Dr. Muhammad Tariq Farman MBBS; FCPS (Cardiology) Senior Registrar KIHD

1. Comparison of Operator Radiation exposure during Coronary Angiograms and Interventions by Radial and Femoral routes – -Can we decrease the risk with increased experience? Dr. Muhammad Tariq Farman MBBS; FCPS (Cardiology) Senior Registrar KIHD (Former Fellow of Interventional Cardiology NICVD, Karachi) Co Authors: NaveedUllah Khan, Abdul Ghaffar Khan, TahirSaghir, SyedNadeemHasanRizvi,Jawaid A. Sial, Khan Shah Zaman

2. Background • Radial route of access is being increasingly used for coronary angiography and intervention • Radiation exposure of operators was significantly high with radial access • Radiation exposure of our operators was not known either with femoral or radial route • Can we decrease the radiation exposure with increased experience?

3. Aims and object • Compare the femoral arterial route radiation exposure with radial arterial route radiation exposure • Determine the relationship of operators experience with radiation exposure

4. Materials and Methods • Conducted at Cath Lab NICVD, from July 1st 2009 to September 30, 2009 • 1,016 patients enrolled, who came for angiography and/or intervention • Patients came for RHC and valvuloplasty were excluded • Written informed consent was taken and questionnaire was filled regarding demographic features and risk factors

5. Materials and Methods • Fluoroscopy time was taken as a surrogate of radiation exposure & Fluoro time was recorded after each procedure • Majority of operators were unaware about the study (14 out of 20) • Route of access, switch over, no. of catheters, volume of contrast, anatomical variations and LMCA involvement were also noted

6. Materials and Methods • Fluoro time of f-CA was separately analyzed in consultants (well experienced), Fellows (less experience), & PG trainees. • Fluoro time of r-CA was analyzed separately in well experienced (> 500 r-CA), less experienced (300-500 r-CA), trainee (<200 r-CA).

7. Results • 1,016 consecutive adult patients were enrolled • 928 were diagnostic coronary angiograms • f – CA ---- 734 (79%) • r – CA ---- 194 (21%) • 88 were Percutaneous Coronary Interventions • f – PCI ---- 64 (72.7 %) • r – PCI ---- 24 (27.2 %)

8. Femoral vs Radial Angiography Baseline characteristics

9. Femoral vs Radial Angiography Procedural Characteristics

10. Femoral vs Radial Angiography

11. Femoral vs Radial PCI Baseline Characteristics

12. Femoral vs Radial PCIProcedural Characteristics

13. Femoral vs Radial PCI Procedural Characteristics

14. Radiation Exposure! Can we decrease the risk with increased Experience?

15. f-CA-- factors affecting fluoro time Univariate Analysis

16. f-CA-- factors affecting fluoro time Multivariate Analysis

17. r-CA-- factors affecting fluoro time Univariate Analysis

18. r-CA-- factors affecting fluoro time Multivariate Analysis

19. Review of Literature • Meta analysis of 23 randomized trials (n=7020) revealed ----radial access was associated with a longer fluoroscopy time with a weighted mean difference (WMD) 0.4 minutes (95 % CI 0.3-0.5 minutes, P <0.001). Jolly et al. Am Heart J 2009 ;157:132-40

20. Review of Literature

21. Conclusion • Increased radiation exposure of operators is a serious health problem for the interventional cardiologist. • Radiation exposure can be minimized with increased experience. • Pure Radialists are more exposed to radiation, even well experienced operators can not minimize their exposure as low as femoral operators. • Extensive use of specific protection devices should be used by pure Radialists • Use of radial route for every patient should be reconsidered in the light of present findings.