This article provides data on the workload of the interventional cardiology centers in Romania during 2022 and highlights the trends in coronary and peripheral interventions between 2014 and 2022.1–9 Members from all interventional cardiology centers in Romania were requested to fill out a standardized form about the total number of various procedures performed during 2022. Data was collected at the initiative of the Interventional Cardiology Working Group of the Romanian Society of Cardiology.
Table 1 summarizes the data from 2022 provided by 40 public and private interventional cardiology centers of Romania. In 2022, there were 66 interventional cardiologists in training, 143 full interventional cardiologists, and 56 functional angiographs in Romania. The exact number of full interventional cardiologists is difficult to know because some interventional cardiologists also work in public and private hospitals.
Reported data from all Interventional Cardiology Centers in Romania in 2022
CITY | Bucuresti | |||||||
---|---|---|---|---|---|---|---|---|
Hospital | CC Iliescu | SUUB | Floreasca | Agrippa Ionescu | Militar | Bagdasar | Elias | Sf Ioan |
3 | 2 | 1 | 2 | 3 | 2 | 1 | 1 | |
7 | 6 | 6 | 2 | 7 | 4 | 6 | 2 | |
5 | 7 | 2 | 0 | 3 | 0 | 5 | 0 | |
Coronarography | 3166 | 1041 | 1619 | 734 | 2631 | 784 | 499 | 271 |
Total nr. of PCI | 1233 | 1092 | 950 | 131 | 995 | 276 | 636 | 75 |
PCI without stents | 98 | 59 | 20 | 17 | 21 | 14 | 41 | 7 |
PCI with stents | 1135 | 1033 | 910 | 114 | 974 | 262 | 595 | 68 |
STEMI with primary PCI | 479 | 811 | 700 | 14 | 268 | 97 | 450 | 17 |
PCI left main | 80 | 54 | 45 | 3 | 32 | 24 | 58 | 3 |
CTO | 45 | 38 | 35 | 12 | 49 | 16 | 42 | 0 |
Stents per patient2 | 1.8 | 1.46 | 1.9 | 1.42 | 1.9 | 1.58 | 1.3 | 1.3 |
Total nr. of stents | 2043 | 1602 | 1805 | 187 | 1851 | 416 | 831 | 103 |
Nr. of DES | 2043 | 1602 | 1805 | 187 | 1845 | 416 | 831 | 103 |
DES/stents ratio (%) | 100% | 100% | 100% | 100% | 99% | 100% | 100% | 100% |
Cutting, Scoring | 45 | 11 | 4 | 5 | 6 | 6 | 0 | 0 |
Rotabalation | 5 | 0 | 9 | 3 | 10 | 0 | 0 | 0 |
Shockwave | 3 | 0 | 6 | 0 | 2 | 0 | 0 | 0 |
FFR/IFR | 12 | 8 | 67 | 14 | 5 | 0 | 0 | 0 |
IVUS | 18 | 2 | 15 | 8 | 1 | 0 | 0 | 0 |
OCT | 12 | 4 | 48 | 2 | 0 | 0 | 0 | 0 |
Peripheral PTA 3 | 150 | 0 | 0 | 17 | 271 | 2 | 24 | 22 |
Renal PTA | 10 | 0 | 0 | 0 | 7 | 1 | 0 | 7 |
Carotid PTA | 4 | 0 | 0 | 17 | 51 | 0 | 2 | 0 |
Total nr. of stents in peripheral PTA | 85 | 0 | 0 | 15 | 220 | 2 | 7 | 34 |
Peripheral angiography | 623 | 57 | 0 | 175 | 1017 | 116 | 158 | 106 |
TAVI | 216 | 36 | 44 | 4 | 38 | 0 | 0 | 0 |
