Aims We evaluated whether radiation exposure during interventional cardiovascular procedures can induce damage to deoxyribonucleic acid (DNA). Methods and results Micronucteus assay (MN) was performed as biomarker of chromosomal damage and intermediate endpoint in carcinogenesis. Seventy-two patients (54 mates, age = 63.8 +/- 10.5 years) undergoing a wide range of radiation exposure during invasive cardiovascular procedures (coronary angiography, n = 9; percutaneous coronary intervention, n = 9; peripheral transluminal angioplasty, n = 37; and cardiac resynchronization therapy, n = 17) were enrolled. MN frequency was evaluated before, 2, and 24 h after the radiation exposure. Dose-area product (DAP; Gy cm(2)) was assessed as physical measure of radiation toad. DAP value was 96.0 +/- 63.9 Gy cm(2). MN frequency, was 15.1 +/- 7. 1 parts per thousand at baseline and showed a significant rise at 2 h (17.5 +/- 6.5 parts per thousand, P = 0.03) and 24 h (18.5 +/- 7.3 parts per thousand P = 0.004) after procedures. Conclusion Our results corroborate the current radioprotection assumption that even modest radiation load can damage the DNA of the cell and induce chromosome alterations which are early predictors of increased cancer risk.