjusting for age and comorbidities (OR1.4, CI 0.89-2/28, p = 0.02). Adult women with breast implants had also a significantly higher rate of coronary angiography after age and multivariate adjustment (OR: 1.3, CI: 1.18–1.46, P < 0.001) but a lower rate of PCI (35.7% vs 46.2%, P < 0.001, unadjusted OR: 0.65, CI 0.54–0.78, adjusted OR 0.78, CI 0.65–0.95, P = 0.01). Conclusions Women with breast implants had higher adjusted positive cardiac functional studies, higher rates of coronary angiography, and 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.