Windecker S, Meyer B J, Bonzel T, Fabian J, Heyndrickx G, Morice M C, Mühlberger V, Piscione F, Rothman M, Wijns W, van den Brand M, Meier B
University Hospital, Bern, Switzerland.
Eur Heart J. 1998 Jan;19(1):40-54. doi: 10.1053/euhj.1997.0798.
The working group Coronary Circulation of the European Society of Cardiology conducts an annual survey of cardiac interventions in Europe with the support of the national societies of cardiology. A detailed questionnaire about cardiac interventions performed during 1994 was mailed 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 interventions performed during 1994 in 29 of 37 members of the European Society of Cardiology, representing a total population of approximately 490 million inhabitants.
A total of 922,687 coronary angiograms were reported during 1994, representing an increase of 22% compared 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.
During 1994, a total of 224,722 coronary angioplasty (PTCA) procedures were reported in Europe, an increase of 22% compared with 1993 and of 52% compared with 1992. Adjusted per capita, the mean incidence of coronary angioplasty was 458/10(6) inhabitants, ranging from 1091/10(6) inhabitants 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 Netherlands 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 emergency coronary artery bypass grafting (0.7%).
Coronary stents were utilized in 21,599 coronary interventions during 1994, an increase of 235% compared with 1993 and thus representing the fastest growth in interventional cardiology. The number of European countries employing stents during coronary angioplasty grew from 14 during 1993 to 24 during 1994. Elective use (38%) became the most frequent indication for coronary stenting during 1994, replacing bail-out stenting as the primary indication during 1993.
Other new interventional 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 ultrasound was utilized in 3032 interventions and coronary angioscopy in 304 cases during 1994. NON-CORONARY INTERVENTIONS: Valvuloplasty remained the most frequent non-coronary intervention in Europe during 1994 with a total of 2622 mitral. 609 pulmonary and 506 aortic valvuloplasties.
The number of facilities per 10(6) inhabitants performing invasive cardiac procedures in Europe during 1994 ranged from 7.7 in Iceland to 0.2 in Romania (European mean 2.9). The number 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 coronary angiograms and 170 PTCAs were performed per catheterization facility in Europe (range: 1052 coronary angiograms and 293 PTCAs per facility in Norway to 218 coronary angiograms and 37 PTCAs per facility in Romania).
The number of both coronary angiograms and coronary angioplasties continues to grow at an annual rate of approximately 20% in Europe. There is a wide range in the amount of revascularization procedures performed between western and eastern European countries. However, countries with the lowest numbers of coronary angiograms and coronary angioplasties, e.g. Romania, also show the fastest annual growth. About one quarter of all patients undergoing coronary angiography are subsequently revascularized by coronary angioplasty. (ABSTRACT TRUN
欧洲心脏病学会冠状动脉循环工作组在各国心脏病学会的支持下，对欧洲的心脏介入治疗进行年度调查。一份关于1994年所施行心脏介入治疗的详细问卷被寄给了欧洲心脏病学会的所有成员。来自8个国家成员的数据不完整或缺失，因此未被纳入最终分析。因此，本报告总结了欧洲心脏病学会37个成员中29个成员在1994年所施行的心脏介入治疗情况，这些成员代表的总人口约为4.9亿居民。
1994年共报告了922,687例冠状动脉造影，与1993年相比增加了22%，与1992年相比增加了35%。冠状动脉造影的平均发生率为每10^6居民中有1881例，范围从德国的每10^6居民中有4417例到罗马尼亚的每10^6居民中有35例，德国、法国、英国和意大利占欧洲人口的50%，却施行着73%的所有心脏介入治疗。
1994年，欧洲共报告了224,722例冠状动脉成形术（PTCA），与1993年相比增加了22%，与1992年相比增加了52%。经人均调整后，冠状动脉成形术的平均发生率为每10^6居民中有458例，范围从德国的每10^6居民中有1091例到罗马尼亚的每10^6居民中有6例。平均而言，PTCA与冠状动脉造影的比例为0.24，范围从荷兰的0.37到塞浦路斯的0.06。临时PTCA占所有PTCA病例的22%。大多数（81%）的PTCA仅限于单支血管。接受PTCA的患者中有2%报告发生了主要并发症，包括死亡（0.3%）、心肌梗死（1.0%）和需要紧急冠状动脉搭桥术（0.7%）。
1994年，21,599例冠状动脉介入治疗中使用了冠状动脉支架，与1993年相比增加了235%，因此代表了介入心脏病学中增长最快的领域。在冠状动脉成形术中使用支架的欧洲国家数量从1993年的14个增加到1994年的24个。1994年，选择性使用（38%）成为冠状动脉支架置入术最常见的适应证，取代了1993年作为主要适应证的补救性支架置入术。
8827例病例中使用了其他新的介入治疗设备。与1993年相比，1994年只有旋磨术使用得更频繁。所有其他新的治疗设备使用量均下降。1994年，冠状动脉超声用于3032例介入治疗，冠状动脉血管镜用于304例。非冠状动脉介入治疗：1994年，瓣膜成形术仍是欧洲最常见的非冠状动脉介入治疗，二尖瓣成形术共2622例、肺动脉瓣成形术609例、主动脉瓣成形术506例。
1994年欧洲每10^6居民中进行侵入性心脏手术的设备数量从冰岛的7.7个到罗马尼亚的0.2个不等（欧洲平均为2.9个）。每10^6居民中训练有素的操作人员数量从德国的24个到罗马尼亚的0.4个不等（欧洲平均为10个）。1994年，欧洲每个导管插入设备平均进行701例冠状动脉造影和170例PTCA（范围：挪威每个设备进行1052例冠状动脉造影和293例PTCA，罗马尼亚每个设备进行218例冠状动脉造影和37例PTCA）。
在欧洲，冠状动脉造影和冠状动脉成形术的数量均继续以每年约20%的速度增长。西欧和东欧国家在血管重建手术的施行数量上存在很大差异。然而，冠状动脉造影和冠状动脉成形术数量最少的国家，如罗马尼亚，其年增长率也最快。所有接受冠状动脉造影的患者中约有四分之一随后通过冠状动脉成形术进行血管重建。（摘要截断）