MitraClip | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Aortic endoprosthesis | UR | 0 | 17 | 0 | 14 | 0 | 0 | 0 |
Interventions in structural heart disease4 | 30 | 23 | 0 | 0 | 2 | 0 | 0 | 0 |
CITY | Bucuresti | Cluj Napoca | ||||||
---|---|---|---|---|---|---|---|---|
Hospital | Sanador | Ares - Monza | Colentina | Medlife | Institutul Inimii Cluj | SCJU Cluj | Monza-Ares Cluj | Sp. Recuperare Cluj |
1 | 3 | 1 | 1 | 3 | 1 | 2 | 1 | |
2 | 7 | 1 | 10 | 10 | 6 | 3 | 2 | |
0 | 0 | 1 | 0 | 1 | 8 | 0 | 0 | |
Coronarography | 1241 | 1043 | 220 | 518 | 2069 | 1345 | 565 | 423 |
Total nr. of PCI | 154 | 420 | 81 | 125 | 1923 | 743 | 228 | 190 |
PCI without stents | 1 | 2 | 1 | 12 | 60 | 47 | 8 | 10 |
PCI with stents | 153 | 418 | 80 | 113 | 1779 | 696 | 220 | 180 |
STEMI with primary PCI | UR | 0 | 1 | 4 | 571 | 216 | 0 | 2 |
PCI left main | UR | 73 | UR | 4 | 75 | 33 | 20 | 10 |
CTO | 10 | 23 | UR | 10 | 64 | 43 | 11 | 9 |
Stents per patient2 | UR | 1.74 | 1.56 | 1.25 | 1.35 | 2.03 | 1.32 | 2 |
Total nr. of stents | UR | 729 | 125 | 156 | 2403 | 1508 | 291 | 360 |
Nr. of DES | UR | 729 | 125 | 156 | 2403 | 1508 | 291 | 349 |
DES/stents ratio (%) | UR | 100% | 100% | 100% | 100% | 100% | 100% | 97% |
Cutting, Scoring | UR | UR | 0 | 1 | 58 | 3 | UR | 0 |
Rotabalation | UR | 31 | 0 | 0 | 20 | 10 | 5 | 0 |
Shockwave | UR | 21 | 0 | 1 | 9 | 0 | 0 | 0 |
FFR/IFR | UR | 0 | 0 | 0 | 80 | 0 | 0 | 0 |
IVUS | UR | 0 | 0 | 0 | 69 | 0 | 0 | 0 |
OCT | 0 | 0 | 0 | 25 | 23 | 0 | 0 | |
Peripheral PTA 3 | 123 | 30 | 19 | 40 | 155 | 288 | 37 | 73 |
Renal PTA | 4 | 0 | 0 | 2 | 14 | 12 | 0 | 2 |
Carotid PTA | UR | 34 | 0 | 6 | 31 | 8 | 22 | 0 |
Total nr. of stents in peripheral PTA | UR | 62 | 14 | 1.6 | 152 | 196 | 58 | 0 |
Peripheral angiography | 594 | 93 | 44 | 125 | 175 | 425 | 60 | 116 |
TAVI | 80 | 62 | 0 | 0 | 141 | 0 | 0 | 0 |
MitraClip | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 |
Aortic endoprosthesis | 24 | 8 | 0 | 0 | 12 | 0 | UR | 0 |
Interventions in structural heart disease4 | 4 | 22 | 0 | 0 | 19 | 0 | 5 | 0 |
CITY | laşi | Târgu Mureş | |||||
---|---|---|---|---|---|---|---|
Hospital | IBCV laşi | Arcadia Iasi | Sp. Sf. Spiridon | IBCV Tg Mureş | CardioMed Tg. Mures | SCJU Tg Mureş | Topmed |
2 | 1 | 2 | 1 | 1 | 2 | 1 | |
6 | 3 | 4 | 6 | 1 | 6 | 4 | |
9 | 0 | 2 | 0 | 11 | 2 | 0 | |
Coronarography | 3783 | 847 | 1221 | 1761 | 987 | 1316 | 1435 |
Total nr. of PCI | 2077 | 92 | 892 | 1104 | 770 | 1026 | 208 |
PCI without stents | 215 | 3 | 3 | 111 | 32 | 43 | 3 |
PCI with stents | 1862 | 90 | 895 | 993 | 737 | 983 | 205 |
STEMI with primary PCI | 863 | 0 | 259 | 406 | 385 | 513 | 0 |
PCI left main | UR | UR | 83 | UR | 12 | 16 | 21 |
