Copyright © 1998 by the European Society of Cardiology.
Working Group Report
Interventional cardiology in Europe 1994
accepted September 19, 1997
Abstract
The working group Coronary Circulation of the European Society of Cardiology conducts an annual survey of cardiac interventions in Europe with the support of the national societies of cardiology. A detailed questionnaire about cardiac interventions performed during 1994 was mailed to all members of the European Society of Cardiology. Incomplete or absent data from eight national members precluded their inclusion in the final analysis. Thus, this report summarizes the cardiac interventions performed during 1994 in 29 of 37 members of the European Society of Cardiology, representing a total population of approximately 490 million inhabitants.
Coronary angiography A total of 922687 coronary angiograms were reported during 1994, representing an increase of 22% compared with 1993 and of 35% compared with 1992. The mean incidence of coronary angiograms was 1881/106inhabitants, ranging from 4417/106inhabitants in Germany to 35/106inhabitants in Romania. Germany, France, Great Britain, and Italy with 50% of the European population performed 73% of all cardiac interventions.
Coronary angioplasty During 1994, a total of 224722 coronary angioplasty (PTCA) procedures were reported in Europe, an increase of 22% compared with 1993 and of 52% compared with 1992. Adjusted per capita, the mean incidence of coronary angioplasty was 458/106inhabitants, ranging from 1091/106inhabitants in Germany to 6/106inhabitants in Romania. On average, the ratio PTCA per coronary angiogram was 0·24, ranging from 0·37 in the Netherlands to 0·06 in Cyprus. Ad hoc PTCA accounted for 22% of all PTCA cases. The majority (81%) of PTCAs were restricted to a single vessel. Major com-plications were reported in 2% of patients undergoing PTCA, including death (0·3%), myocardial infarction (1·0%) and need for emergency coronary artery bypass grafting (0·7%).
Coronary stenting Coronary stents were utilized in 21599 coronary interventions during 1994, an increase of 235% compared with 1993 and thus representing the fastest growth in interventional cardiology. The number of European countries employing stents during coronary angioplasty grew from 14 during 1993 to 24 during 1994. Elective use (38%) became the most frequent indication for coronary stenting during 1994, replacing bail-out stenting as the primary indication during 1993.
Other new devices Other new interventional therapeutic devices were employed in 8827 cases. Only the Rotablator was used more frequently during 1994 as compared with 1993. All other new therapeutic devices showed a decline. Coronary ultrasound was utilized in 3032 interventions and coronary angioscopy in 304 cases during 1994.
Non-coronary interventions Valvuloplasty remained the most frequent non-coronary intervention in Europe during 1994 with a total of 2622 mitral, 609 pulmonary and 506 aortic valvuloplasties.
Catheterization facilities The number of facilities per 106inhabitants performing invasive cardiac procedures in Europe during 1994 ranged from 7·7 in Iceland to 0·2 in Romania (European mean 2·9). The number of trained operators per 106inhabitants ranged from 24 in Germany to 0·4 in Romania (European mean 10). During 1994, a mean of 701 coronary angiograms and 170PTCAs were performed per catheterization facility in Europe (range: 1052 coronary angiograms and 293PTCAs per facility in Norway to 218 coronary angiograms and 37PTCAs per facility in Romania).
Conclusions The number of both coronary angiograms and coronary angioplasties continues to grow at an annual rate of approximately 20% in Europe. There is a wide range in the amount of revascularization procedures performed between western and eastern European countries. However,countries with the lowest numbers of coronary angiogramsand coronary angioplasties, e.g. Romania, also show the fastest annual growth. About one quarter of all patients undergoing coronary angiography are subsequently revascularized by coronary angioplasty. Coronary angioplasty is employed for the treatment of a single vessel in the majorityof cases. Coronary stenting is the fastest growing procedure in interventional cardiology and its primary indication has changed from bail-out stenting in previous years to its elective use during 1994.
Key Words: Coronary angiography • PTCA • coronary stent
Footnotes
f1 Correspondence: B. Meier, MD, Professor and Head of Cardiology, University Hospital, 3010 Bern, Switzerland.
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