Spanish Cardiac Catheterization and Coronary Intervention Registry. 14th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2004)

This article presents the findings of the Spanish Society of Cardiology registry of cardiac catheterization and interventional cardiology in the year 2004. Data were obtained from 121 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 110 performed catheterization mainly in adults, and 11 carried out procedures in only pediatric patients. In 2005, 111,451 diagnostic catheterization procedures were performed, including 97,785 coronary angiograms. This was 6.6% higher than in 2003. The population-adjusted rate was 2263 coronary angiograms per million inhabitants. A total of 45,469 coronary interventions were performed, 12% more than in 2003. The population-adjusted rate was 1052 per million inhabitants. Coronary stents were used in 91.4% of procedures; 68,892 stents were implanted, which was 12% more than in 2003. Of these, 25,148 (36.5%) were drug-eluting stents. Some 7326 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, 20.5% more than in 2003. These accounted for 16.1% of all percutaneous coronary interventions. Among non-coronary interventions, there was a decrease in the number of percutaneous mitral valvuloplasties (8%) and atrial septal defect closures (7%). In addition, there was a small increase in pediatric interventions (12%). Finally, it is important to note that the percentage of centers participating in the registry was high, what ensures that the data presented here are highly representative of the work carried out in cardiac catheterization laboratories in Spain.     

Percutaneous coronary interventions in Europe 1992-2001.

AIMS: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer re-vascularisation approaches and its distribution in different regions in Europe. We report the data of the year 2001 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. METHODS AND RESULTS: Questionnaires were distributed to delegates of the individual national societies of cardiology represented in the European Society of Cardiology. These were completed by the local institutions and operators and showed that 1,806,238 angiograms and 617,176 percutaneous transluminal coronary angioplasties (PTCAs) were performed in 2001. This is an increase of 10% and 17%, respectively, compared with the year 2000. The population-adjusted PTCA rate rose from nearly 800 procedures per 10(6) inhabitants in the year 2000 to approximately 990 procedures per 10(6) inhabitants in 2001. Coronary stenting increased by 25% to about 488,900 stents implanted in 2001. Complication rates remained unchanged, and the need for emergency coronary artery bypass grafting is still at 0.2% per percutaneous intervention. CONCLUSION: Interventional cardiology in Europe is still expanding, mainly due to rapid growth in countries with lower socio-economical levels. Most central European countries reported only minor increases in procedures performed. Coronary stenting remains the only noteworthy adjunctive strategy to balloon angioplasty.     

Spanish Registry of Cardiac Catheterization and Coronary Interventions. Thirteenth Official Report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (1990-2003)

The results of the Registry of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology for 2003 are presented. Data were obtained from 112 centers representing nearly all cardiac catheterization laboratories in Spain; 104 centers performed mainly adult catheterization and 8 carried out pediatric procedures only. In 2003, 105,939 diagnostic catheterization procedures were performed, including 90 939 coronary angiograms, representing a total increase of 8.5% in comparison to 2002. The population-adjusted rate was 2171 coronary angiograms per 106 inhabitants. Coronary interventions increased by 14.4% in comparison to 2002, with a total of 40,584 procedures and a rate of coronary interventions of 969 per 106 inhabitants. Coronary stents were used in 92.5% of the procedures (47,249 units implanted, for a total increase of 22% in comparison to 2002). About one fifth (20.2%) of the implanted stents were drug-eluting stents (11,699 units). A total of 6080 percutaneous coronary interventions were done in patients with acute myocardial infarction, representing an increase of 27.5% in comparison to 2002, and accounting for 14.9% of all interventional procedures. Of the noncoronary interventions recorded, we note the increase in percutaneous mitral valvuloplasties (21.6%) and atrial septal defect closures (86%), and also the increase in pediatric interventions (13.3%). In conclusion, we emphasize the high rate of reporting by laboratories, which allows the Registry to compile data that are highly representative of the activity at cardiac catheterization laboratories in Spain.     