CTO | UR | UR | 25 | 20 | 31 | 41 | 13 |
Stents per patient2 | 1.47 | 1..43 | 1.47 | 1.41 | 1 | 1.17 | 1.24 |
Total nr. of stents | 3048 | 129 | 1318 | 1567 | 829 | 1105 | 258 |
Nr. of DES | 3048 | 129 | 1318 | 1567 | 765 | 1020 | 258 |
DES/stents ratio (%) | 100% | 100% | 100% | 100% | 100% | 92% | 100% |
Cutting, Scoring | 0 | UR | 30 | 0 | 0 | 0 | 7 |
Rotabalation | 0 | UR | 0 | 6 | 0 | 0 | 11 |
Shockwave | 0 | UR | 0 | 5 | 0 | 0 | 0 |
FFR/IFR | 21 | UR | 19 | 28 | 19 | 25 | 0 |
IVUS | 16 | UR | 12 | 0 | 0 | 0 | 0 |
OCT | 0 | UR | 0 | 12 | 31 | 41 | 4 |
Peripheral PTA 3 | 67 | 6 | 9 | 89 | 22 | 29 | 17 |
Renal PTA | 8 | 0 | 12 | 0 | 2 | 3 | 0 |
Carotid PTA | 31 | 12 | 8 | 28 | 0 | 0 | 7 |
Total nr. of stents in peripheral PTA | 106 | UR | 21 | 60 | 7 | 9 | 18 |
Peripheral angiography | 708 | 118 | 32 | 120 | 61 | 81 | 129 |
TAVI | 53 | 0 | 0 | 132 | 0 | 0 | 0 |
MitraClip | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Aortic endoprosthesis | 8 | 0 | 0 | 13 | 0 | 0 | 0 |
Interventions in structural heart disease4 | 0 | 2 | 0 | 12 | 0 | 0 | 0 |
CITY | Timişoara | Braşov | Oradea | Suceava | Baia Mare | |
---|---|---|---|---|---|---|
Hospital | IBCV Timişoara | Clinicco Brasov | Sp. Jud. Brasov | Sp. Jud. Oradea | Sp. Jud. Suceava | Sp. Jud. Baia Mare |
2 | 1 | UR | 2 | UR | 3 | |
6 | 2 | UR | 4 | UR | 3 | |
4 | 0 | UR | 2 | UR | 0 | |
Coronarography | 3250 | 1009 | UR | 671 | UR | 286 |
Total nr. of PCI | 1876 | 294 | UR | 811 | UR | 592 |
PCI without stents | 40 | 7 | UR | 31 | UR | 24 |
PCI with stents | 1722 | 287 | UR | 780 | UR | 568 |
STEMI with primary PCI | 985 | 3 | UR | 326 | UR | 257 |
PCI left main | 196 | 42 | UR | 45 | UR | 35 |
CTO | 56 | 5 | UR | 71 | UR | 8 |
Stents per patient2 | 1.95 | 1.66 | UR | 1.87 | UR | 1.51 |
Total nr. of stents | 3590 | 477 | UR | 1456 | UR | 859 |
Nr. of DES | 3532 | 477 | UR | 1456 | UR | 859 |
DES/stents ratio (%) | 98.30% | 100% | UR | 100% | UR | 100% |
Cutting, Scoring | 11 | 0 | UR | 14 | UR | 14 |
Rotabalation | 0 | 0 | UR | 17 | UR | 1 |
Shockwave | 0 | 11 | UR | 1 | UR | 0 |
FFR/IFR | 4 | 0 | UR | 10 | UR | 9 |
IVUS | 0 | 0 | UR | 12 | UR | 0 |
OCT | 3 | 0 | UR | 0 | UR | 4 |
Peripheral PTA 3 | 66 | 10 | UR | 59 | UR | 32 |
Renal PTA | 9 | 1 | UR | 2 | UR | 3 |
Carotid PTA | 66 | 1 | UR | 19 | UR | 0 |
Total nr. of stents in peripheral PTA | 121 | 15 | UR | 21 | UR | 23 |
Peripheral angiography | 486 | 6 | UR | 105 | UR | 119 |
TAVI | 52 | 1 | UR | 0 | UR | 0 |
MitraClip | 0 | 4 | UR | 0 | UR | 0 |
Aortic endoprosthesis | 9 | 0 | UR | 13 | UR | 10 |
Interventions in structural heart disease4 | 12 | 1 | UR | 0 | UR | 0 |
