title: Transradial access and radiation exposure in diagnostic and interventional coronary procedures.
abstract: BACKGROUND
  Although transradial access (TRA) is being increasingly used in interventional cardiology, there are concerns about a possible increase in radiation exposure (RE) as compared to transfemoral access (TFA).
  
  
  METHODS
  In this retrospective study, we aimed to compare RE during coronary angiography and percutaneous coronary intervention (PCI) according to the vascular access route (TRA vs TFA). We included all procedures performed in our laboratory, in which RE data (dose area product, cGy•cm²) were available, from May 2009 to May 2013. Both multiple linear regression analysis and propensity score matching were performed in order to compare RE between TRA and TFA after adjusting for clinical and procedural confounders.
  
  
  RESULTS
  DAP values were available for 1396 procedures; TRA rate was 82.6%. TRA patients were younger, less frequently female, and had higher body mass index as compared to TFA patients; the rates of PCI, ad hoc PCI, bypass angiography, thrombus aspiration, and primary angioplasty, as well as the number of stents implanted, fluoroscopy time, and contrast dose were significantly higher in TFA. Median DAP value was significantly higher in TFA than in TRA (9670 cGy•cm² vs 7635 cGy•cm²; P<.01). After adjusting for clinical and procedural confounders, vascular access was not found to be an independent predictor of RE at multiple regression analysis; this was also confirmed by stratified comparison of DAP values by quintiles of propensity score.
  
  
  CONCLUSIONS
  After adjusting for clinical and procedural confounders, TRA was not found to be associated with increased RE as compared to TFA in an experienced TRA center.
authors.affiliation: UOSD Emodinamica Interventistica, Ospedale Sandro Pertini, Via dei Monti Tiburtini 385, 00157 Roma, Italy. stefanorigattieri@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Sven
authors.initials: S
authors.lastname: Drefahl
authors.forename: Eleonora
authors.initials: E
authors.lastname: Mussino
authors.forename: Maria
authors.initials: M
authors.lastname: Cera
authors.forename: Cristian
authors.initials: C
authors.lastname: Di Russo
authors.forename: Silvio
authors.initials: S
authors.lastname: Fedele
authors.forename: Francesco Rocco
authors.initials: FR
authors.lastname: Pugliese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D011834:Radiation Monitoring / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012189:Retrospective Studies; D013997:Time Factors