Spanish Cardiac Catheterization and Coronary Intervention Registry. 15th official report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2005)

This article summarizes the findings contained in the 2005 registry of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology. Data were obtained from 128 centers, which comprise almost all cardiac catheterization laboratories in Spain. Of these, 118 performed catheterizations mainly in adults, while 10 carried out procedures in only pediatric patients. In 2005, 117,245 diagnostic catheterization procedures were performed, including 103,646 coronary angiograms, which was 5.9% more than in 2004. The population-adjusted rate was 2326 coronary angiograms per million inhabitants. A total of 51,689 coronary interventions were performed, which is 13.6% more than in 2004 and which corresponds to a rate of 1161 per million inhabitants. Coronary stents were used in 96% of procedures. Of the 80,569 stents implanted, 41,352 (51.3%) were drugeluting stents. Some 8341 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, which is 13.8% more than in 2004. They accounted for 16.1% of all such interventions. Among the non-coronary interventions recorded, the number of percutaneous mitral valvuloplasties decreased by 7%. The number of procedures carried out to close atrial septal defects increased by 40% compared with 2004. The number of pediatric interventions increased by 1.7%. Finally, it is important to note that a large proportion of laboratories reported results, which helped to ensure that the data summarized here are highly representative of the work carried out at cardiac catheterization laboratories in Spain.     

Evolution of percutaneous transluminal coronary angioplasty in Europe from 1992-1996.

BACKGROUND: The working group Coronary Circulation of the European Society of Cardiology has been conducting a yearly survey on coronary interventions in Europe. The purpose of this study is to present the evolution of percutaneous transluminal coronary angioplasty (PTCA) with epidemiological and economic implications. METHODS: Coronary interventions were polled by questionnaires distributed to all institutions performing cardiac catheterization. Aggregated country data of the years 1992-1996 on indication, type of procedure, technique, and outcome of coronary interventions were analysed. RESULTS: Population-adjusted coronary angiographies and PTCA procedures increased by 76% and by 105%, respectively. The Percentage of coronary stenting increased from zero to almost half of all procedures. Analysis per country groups reveals considerable variation, ranging, e.g. for PTCA in 1996 from 157 procedures per million population in a group of eastern countries to 1138 in a central European group. Relating total revascularization (R) to standardized death rate for ischaemic heart disease (SDR) and to gross domestic product (GDP), there was an increase from 1.0 to 1.8 R/SDR and 40 to 61 R/GDP in the central European group compared with an increase from 0.06 to 0.18 R/SDR and 43 to 85 R/GDP in the eastern group. CONCLUSIONS: An overall increase in PTCAs at an annual rate between 15 and 25% was observed. The wide variation in the use of PTCA in Europe appears to be dependent mostly on economic factors and national health care policies.     

Spanish Registry on Cardiac Catheterization and Coronary Interventions. Twelfth official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (1990-2002)

The results of the Registry of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology for 2002 are presented. Data were obtained from 101 centers representing all cardiac catheterization laboratories in Spain; 95 centers performed mainly adult catheterization and 6 carried out only pediatric procedures.In 2002, 97,609 diagnostic catheterization procedures were performed, including 83,667 coronary angiograms, representing a total increase of 5.1% in comparison to 2001. The population-adjusted rate was 2,053 coronary angiograms per 106 inhabitants.Coronary interventions increased by 11% in comparison to 2001, with a total of 34,723 procedures and a rate of coronary interventions of 850 per 106 inhabitants. Coronary stents were the devices used most frequently, with 47,249 implanted in 2002, for a total increase of 20% in comparison to 2001. Stenting accounted for 91.7% of all procedures. Direct stenting was done in 13 768 procedures (43.2%). IIb-IIIa glycoprotein inhibitors were used in 9966 procedures (28.7%). Multivessel percutaneous coronary interventions were performed in 9,830 patients (28%), and ad hoc interventions were done in the course of diagnostic coronary angiography in 26,341 patients (76%).A total of 4,766 percutaneous coronary interventions were done in patients with acute myocardial infarction, representing an increase of 23.9% in comparison to 2001, and accounting for 13.7% of all interventional procedures.Of the noncoronary interventions recorded, we note the decrease in percutaneous mitral valvuloplasties (21.2%) and atrial septal defect closures (11.1%), and the slight increase in pediatric interventions (3.7%).In conclusion, we emphasize the high rate of reporting by laboratories, which allows the Registry to compile data that are highly representative of the activity at cardiac catheterization laboratories in Spain     

