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Coronary interventions in Europe 1992. The Working Group on Coronary Circulation of the European Society of
1Cardiology, University Hospital, Bern, Switzerland.
Insights
This survey reveals wide variations in coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) rates across European countries. PTCA is a well-accepted treatment for coronary artery disease, frequently performed more often than coronary artery bypass grafting (CABG).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Public Health
Background:
- Coronary interventions are influenced by diverse factors including traditional, cultural, socioeconomic, and personal aspects.
- Data on coronary intervention practices across European Society of Cardiology member countries were previously limited.
Purpose of the Study:
- To collect and analyze data on coronary interventions across member countries of the European Society of Cardiology.
- To assess the incidence and trends of coronary angiography and percutaneous transluminal coronary angioplasty (PTCA).
Main Methods:
- Survey distributed to national members of the European Society of Cardiology.
- Data collection on coronary angiograms, percutaneous transluminal coronary angioplasty (PTCA), stent implantation, and coronary artery bypass grafting (CABG).
- Exclusion of data from 12 countries due to missing or incomplete information.
Main Results:
- A total of 683,888 coronary angiograms were reported, with significant variations in incidence per million inhabitants across countries.
- 147,729 percutaneous transluminal coronary angioplasties (PTCA) were performed, accounting for 19% of angiograms, with Germany reporting the highest incidence.
- Stent implantation was the most common additional procedure in PTCA (2.7%), while other new devices were rarely used; PTCA was performed more frequently than CABG (ratio 2.3).
Conclusions:
- Percutaneous transluminal coronary angioplasty (PTCA) is a well-accepted treatment for coronary artery disease.
- Significant disparities exist in the rates of coronary angiography and PTCA per million inhabitants across Europe.
- Stent implantation is common, but the application of other novel interventional devices remains limited.
Abstract:
The general practice of coronary interventions is influenced by various aspects, traditional, cultural, socioeconomic and personal. The aim of this survey was to collect the data on coronary intervention in all member countries of the European Society of Cardiology. The data from 12 of the 35 national members were missing or grossly incomplete and were therefore excluded from the analysis.
Coronary Angiography:
The total number of coronary angiograms was reported as 683,888, an incidence of 1009 +/- 1021 per million inhabitants (range 9 (Romania) to 3076 (Germany)). Germany (246,115 cases), France (144,754), the United Kingdom (76,296), Italy (45,517) and Spain (43,495) registered 81% of all the coronary angiograms performed.
Percutaneous Transluminal Coronary Angioplasty:
(PTCA) The total number of reported PTCAs was 147,729, which on average accounted for 19 +/- 11% (range 2 (Lithuania) to 53% (Netherlands)) of the coronary angiograms. Most of the PTCAs (82%) were confined to a single vessel. The highest incidence of multivessel PTCA was reported from Slovakia (28%). PTCA took place immediately after the diagnostic study in only 18% of cases. Adjusted per capita, Germany ranked first with 703 PTCAs per million inhabitants, followed by Iceland (619), France (614), Belgium (568) and Austria (485). A major in-hospital complication was reported in 2.5% of the patients undergoing PTCA: 0.4% hospital deaths, 1.0% emergency CABGs and 1.1% myocardial infarctions.
New Devices:
Stents were implanted in 3211 patients (2.7% of all PTCA patients), equally distributed between emergency situations (53%) and elective procedures. Other interventional devices were applied in 4133 cases (2.8% of all PTCA cases): directional atherectomy, rotablator, transluminal extraction catheter, laser and Rotacs accounted for 1452, 1232, 55, 558 and 222, respectively. Coronary ultrasound (1350 cases) and coronary angioscopy (373 cases) were rarely performed.
Coronary Artery Bypass Grafting (Cabg):
A total of 63,477 patients underwent CABG in the reporting centres resulting in a PTCA/CABG ratio of 2.3. A significant under-reporting of surgery in the participating centres must be assumed.
Conclusions:
Although partial reporting might bias conclusions, several findings of this survey are noteworthy: (1) PTCA was a well accepted treatment for coronary artery disease, (2) PTCA was applied more frequently than CABG, (3) there was an extremely wide range of coronary angiography and PTCA performed per million inhabitants, (4) the most common additional procedure was stent implantation, but other new devices were only rarely applied.
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