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The Workload of the Interventional Cardiology Centers from Romania: a 2020 Overview and 2014–2020 Trends

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There is a continuous need to be UpToDate with the annuary trend of the number of different percutaneous procedures in the interventional cardiology field in our country. Based on this number we can assess the needs for development in specific domain of interventional cardiology. The statistics of 2020 is of utmost importance being a pandemic year that has impacted a lot the activity in this field.

This article provides data of the workload of the interventional cardiology centers from Romania during 2020 and it highlights the trends in coronary or peripheral interventions between 2014 and 20201–6. Members from all interventional cardiology centers from Romania were requested to fill a standardized form about the total number of various procedures performed during 2020. Data was collected from 36 of 38 interventional cardiology centers from Romania at the initiative of the Interventional Cardiology Working Group of Romanian Society of Cardiology.

Table 1 summarizes the data from 2020 provided by 36 public and private interventional cardiology centers from Romania. Currently, there are 38 interventional cardiology centers in Romania, of which 13 are private centers and 25 public centers. In 2019, in Romania were 51 interventional cardiologists in training. The exact number of full interventional cardiologist is difficult to know because of some interventional cardiologists are working in public and private hospitals, also.

Reported data from all Interventional Cardiology Centers from Romania in 2020

City Bucharest
Hospital CC Iliescu SUUB Floreasca Agrippa Ionescu Militar Bagdasar-Arseni Elias Sf. Ioan
No. of cathlabs 1 2 1 1 3 1 2 1
No. of independent operators 7 6 5 2 5 2 5 2
Nr. of in training operators 12 5 4 0 1 2 3 0
Coronary interventions
Coronarography 2057 1193 1185 525 1938 434 1282 252
Total nr. of PCI1 1025 770 809 110 881 129 593 72
PCI without stents 88 46 25 3 54 4 17 0
PCI with stents 937 724 784 107 733 125 576 72
STEMI with primary PCI 506 516 777 3 271 12 307 11
PCI left main 156 30 64 9 14 7 UR 0
CTO 72 25 UR 5 68 11 UR 0
Stents per patient2 1.5 1.63 1.36 1.46 1.27 1.56 1.28 1.26
Total nr. of stents 1407 1257 1008 161 929 195 743 91
Nr. of DES 1407 1257 1008 161 918 195 735 91
DES/stents ratio (%) 100% 100% 100.00% 100% 99% 100 99% 100%
Cutting, scoring 65 5 5 6 3 0 0 0
Rotabalation 16 0 8 2 2 0 0 0
Shockwave 3 0 0 0 0 0 0 0
FFR/IFR 5 10 7 7 0 0 0 0
IVUS 7 0 12 2 0 0 0 0
OCT 3 10 5 5 0 0 0 0
Peripheral interventions
Peripheral PTA3 106 0 0 8 154 0 15 11
Renal PTA 4 1 0 1 7 0 0 3
Carotid PTA 3 0 0 16 37 0 5 0
Total nr. of stents in peripheral PTA 60 0 0 7 157 0 5 17
Peripheral angiography 301 50 15 75 595 22 87 54
Other interventions
TAVI 146 24 0 8 12 0 0 0
MitraClip 0 0 0 0 0 0 0 0
Aortic endoprothesis 11 0 0 3 11 0 0 0
Interventions in structural heart disease4 23 44 0 0 1 0 0 0
City Bucharest
Hospital Sanador Ares - Monza Colentina Medlife CDT Victor Babes
Nr. of cathlabs 2 3 1 1 1
Nr. of independent operators 2 7 1 5 1
Nr. of in training operators 0 0 1 0 0
Coronary interventions
Coronarography 858 1038 56 438 46
Total nr. of PCI1 142 510 25 112 28
PCI without stents 0 15 0 9 2
PCI with stents 142 495 25 103 26
STEMI with primary PCI 11 5 2 2 0
PCI left main 3 UR 0 3 UR
CTO UR UR 0 10 UR
Stents per patient2 1.42 1.65 1.36 1.5 1.7
Total nr. of stents 202 834 34 169 44
Nr. of DES 202 834 34 169 44
DES/stents ratio (%) 100% 100% 100% 100% 100%
Cutting, Scoring 52 0 0 4 0
Rotablation 2 15 0 0 0
Shockwave 0 UR 0 1 0
FFR/IFR 0 0 0 0 0
IVUS 0 1 0 0 0
OCT 0 0 0 0 0
Peripheral interventions
Peripheral PTA3 56 75 3 28 4
Renal PTA 2 1 0 2 0
Carotid PTA 0 3 0 6 0
Total nr. of stents in peripheral PTA 15 31 3 51 7
Peripheral angiography 451 13 12 197 12
Other interventions
TAVI 18 57 0 0 0
MitraClip 0 1 0 0 0
Aortic endoprothesis 8 3 0 0 0
Interventions in structural heart disease4 0 31 0 1 0
City Cluj Napoca Iasi
Hospital Heart Institute, Cluj Emergency County Clinical Hospital, Cluj Monza-Ares Cluj Rehabilitation Hospital, Cluj IBCV Iasi Arcadia Iasi
Nr. of cathlabs 2 1 1 UR 3 1
Nr. of independent operators 9 4 1 UR 6 2
Nr. of in training operators 1 9 0 UR 3 0
Coronary interventions
Coronarography 1430 730 510 UR 2075 857
Total nr. of PCI1 1105 428 230 UR 1492 142
PCI without stents 93 19 8 UR 160 5
PCI with stents 1012 409 222 UR 1332 137