CITY | Sibiu | Constanta | Ploiesti | Pitesti | |
---|---|---|---|---|---|
Hospital | Polisano Sibiu | Sp. Jud. Sibiu | Monza - Ares Constanta | Sp. Jud. Ploiesti | Sp. Jud. Pitesti |
1 | UR | 1 | 1 | 1 | |
1 | UR | 2 | 2 | 3 | |
0 | UR | 1 | 0 | 0 | |
Coronarography | 610 | UR | 1005 | 588 | 635 |
Total nr. of PCI | 251 | UR | 548 | 396 | 516 |
PCI without stents | 2 | UR | 16 | 26 | 22 |
PCI with stents | 249 | UR | 532 | 370 | 494 |
STEMI with primary PCI | 0 | UR | 196 | 217 | 361 |
PCI left main | 12 | UR | 17 | 5 | 27 |
CTO | 25 | UR | 3 | 0 | 23 |
Stents per patient2 | 1.7 | UR | 1.3 | 1.56 | 1.67 |
Total nr. of stents | 415 | UR | 721 | 578 | 866 |
Nr. of DES | 415 | UR | 721 | 578 | 866 |
DES/stents ratio (%) | 100% | UR | 100% | 100% | 100% |
Cutting, Scoring | 0 | UR | 0 | 3 | 31 |
Rotabalation | 12 | UR | 4 | 0 | 6 |
Shockwave | 5 | UR | 4 | 0 | 4 |
FFR/IFR | 0 | UR | 0 | 0 | 10 |
IVUS | 0 | UR | 0 | 0 | 12 |
OCT | 0 | UR | 0 | 0 | 0 |
Peripheral PTA 3 | 17 | UR | 32 | 3 | 72 |
Renal PTA | 0 | UR | 0 | 0 | 0 |
Carotid PTA | 0 | UR | 1 | 0 | 18 |
Total nr. of stents in peripheral PTA | 15 | UR | 15 | 3 | UR |
Peripheral angiography | 30 | UR | 40 | 102 | 145 |
TAVI | 70 | UR | 0 | 0 | 0 |
MitraClip | 0 | UR | 0 | 0 | 0 |
Aortic endoprosthesis | 2 | UR | 0 | 0 | 0 |
Interventions in structural heart disease4 | 2 | UR | 0 | 0 | 0 |
CITY | Pitesti | Craiova | Tulcea | Buzau | |
---|---|---|---|---|---|
Hospital | Memorial Hospital | Sp. Muntenia | Sp. Jud. Craiova | Monza - Ares Tulcea | Sp. Jud. Buzau |
1 | 1 | 2 | 1 | 1 | |
1 | 2 | 4 | 1 | 1 | |
1 | 0 | 1 | 0 | 1 | |
Coronarography | 14 | 85 | 2285 | 239 | 115 |
Total nr. of PCI | 5 | 13 | 884 | 119 | 42 |
PCI without stents | 0 | 1 | 28 | 10 | 1 |
PCI with stents | 5 | 12 | 856 | 109 | 41 |
STEMI with primary PCI | 0 | 0 | 491 | 0 | 4 |
PCI left main | 0 | 0 | 63 | 10 | 0 |
CTO | 0 | 0 | 11 | 0 | 2 |
Stents per patient2 | 2 | 1.92 | 1.2 | 1.4 | 1.4 |
Total nr. of stents | 10 | 25 | 1046 | 167 | 59 |
Nr. of DES | 10 | 25 | 1046 | 167 | 59 |
DES/stents ratio (%) | 100% | 100% | 100% | 100% | 100% |
Cutting, Scoring | 0 | 0 | 10 | 0 | 0 |
Rotabalation | 0 | 0 | 0 | 0 | 0 |
Shockwave | 0 | 0 | 5 | 0 | 0 |
FFR/IFR | 0 | 0 | 3 | 0 | 0 |
IVUS | 0 | 0 | 0 | 0 | 0 |
OCT | 0 | 0 | 0 | 0 | 0 |
Peripheral PTA 3 | 4 | 0 | 0 | 11 | 0 |
Renal PTA | 0 | 0 | 2 | 0 | 0 |
Carotid PTA | 1 | 0 | 0 | 0 | 0 |
Total nr. of stents in peripheral PTA | 4 | 0 | 2 | 16 | 0 |
Peripheral angiography | 32 | 11 | 83 | 8 | 4 |
TAVI | 0 | 0 | 0 | 0 | 0 |
MitraClip | 0 | 0 | 0 | 0 | 0 |
Aortic endoprosthesis | 0 | 0 | 0 | 0 | 0 |
Interventions in structural heart disease4 | 0 | 0 | 0 | 0 | 0 |