Interventional Cardiology in Europe 1993

An annual survey on cardiac interventions in Europe is performedby the working group on Coronary Circulation of the EuropeanSociety of Cardiology with the help of the national societiesof cardiology. A questionnaire about cardiac interventions in1993 was mailed to a representative of the national societiesof 35 members of the European Society of Cardiology. The datacollection of coronary interventions was delayed by slow backreportingand from 10 of the 35 national members data were missing orgrossly incomplete. They were excluded from the analysis. Coronary anglography A total of 756 822 coronary angiogramswere reported resulting in an incidence of 1146 ± 1024per 10⁶ inhabitants, ranging from 24 (Romania) to 3499 (Germany).This represents an increase of 12% compared to 1992. Germany(279 882 cases), France (157 237), the United Kingdom (77 000),Italy (44 934) and Spain (37 591) registered 79% of all thecoronary angiograms performed. Percutaneous transluminal coronary angioptasty A total of 183728 percutaneous transluminal coronary angioplasty cases werereported in 1993, 24% more than in 1992. On average, they accountedfor 18 ± 7% (range 8 (Romania) to 35% (Sweden)) of thecoronary angiograms. Most of these percutaneous transluminalcoronary angioplasties (82%) were confined to a single vessel.In 13% only, percutaneous transluminal coronary angioplastytook place immediately after the diagnostic study. Adjustedper capita, Germany ranks first with 873 percutaneous transluminalcoronary angioplasties per 10⁶ inhabitants, followed by France(737), Holland (725), Belgium (713), and Switzerland (665).The European mean of percutaneous transluminal coronary angioplastiesper 10⁶ inhabitants was 270 ± 279, representing an increaseof 14% compared with 1992. A major in-hospital complicationwas reported in 3.8% of the patients undergoing percutaneoustransluminal coronary angioplasty: 0.6% hospital deaths, 1.5%emergency coronary artery bypass graftings, and 1.7% myocardialinfarctions. New devices In 1993 stents were implanted in 6444 patients (3.5%of all percutaneous transluminal coronary angioplasty patients),equally distributed between bail-out situations (53%) and electiveprocedures. The 14 stent implanting countries showed a meanincrease in the incidence of coronary stenting of 53% comparedwith 1992. Other interventional devices were applied in 7045cases, i.e. 3.8% of all percutaneous transluminal coronary angioplastycases. Coronary ultrasound (2194 cases) and coronary angioscopy(380 cases) were performed infrequently. Non-coronary interventions Valvuloplasties were the most frequentlyperformed non-coronary interventions. Six European countriesperformed more than 300 valvuloplasties each in 1993. Most ofthem were mitral valvuloplasties in southern countries. Conclusions Although partial backreporting might bias conclusions,several findings of this survey are noteworthy for the participatingcountries: The number of percutaneous transluminal coronaryangioplasties is universally increasing. There is an extremelywide range of coronary angiography and percutaneous transluminalcoronary angioplasties performed per population. The most commonadditional procedure is a stent implantation while other newdevices are only rarely applied. Mitral valvuloplasty is themost frequently performed non-coronary intervention. (Eur HeartJ 1996; 17: 1318–1328)     

Quinze anos de ecografia intravascular coronária em intervenção coronária percutânea em Portugal

