Abstract
Because of a presumably increased incidence of long-term malignancy in interventional cardiologists, radiation exposure of the operator (ORE) during coronary interventions is of rising concern. A few studies comparing femoral to radial or right to left radial access have been published, but no data comparing the three access sites are available to our knowledge. We sought to compare ORE by right femoral (RFA), right radial (RRA) and left radial (LRA) access during percutaneous catheterization for diagnostic coronary angiography (CA) with or without coronary angioplasty (PCI). From September 2014 to February 2015, all consecutive patients undergoing elective or emergency CA/PCI were prospectively included. Selection of the access site was left to the discretion of the cardiologist. ORE was measured using individual electronic radiation dosimeter badges positioned externally on the sternum. Radioprotection materials and equipment was similar for all procedures. Primary endpoint was ORE quantified as cumulative dose (CD) per dose-area product (DAP), in order to adjust for the administered radiation dose. In total 692 consecutive procedures, 386CA (56%) and 306PCI (44%) were performed, 380 (55%) via RFA, 232 (34%) via RRA and 80 (11%) via LRA. The CD was lower in the RFA (6.9±11.8 ∞Sv vs. RRA 26.4±54.1 μSv, p<0.001, vs. LRA 9.9±18.5 μSv, p<0.001). There was no difference in the DAP between LRA and RRA (34.4±23.8Gycm2 vs. 40.3±28.5Gycm 2 , p=0.13). The RFA demonstrated higher levels (55.3±64.3Gycm 2 ) compared to both RRA (p=0.03) and LRA (p<0.01). The adjusted ORE was significantly lower in the RFA (0.17±0.27 ∞Sv/ Gycm 2 ) compared to the RRA (0.62±0.69 ∞Sv/Gycm 2 , p<0.001) or the LRA group (0.30±0.36 ∞Sv/Gycm 2 , p<0.001), as was for the LRA compared to the RRA (p<0.001). The RFA in CA and PCI is associated with significantly lower ORE when compared to the RRA or LRA. The LRA is associated with significantly lower ORE when compared to the RRA.
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