Total number of elective and urgent PCIs
It will represent the ratio between the total number of implanted stents and the total number of patients undergoing PCI
Number of peripheral angioplasty (lower and upper limbs artery, not including carotid arteries)
Interventions in cardiac structural diseases: percutaneous closures of DSA, DSV, PFO, arterial duct, balloon valvulotomies, left atrial appendage closure (PCI - percutaneous coronary intervention, STEMI - ST segment elevation myocardial infarction, DES – drug eluting stent, BVS - bioresorbable vascular scaffold, FFR - fractional flow reserve, IFR - instantaneous wave-free ratio, IVUS – intravascular ultrasound, OCT - optical coherence tomography, PTA - percutaneous transluminal angioplasty, TAVI - transcatheter aortic valve implantation, UR – unreported or data not available)
The annual number of PCIs in every interventional cardiology center in Romania is represented in Figure 1. A direct comparison of data from 2014 to 2022 was done, which highlights the continuous increase of the workload of the interventional cardiology centers of Romania until 2021 when we have a clear decrease (Figure 2). In 2021, the number of PCIs increased close to the pre-pandemic era. In 2022, 21,767 PCIs were performed in Romania compared to 19,862 in 2021, which represents an increase of 9.5%. The total number of primary PCIs increased in 2022 by 22% compared to 2021 (figure 3).
Although the total number of peripheral angioplasties doubled from 2014 to 2018, there was a decrease by 13% in 2019. It further decreased in 2020 by 38% (Figure 4), but in 2022, 1,796 peripheral angioplasties were performed.
The number of TAVI procedures doubled every year between 2015 and 2019, and the trend continued in 2022 with an increase of 31% compared to 2021 (figure 5). The number of procedures performed in structural heart diseases decreased by 47% between 2021 and 2022 (figure 5).
The data analysis in this study is limited to those centers that actively responded to the request from the Interventional Cardiology Working Group. Some centers did not participate or provided poor quality data not feasible for the analysis. We emphasized the importance of participation and providing useful and accurate data from all interventional cardiology centers in Romania to have a better picture of the phenomenon.
There is a continuous need to implement a Mandatory Interventional Cardiology National Registry capable of monitoring objectively these key health care services in a standard manner. This national registry can guide further development of interventional cardiology in Romania1–6.