IntroductionCoronary intravascular ultrasound (IVUS) is increasingly important in catheterization laboratories due to its positive prognostic impact. This study aims to characterize the use of IVUS in percutaneous coronary intervention (PCI) in Portugal.MethodsA retrospective observational study was performed based on the Portuguese Registry on Interventional Cardiology of the Portuguese Society of Cardiology. The clinical and angiographic profiles of patients who underwent PCI between 2002 and 2016, the percentage of IVUS use, and the coronary arteries assessed were characterized.ResultsA total of 118 706 PCIs were included, in which IVUS was used in 2266 (1.9%). Over time, use of IVUS changed from none in 2002 to generally increasing use from 2003 (0.1%) to 2016 (2.4%). The age of patients in whom coronary IVUS was used was similar to that of patients in whom IVUS was not used, but in the former group there were fewer male patients, and a higher prevalence of cardiovascular risk factors (hypertension, hypercholesterolemia and diabetes), previous myocardial infarction, previous PCI, multivessel coronary disease, C‐type or bifurcated coronary lesions, and in‐stent restenosis. IVUS was used in 54.8% of elective PCIs and in 19.15% of PCIs of the left main coronary artery.ConclusionCoronary IVUS has been increasingly used in Portugal since 2003. It is used preferentially in elective PCIs, and in patients with higher cardiovascular risk, with more complex coronary lesions and lesions of the left main coronary artery.     

Spanish Cardiac Catheterization and Coronary Intervention Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2006)

This article summarizes the data reported to the 2006 registry of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology. Data were obtained from 135 centers. Of these, 125 performed catheterizations mainly in adults, while 10 carried out procedures in pediatric patients only. In 2006, 126,196 diagnostic catheterizations were carried out. Of these, 113,228 were coronary angiograms, 7.6% more than in 2005. The population-adjusted rate was 2560 coronary angiograms per million inhabitants. A total of 57,041 percutaneous coronary interventions were performed, which was 7.8% more than in the previous year and which corresponds to a rate of 1293 per million inhabitants. Stents were used in 96.1% of coronary interventions. Overall, 90,006 stents were implanted, of which 59.3% were drug-eluting stents. Moreover, 10,067 interventions were carried out for acute myocardial infarction, 20.6% more than in 2005 and accounting for 17.6% of all percutaneous coronary interventions. Non-coronary interventions were most frequently performed for adult congenital heart disease, with closure of an atrial septal defect being the most numerous, at 334 procedures. Percutaneous mitral valvuloplasties were performed in 431 cases, a similar figure to that recorded in the previous registry, and the success rate was 93.6%. Each year, radial access continues to be used more frequently for coronary procedures. Finally, it is important to emphasize that a high percentage of laboratories reported results, which ensures that the data presented here can serve as an international reference source for percutaneous cardiac interventions performed in Spain.     

Percutaneous coronary interventions in Europe 2000

AIMS: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. METHODS AND RESULTS: Questionnaires distributed to delegates of the national societies of cardiology represented in the European Society of Cardiology to be completed by local institutions and operators yielded that 1637148 angiograms and 525983 coronary angioplasty (PTCAs) were performed in 2000. This is an increase of 15% and 23%, respectively, compared with 1999, particularly due to increases in eastern European countries. The population-adjusted PTCA rate rose from 714 procedures per 10(6) inhabitants in 1999 to approximately 800 procedures per 10(6) inhabitants in the year 2000. Coronary stenting increased by 26% to about 395000 stented cases in 2000. Complication rates remained unchanged, the need for emergency coronary artery bypass grafting (CABG) further decreased to 0.2% per percutaneous intervention. CONCLUSION: Interventional cardiology in Europe is still expanding, mainly due to rapid growth in countries with lower socioeconomical levels. Most central European countries reported only minor increases in procedures performed. Coronary stenting remains the only noteworthy adjunctive or alternative strategy to balloon angioplasty.     

