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
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 |
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 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 |
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 |
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 |
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 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 |
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 |
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 |
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 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 |
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 |
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 |
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 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 |
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 |
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 |
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 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 |
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 |
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 |
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 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 |
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).
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).
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).
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.