STEMI with primary PCI 422 152 0 UR 606 0
PCI left main 34 32 UR UR UR UR
CTO 12 33 UR UR UR UR
Stents per patient2 1.03 1.96 1.5 UR 1.24 1.3
Total nr. of stents 1138 840 310 UR 1849 178
Nr. of DES 1134 840 310 UR 1811 178
DES/stents ratio (%) 99% 100.00% 100% UR 98% 100%
Cutting, Scoring 6 0 0 UR 0 0
Rotablation 4 0 0 UR 0 0
Shockwave 0 0 UR UR 0 0
FFR/IFR 35 0 2 UR 0 0
IVUS 18 0 0 UR 0 0
OCT 5 8 0 UR 0 0
Peripheral interventions
Peripheral PTA3 62 84 46 UR 18 18
Renal PTA 12 5 5 UR 2 1
Carotid PTA 17 2 17 UR 4 9
Total nr. of stents in peripheral PTA 63 62 79 UR 14 UR
Peripheral angiography 40 181 54 UR 363 121
Other interventions
TAVI 95 0 0 UR 31 0
MitraClip 0 0 1 UR 1 0
Aortic endoprothesis 14 0 0 UR 0 0
Interventions in structural heart disease4 10 0 4 UR 15 1
City Targu Mures Timisoara Brasov
Hospital IBCV Tg. Mures CardioMed Tg. Mures Emergency County Clinical Hospital, Tg. Mures Nova Vita IBCV Timisoara Clinicco Brasov County Hospital Brasov „Sf. Constantin” Hospital
Nr. of cathlabs 2 2 2 1 2 1 1 1
Nr. of independent operators 6 5 6 6 7 2 4 3
Nr. of in training operators 0 0 2 0 2 0 0 0
Coronary interventions
Coronarography 1106 499 157 743 2300 823 1548 655
Total nr. of PCI1 620 299 492 81 1490 270 982 103
PCI without stents 65 26 26 0 98 4 233 1
PCI with stents 564 203 466 81 1392 266 749 102
STEMI with primary PCI 302 0 303 0 871 9 384 2
PCI left main 30 2 24 0 UR 19 UR 3
CTO 5 UR 38 0 UR 0 UR 0
Stents per patient2 1.4 1,1 1.31 1.18 1.94 1.6 1.2 1.3
Total nr. of stents 863 262 611 96 2710 426 878 138
Nr. of DES 862 262 385 96 2601 426 878 138
DES/stents ratio (%) 99% 100% 63% 100% 96% 100% 100% 100%
Cutting, scoring 5 0 0 0 3 1 4 2
Rotablation 5 0 2 0 0 2 0 2
Shockwave 0 0 0 0 0 11 0 0
FFR/IFR 33 19 2 0 1 0 31 0
IVUS 0 19 1 0 0 0 0 0
OCT 5 5 15 0 0 0 4 0
Peripheral interventions
Peripheral PTA3 47 69 9 18 44 11 0 10
Renal PTA 2 0 0 0 10 0 0 1
Carotid PTA 11 1 0 4 37 0 10 0
Total nr. of stents in peripheral PTA 24 12 3 10 84 10 0 12
Peripheral angiography 112 88 13 64 1620 17 30 23
Other interventions
TAVI 41 0 2 0 6 3 0 14
MitraClip 0 0 0 0 0 0 0 0
Aortic endoprothesis 17 0 0 0 6 1 0 5
Interventions in structural heart disease4 38 0 0 0 0 0 0 0
City Oradea Arad Suceava Baia Mare Sibiu
Hospital County Hospital Oradea County Hospital Arad County Hospital Suceava County Hospital Baia Mare Polisano Sibiu County Hospital Sibiu
Nr. of cathlabs 2 1 UR 2 1 1
Nr. of independent operators 3 1 UR 3 1 2
Nr. of in training operators 1 1 UR 1 0 0
Coronary interventions
Coronarography 880 647 UR 221 714 440
Total nr. of PCI1 508 276 UR 431 312 165
PCI without stents 18 8 UR 18 5 0
PCI with stents 490 268 UR 413 307 165
STEMI with primary PCI 226 25 UR 233 22 79
PCI left main 23 41 UR 22 12 UR
CTO 27 10 UR 0 34 UR
Stents per patient2 1.9 1.59 UR 2.21 1.44 1.28
Total nr. of stents 969 439 UR 695 440 212
Nr. of DES 951 439 UR 686 439 212
DES/stents ratio (%) 98% 100% UR 99.00% 99% 100%
Cutting, scoring 0 5 UR 7 0 0
Rotablation 3 0 UR 0 12 0
Shockwave 0 0 UR 0 0 0
FFR/IFR 16 38 UR 14 0 0
IVUS 0 0 UR 0 0 0
OCT 0 0 UR 7 0 0
Peripheral interventions
Peripheral PTA3 4 31 UR 20 10 42
Renal PTA 0 0 UR 0 0 0
Carotid PTA 0 23 UR 0 0 0
Total nr. of stents in peripheral PTA 3 36 UR 7 12 19
Peripheral angiography 23 109 UR 103 22 62
Other interventions
TAVI 0 0 UR 0 37 0
MitraClip 0 0 UR 0 0 0
Aortic endoprothesis 6 0 UR 3 2 0
Interventions in structural heart disease4 0 0 UR 0 3 0
City Constanta Ploiesti Pitesti Craiova
Hospital Monza - Ares Constanta County Hospital Ploiesti County Hospital Pitesti Muntenia Hospital County Hospital Craiova
Nr. of cathlabs 1 1 1 1 1
Nr. of independent operators 1 2 3 1 4
Nr. of in training operators 0 1 1 0 1
Coronary interventions
Coronarography 492 411 405 33 846
Total nr. of PCI1 369 305 295 12 266
PCI without stents 20 9 31 1 5
PCI with stents 349 296 264 11 261
STEMI with primary PCI 213 166 31 0 118
PCI left main UR 6 UR 0 19
CTO UR UR UR 0 0
Stents per patient2 1.32 1.2 1.3 1 1.74
Total nr. of stents 743 306 332 11 455
Nr. of DES 743 306 332 11 455
DES/stents ratio (%) 100% 100% 100.00% 100.00% 100%
Cutting, scoring 0 0 9 0 0
Rotablation 0 0 4 0 0
Shockwave 0 0 0 0 0
FFR/IFR 0 0 9 0 4
IVUS 0 0 7 0 0
OCT 0 0 0 0 0
Peripheral interventions
Peripheral PTA3 0 4 107 0 0
Renal PTA 0 0 0 0 0
Carotid PTA 0 0 8 0 0
Total nr. of stents in peripheral PTA 0 0 38 0 0
Peripheral angiography 2 40 163 2 48
Other interventions
TAVI 0 0 0 0 0
MitraClip 0 0 0 0 0
Aortic endoprothesis 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)