Spanish Registry on Cardiac Catheterization Interventions. 11th official report of the Working Group on Cardiac Catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001)

The results of the Spanish Registry of the Working Group on cardiac catheterization and Interventional Cardiology of the Spanish Society of Cardiology (years 1990-2001) are presented. One-hundred-and-three centers contributed data, all the cardiac catheterization laboratories in Spain; 97 centers performed mainly adult catheterization and 6 carried out only pediatric procedures.In 2001, 95,430 diagnostic catheterization procedures were performed, with 79,607 coronary angiograms, representing a total increase of 8.4% over 2000. The population-adjusted incidence was 1947 coronary angiograms per 106 inhabitants.Coronary interventions increased by 15.4% compared with 2000, with a total of 31,290 procedures and an incidence of coronary interventions of 761 per 106 inhabitants. Coronary stents were the most frequently used devices with 39,356 implanted in 2001, and increase of 33.4% over 2000. Stenting accounted for 88.2% of procedures. Direct stenting was done in 11,280 procedures (40.9%). IIb-IIIa glycoprotein inhibitors were given in 7,012 procedures (22.4%). Multivessel percutaneous coronary interventions were performed in 8,445 cases (27%) and interventions were performed ad hoc during diagnostic study in 23,144 cases (74 %).A total of 3,845 percutaneous coronary interventions were carried out in patients with acute myocardial infarction, an increase of 22.9% over 2000 and 12.3% of all interventional procedures.Among non-coronary interventions, atrial septal defect closure was performed more often (161 cases, a 60% increase over 2000). Pediatric interventions increased by 15.4% (from 817 to 943 cases).Lastly, we would like to underline the high rate of reporting by laboratories, which allowed the Registry to compile data that are highly representative of hemodynamic interventions in Spain.     

Spanish Cardiac Catheterization and Coronary Intervention Registry. 22nd Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2012)

Introduction and objectives

The Working Group on Cardiac Catheterization and Interventional Cardiology presents the yearly report on the data collected for the Spanish registry.

Methods

Institutions provided their data voluntarily (online) and the information was analyzed by the Working Group's Steering Committee.

Results

Data were provided by 109 hospitals (71 public and 38 private) that mainly treat adults. There were 136 912 diagnostic procedures, 120 441 of which were coronary angiograms, slightly fewer than the year before, with a rate of 2979 diagnostic studies per million population. Percutaneous coronary interventions increased slightly to 65 909 procedures, for a rate of 1434 interventions per million population. Of the 99 110 stents implanted, 62% were drug-eluting stents. In all, 17 125 coronary interventions were carried out during the acute phase of myocardial infarction, 10.5% more than in 2011, representing 25.9% of the total number of coronary interventions. The most frequently performed intervention for adult congenital heart disease was atrial septal defect closure (292 procedures). The use of percutaneous mitral valvuloplasty continued to decline (258 procedures) and percutaneous aortic valve implantations increased by only 10% in 2012.

Conclusions

In 2012, the only increase in hemodynamic activity occurred in the field of ST-elevation myocardial infarction, and the increasing trend had slowed for percutaneous aortic valve implantation and other procedures affecting structure.     

Stent-based delivered anti-proliferative drugs in the prevention of coronary stent restenosis

Coronary stents are currently used in most percutaneous coronary interventions, since they have demonstrated to reduce restenosis and allow to solve threatened closure after balloon angioplasty. Despite these beneficial effects, restenosis remains as the main limitation of percutaneous coronary interventions even with the use of coronary stents. In the last 3 years, some coronary stents eluting anti-proliferative drugs have demonstrated to dramatically reduce the risk of restenosis. By November 2004, two different types of antiproliferative drugs eluted by coronary stents are commercially available: sirolimus (rapamycin) and paclitaxel. The mechanisms, clinical evidence, as well as the remaining limitations of these drug-eluting stents are reviewed. The current knowledge of other anti-proliferative drugs that are currently under investigation is also reviewed.     

