Comparative Analysis of Radial Versus Femoral Diagnostic Cardiac Catheterization Procedures in a Cardiology Training Program.

OBJECTIVES: This study was conducted to evaluate the differences in the procedural variables between transradial and transfemoral access for coronary angiography, with cardiology fellows as the primary operators.

METHODS: This was a retrospective study of 163 radial and 180 femoral access diagnostic cardiac catheterization procedures, and involved cardiology fellowship trainees as primary operators.

RESULTS: The radial approach was associated with significantly higher fluoroscopy time (8.0 ± 6.97 min vs 4.25 ± 3.01 min; P<.001), dose area product (10775 ± 6724 μGy/m² vs 7952 ± 4236 μGy/m²; P<.001), procedure time (38.31 ± 12.25 min vs 27 ± 17.56 min; P<.001), procedure start to vascular access time (8.24 ± 6.31 min vs 5.31 ± 4.59 min; P<.001), and vascular access to procedure end time (30 ± 15.34 min vs 21.2 ± 9.57 min; P<.001). These differences persisted after adjusting for patients with bypass grafts and additional imaging (P<.001). The contrast amount was not significantly different between the two groups (P=.12). Procedure start to vascular access time improved significantly with fellowship training year in both the radial (9.57 ± 6.96 min vs 8.23 ± 6.08 min vs 5.57 ± 4.82 min) and femoral groups (6.17 ± 5.07 min vs 5.47 ± 4.75 min vs 4.01 ± 3.31 min). Fluoroscopy time showed significant difference in only the femoral access group (P=.01). Dose area product did not improve with training in either access group.

CONCLUSION: Radial procedures were associated with higher radiation dose and longer procedure time. Despite decrease in total procedural time for radial cases with the level of training, total radiation dose did not decrease.