KUMJ | VOL. 24 | NO. 3 | ISSUE 96 | JULY-SEPTEMBER, 2026

Clinical and Procedural Determinants of Cumulative Air Kerma During Coronary Angiography and Percutaneous Coronary Intervention: A Prospective Observational Study
KC B, Gautam S, Dhungel S, Shakya A, Khan M, Ghimire JP, Thapa B

Abstract:
Background Radiation exposure remains an important safety concern during fluoroscopy-guided coronary procedures. Cumulative air kerma is a useful indicator of patient radiation exposure. Objective To identify clinical and procedural determinants of radiation exposure, measured as cumulative air kerma, during coronary angiography and percutaneous coronary intervention. Method We prospectively studied 723 consecutive patients undergoing coronary angiography and/or percutaneous coronary intervention between June 15, 2025, and June 15, 2026. Demographic, clinical, angiographic, procedural, and radiation exposure data were collected. Univariable analyses identified factors associated with logtransformed cumulative air kerma, followed by multivariable linear regression to determine independent predictors. Result Of 723 procedures, 353 (48.8%) were diagnostic coronary angiography and 370 (51.2%) were percutaneous coronary intervention. Procedure type, vascular access, fluoroscopy time, number of vessels and lesions treated, total stent length, and number of implanted stents was significantly associated with log-transformed cumulative air kerma in univariable analysis (all p < 0.05). The multivariable model was statistically significant (p < 0.001) and explained 69.6% of the variability in radiation exposure (adjusted R² = 0.693). Fluoroscopy time (β = 0.495, p < 0.001), percutaneous coronary intervention versus coronary angiography (β = 0.390, p < 0.001), female versus male sex (β = −0.107, p < 0.001), and femoral versus radial access (β = −0.055, p = 0.009) were independent predictors. Age, clinical indication, lesion type, and total stent length were not independently associated with cumulative air kerma. Conclusion Fluoroscopy time and procedure type were the strongest independent predictors of cumulative air kerma, highlighting procedural complexity as a major determinant of radiation exposure.
Keyword : Coronary angiography, Fluoroscopy, Percutaneous coronary intervention, Radiation exposure