Impact of the COVID-19 pandemic on percutaneous coronary interventions in Portugal

IntroductionThe COVID-19 pandemic has imposed an unprecedented burden on healthcare systems worldwide, changing the profile of interventional cardiology activity.ObjectivesTo quantify and compare the number of percutaneous coronary interventions (PCIs) performed for acute and chronic coronary syndromes during the first COVID-19 outbreak with the corresponding period in previous years.MethodsData on PCI from the prospective multicenter Portuguese Registry on Interventional Cardiology (RNCI) were used to analyze changes in PCI for ST-elevation myocardial infarction (STEMI), non-ST-elevation acute coronary syndromes (NSTE-ACS) and chronic coronary syndromes (CCS). The number of PCIs performed during the initial period of the COVID-19 outbreak in Portugal, from March 1 to May 2, 2020, was compared with the mean frequency of PCIs performed during the corresponding period in the previous three years (2017–2019).ResultsThe total number of PCIs procedures was significantly decreased during the initial COVID-19 outbreak in Portugal (?36%, p<0.001). The reduction in PCI procedures for STEMI, NSTE-ACS and CCS was, respectively, ?25% (p<0.019), ?20% (p<0.068) and ?59% (p<0.001).ConclusionsCompared with the corresponding period in the previous three years, the number of PCI procedures performed for STEMI and CCS decreased markedly during the first wave of the COVID-19 pandemic in Portugal.     

Registro Español de Hemodinámica y Cardiología Intervencionista. XXII Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2012)

Introduction and objectives

The Working Group on Cardiac Catheterization and Interventional Cardiology presents the yearly report on the data collected for the Spanish registry.

Methods

Institutions provided their data voluntarily (online) and the information was analyzed by the Working Group's Steering Committee.

Results

Data were provided by 109 hospitals (71 public and 38 private) that mainly treat adults. There were 136 912 diagnostic procedures, 120 441 of which were coronary angiograms, slightly fewer than the year before, with a rate of 2979 diagnostic studies per million population. Percutaneous coronary interventions increased slightly to 65 909 procedures, for a rate of 1434 interventions per million population. Of the 99 110 stents implanted, 62% were drug-eluting stents. In all, 17 125 coronary interventions were carried out during the acute phase of myocardial infarction, 10.5% more than in 2011, representing 25.9% of the total number of coronary interventions. The most frequently performed intervention for adult congenital heart disease was atrial septal defect closure (292 procedures). The use of percutaneous mitral valvuloplasty continued to decline (258 procedures) and percutaneous aortic valve implantations increased by only 10% in 2012.

Conclusions

In 2012, the only increase in hemodynamic activity occurred in the field of ST-elevation myocardial infarction, and the increasing trend had slowed for percutaneous aortic valve implantation and other procedures affecting structure.Full English text available from:www.revespcardiol.org/en     

Registro Español de Hemodinámica y Cardiología Intervencionista. XXI Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (1990-2011)

Introduction and objectives

The Working Group on Cardiac Catheterization and Interventional Cardiology presents a yearly report on the data collected for the national registry. This information shows how procedures are distributed throughout Spain and makes comparisons with other countries feasible.

Methods

Institutions provided their data voluntarily (online) and were analyzed by the Working Group's Steering Committee.

Results

Data were provided by 108 hospitals (72 public and 36 private) that mainly treat adults, Covering 138 480 diagnostic procedures, 123 746 of which were coronary angiograms, slightly more than the year before, with a rate of 3008 coronary angiograms per million population. Percutaneous coronary interventions decreased slightly to 63 202 procedures with a rate of 1373 interventions per million population. Of the 94 701 stents implanted, 61% were drug-eluting stents. In the acute phase of myocardial infarction, 15 491 coronary interventions were performed, 9.4% more than in 2010, representing 24.6% of the total number of coronary interventions. The most frequent intervention for adult congenital heart disease was atrial septal defect closure (298 procedures). Percutaneous mitral valvuloplasty continued to decrease (286 procedures) and percutaneous aortic valve implantations increased, but at a slower pace than in the previous year, with 770 units implanted in 2011.

