INTERVENTIONAL CARDIOLOGY IN EUROPE 1994

The working group Coronary Circulation of the European Society of Card iology conducts an annual survey of cardiac interventions in Europe wi th the support ol. the national societies of cardiology. A detailed qu estionnaire about cardiac interventions performed during 1994 was mail ed 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 intervent ions performed during 1994 in 29 of 37 members of the European Society of Cardiology, representing a total population of approximately 490 m illion inhabitants. Coronary angiography A total of 922 687 coronary a ngiograms were reported during 1994, representing an increase of 22% c ompared with 1993 and of 35% compared with 1992. The mean Incidence of coronary angiograms was 1881/10(6) inhabitants, ranging from 4417/ 10 (6) inhabitants in Germany to 35/10(6) inhabitants in Romania. Germany , France, Great Britain, and Italy with 50% of the European population performed 73% of-all cardiac interventions. Coronary angioplasty Duri ng 1994, a total of 224 722 coronary angioplasty (PTCA) procedures wer e reported in Europe. an increase of 22% compared with 1993 and of 52% compared with 1992. Adjusted per capita, the mean incidence of corona ry angioplasty was 458/10(6) inhabitants, ranging from 1091/10(6) inha bitants in Germany to 6/10(6) inhabitants in Romania. On average, the ratio PTCA per coronary angiogram was 0.24 ranging from 0.37 in the Ne therlands 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 complications were reported in 2% of patients undergoing PTCA, including death (0.3%), myocardial infarction (1.0%) and need for eme rgency coronary artery bypass grafting (0.7%). Coronary stenting Coron ary stents were utilized in 21 599 coronary interventions during 1994, an increase of 235% compared with 1993 and thus representing the fast est growth in interventional cardiology. The number of European countr ies employing stents during coronary angioplasty grew from 14 during 1 993 to 24 during 1994. Elective use (38%) became the most frequent ind ication for coronary stenting during 1994, replacing bail-put stenting as the primary indication during 1993. Other new devices Other new in terventional 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 ultraso und was utilized in 3032 interventions and coronary angioscopy in 304 cases during 1994. Non-coronary interventions Valvuloplasty remained t he 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 10(6) inhabita nts performing invasive cardiac procedures in Europe during 1994 range d from 7.7 in Iceland to 0.2 in Romania (European mean 2.9). The numbe r of trained operators per 10(6) inhabitants ranged from 24 in Germany to 0.4 in Romania (European mean 10). During 1994, a mean of 701 coro nary angiograms and 170 PTCAs were performed per catheterization facil ity in Europe (range: 1052 coronary angiograms and 293 PTCAs per facil ity in Norway to 218 coronary angiograms and 37 PTCAs per facility in Romania). Conclusions The number of both coronary angiograms and coron ary angioplasties continues to grow at an annual fate of approximately 20% in Europe. There is a wide range in the amount of revascularizati on procedures performed between western and eastern European countries . However, countries with the lowest numbers of coronary angiograms an d coronary angioplasties, e.g. Romania, also show the fastest annual g rowth. About one quarter of all patients undergoing coronary angiograp hy are subsequently revascularized by coronary angioplasty. Coronary a ngioplasty is employed for the treatment of a single vessel in the maj ority of 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.