The annual number of PCIs in every interventional cardiology center from Romania is represented in Figure 1. A direct comparison of data from 2014 to 2020 was done, that highlights the continuous increase of workload of the interventional cardiology centers from Romania until 2020 when we have a clear decrease (Figure 2). In 2020, in Romania, 15879 PCIs were performed compared to 21783 in 2019, that represent a 27.1%. The total number of primary PCIs decreased in 2020 with 20.5% compared to 2019 (from 8281 in 2019 to 6587 in 2020) (Figure 3).

Figure 1

Total number of PCIs in 2020 in all interventional centers from Romania (PCI - percutaneous coronary intervention).

Figure 2

Total number of percutaneous coronary interventions from 2014 to 2020 in Romania.

Figure 3

Total number of primary PCIs in STEMI patients from 2015 to 2020 in interventional centers from Romania (PCI - percutaneous coronary intervention, STEMI - ST segment elevation myocardial infarction).

Although, from 2014 to 2018 the total number of peripheral angioplasties doubled, in 2019 there was a decreased in this regard by 13%, further decreasing in 2020 by 38% compared to 2019 (Figure 4).

Figure 4

Total number of peripheral angioplasties from 2014 to 2020 in Romania (only in interventional cardiology centers).

The number of TAVI procedures doubled every year between 2015–2019 and the trend maintained in 2020 with an increased by 13.3% compared to 2019 (Figure 5). The number of procedures performed in structural heart diseases increased from 2019 to 2020 by 18.1% (Figure 5).

Figure 5

Total number of TAVI and interventions in SHDs performed from 2017 to 2020 in Romania (TAVI - transcatheter aortic valve implantation, SHDs – structural heart diseases).

There is a continuous need of implementing 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 the interventional cardiology in Romania1,2,3,4,5,6.