Conclusions

The greatest increase in activity has occurred in the field of myocardial infarction and percutaneous aortic valve implantation. The number of other procedures, both diagnostic and therapeutic, remained stable.Full English text available from: www.revespcardiol.org     

Spanish Registry of the Section of Hemodynamic and Interventional Cardiology Activity for 1999

The results of the Spanish Registry of Hemodynamic and Interventional Cardiology in 1999 are presented. The activity of 90 centers representing all the cardiac catheterization laboratories in Spain is reported, with 83 centers performing mainly adult cardiac catheterization and 7 centers exclusively carrying out pediatric cardiac catheterization. In 1999, a total of 82,805 diagnostic catheterization procedures, 79% being coronary angiographies (65,234; 1,637 per million inhabitants), were performed, representing a total increase of 11.4% compared to 1998. Compared to 1998, coronary intervention increased by 14.2%, with a total number of 23,010 procedures. The ratio of coronary interventions per million inhabitants was 590. Success rates for coronary interventions (94%) and complications (2.2%) were similar to those registered in previous years, and in 12.4% of the cases IIb-IIIa glycoprotein inhibitors were used. Ten point two per cent of the procedures were performed to treat acute myocardial infarction. Coronary stenting is the main device for coronary intervention. In 1999, coronary stents were used in 17,783 cases (23% increase compared to 1998), representing 77.3% of all coronary revascularization procedures. A total of 22,946 prostheses were implanted, 87% electively and 21.4% as a primary stenting procedure, with a low rate of complications (0.85% subacute closure, 1.95% myocardial infarction and 0.9% mortality). Compared to 1998, both directional coronary atherectomy (52 procedures) and rotational atherectomy (473 procedures) showed a slight decrease.A slight increase (4% compared to 1998) was reported in adult valvuloplasties (525 vs 505)while pediatric interventional procedures increased by 21% (678 vs 557 procedures) compared to 1998. In conclusion, we would like to underline the high degree of laboratory participation in the Registry, and despite the increase in activity, the current rates remain lower than European figures.     

Interventional cardiology in Europe 1995. Working Group Coronary Circulation of the European Society of Cardiology.

The working group Coronary Circulation of the European Societyof Cardiology conducts, with the support of the national societiesof cardiology, an annual survey on cardiac interventions inEurope. This report is the fourth consecutive summary on cardiacinterventions in Europe and gives an overview of interventionalcardiology activities during 1995 in 30 member countries ofthe European Society of Cardiology, representing a populationof 550 million people. Coronary angiography A total of 1065485 diagnostic coronaryangiograms were reported, a 15% increase compared with 1994.The mean incidence of coronary angiograms increased to 1937per 10⁶inhabitants, ranging from 4667 per 10⁶inhabitants inGermany to 67 per 10⁶inhabitants in Romania. Coronary angioplasty A total of 278982 coronary angioplasty(PTCA) procedures were reported, an increase of 24% comparedwith 1994. The mean incidence of coronary angioplasty per capitawas 507 per 10⁶inhabitants, ranging from 1358 per 10⁶inhabitantsin Germany to 12 per 10⁶inhabitants in Romania. The ratio ofPTCAs per coronary angiogram was 0·26, ranging from 0·40in the Netherlands to 0·08 in Cyprus. Ad hoc PTCA (combineddiagnostic angiography and PTCA) accounted for 24% of all PTCAcases. The majority (85%) of PTCA procedures were restrictedto a single vessel. Coronary stenting Coronary stents were used in 80383 coronaryinterventions, an increase of 272% compared with 1994, representingthe fastest growth. The European mean ratio of coronary stentingper PTCA procedure was 0·29. Other new devices Other new interventional therapeutic deviceswere employed in 9798 cases, accounting for 3·5% of allcoronary interventions. Coronary ultrasound wasused in 4787(1·7%) and coronary angioscopy in 543 interventions (0·2%). Non-coronary interventions Balloon valvuloplasty remained themost frequent non-coronary intervention during 1995 with a totalof 2715 mitral, 615 pulmonary, and 719 aortic valvuloplasties. Catheterization facilities There were a mean of 2·5 diagnosticcardiac catheterization institutions with a mean of 3·4diagnostic laboratories per 10⁶inhabitants in Europe. The numberof PTCA institutions and laboratories were a mean of 0·7and 0·9 per 10⁶inhabitants, respectively. The mean numbersof trained operators were 11 for diagnostic cardiac catheterizationand eight for PTCA per 10⁶inhabitants. On average, 704 yearlycoronary angiograms per diagnostic catheterization laboratoryand 203 yearly PTCAs per PTCA laboratory were reported in Europe.The average operator performed 210 coronary angiograms and 78PTCAs per year. Conclusions During 1995, coronary angiography increased at amean annual rate of 10% and coronary angioplasty at a mean annualrate of nearly 20% in Europe. Coronary angioplasty was employedon a single vessel per procedure in the majority of cases. Coronarystenting remained the fastest growing procedure in interventionalcardiology and the European mean ratio of coronary stentingper PTCA increased to 0·29. The ratio of PTCA to CABGfurther increased to 1·4:1. New devices were reservedfor niche indications and balloon valvuloplasty was the mostfrequent non-coronary intervention.     

Interventional cardiology in Europe 1999.

AIMS: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. METHODS AND RESULTS: Questionnaires distributed to delegates of the national societies of cardiology represented in the European Society of Cardiology to be completed by local institutions and operators yielded that 1,452,751 angiograms and 452,019 PTCAs were performed in 1999. This is an increase of 28% and 16%, respectively, compared with 1998. Most of these increases are due to high relative increases in eastern European countries. The number of PTCAs per 106 inhabitants rose to 714 in 1999. Coronary stenting increased by 31% to about 313,000 stents implanted in 1999. Complication rates remained stable, the need for emergency coronary artery bypass grafting showing a further slight decrease to currently 0.3%. CONCLUSION: Interventional cardiology in Europe is still growing, mainly due to rapid growth in countries with lower socio-economical levels. In some central European countries a saturation seemed to be reached with only minor increases in procedures performed. Coronary stenting remains the only noteworthy and growing complement or alternative to balloon angioplasty.     

Elective and primary angioplasty at hospitals without on-site surgery versus with on-site surgery: results from a national registry

INTRODUCTION: Current European clinical guidelines do not restrict interventional cardiology at centers without on-site surgical backup, but disagreement still exists whether hospitals with cardiac catheterization laboratories, but without on-site cardiac surgery, should develop percutaneous coronary intervention (PCI) programs. Technical improvements in equipment and pharmacologic adjunctive therapy have increased the safety margins of diagnostic and therapeutic cardiac catheterization and more than half of the patients treated by PCI in Portugal are treated at hospitals without on-site cardiac surgery. OBJECTIVES: We set out to compare clinical outcomes of elective and primary PCI for ST-segment elevation myocardial infarction at centers without on-site cardiac surgery with those at centers with on-site cardiac surgery. METHODS: Based on the Portuguese Registry of Interventional Cardiology, we retrospectively reviewed a total of 13,235 PCI procedures performed from January 2002 to June 2006 and compared the results for 7,112 patients treated at hospitals without on-site cardiac surgery with 6,123 patients treated at hospitals with on-site cardiac surgery. RESULTS: Demographic data were similar, with a mean age of 64 (55-72) vs. 63 (54-71) years, 75% vs. 76% male and 25.0% vs. 24.2% with diabetes respectively at centers without and with on-site surgical backup. Hospital mortality at centers without and with on-site surgical backup respectively was: chronic angina: 0.3% vs. 0.3% (NS); acute coronary syndromes: 1.5% vs. 1.0% (NS); acute myocardial infarction with ST elevation and without cardiogenic shock: 4.0% vs. 5.0% (NS); cardiogenic shock: 50.9% vs. 53.4% (NS). CONCLUSIONS: Similar clinical outcomes for interventional cardiology were achieved at hospitals without on-site cardiac surgery and those with on-site cardiac surgery. In the era of coronary stents, adjunctive therapy and experienced operators, elective and primary PCI can safely be performed without on-site surgical backup.