ABSTRACT
Using methods on cardiac catheterization from ANCALAR complete data from reporting year 2020 are now available. The rate of diagnostic coronary angiography procedures (CAG;-8,7%), total acute plus non-acute PCI (-9.9%), including non-acute PCI (-9.5%), interventions for acute PCI (-10.6%) and including STEMI-PCI (-6.8%) declined during the pandemic year 2020 for the first time compared to the years before. Moreover left ventricular angiography (-12.2%), right heart catheterization (-17.3%), myocardial biopsies (-42.5%), PCI for chronic total occlusions (CTO;-14.1%), clot catcher (-10.3%), and rotablator procedures (-6.7%), as well as electrophysiologic diagnostics (-8.3%) und therapies (ablations;-6.9%) decreased in 2020 compared to 2019 in 27 Austrian Catheterization Laboratories. It is possible that patients suffering from acute, subacute or chronic symptoms presented less frequently in tertiary centres. Private Institutions rather increased the rate of elective procedures during the pandemic year 2020 (elective non acute PCI +9.7%) in contrast to the Austrian trend. Private Institutions but decreased the rate of acute PCI (-40,5%) on a basis of low numbers in pre-existing procedures. On the other hand in non-private Institutions in five centres there was an increase in STEMI-PCI by 23% in contrast to the Austrian decreasing trend. Possibly due to limited access to surgical intensive care wards during the pandemic, percutaneous aortic valve implantations (TAVI;+4.3%), percutaneous Mitral-Clipping (+28%) and defect closure procedures (+2.2%) within Cathlabs increased in 2020 within the whole country, compared to all the years before. This new trend in cardiac procedures within catheterization laboratories was not expected fora whole year and is now documented for Austria correlating to results in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). The presentation is also available at http://iik.i-med.ac.at.
ABSTRACT
Using methods on cardiac catheterization from ANCALAR we compared data from year 2020 to data from 2019 and previous years by conducting a late breaking survey. 12 centres voluntarily provided data for comparative analyses. During the COVID-19 pandemic in 2020 cardiac catheterization procedures decreased markedly and for the first time. The rate of diagnostic coronary angiographic procedures (CAG) declined by -8.2 % (p < 0.001), total acute plus non-acute PCI by -10.0 % (p < 0.001), interventions for acute PCI declined by -12.5 % (p < 0.001) and STEMI-PCI declined by -2.0 % (p = 0.6). Data scattering concerning urban or rural areas, concerning private or public institutions was present but not causative. Moreover left ventricular angiography, right heart catheterization, myocardial biopsies, PCI for chronic total occlusions (CTO), clot catcher, and rotablator procedures, as well as electrophysiologic dia-gnostics und therapies (ablations) decreased. On the other hand percutaneous aortic valve implantation (TAVI), Mitral-Clipping and defect closures within CathLabs increased in 2020. It is possible that patients suffering from acute or subacute symptoms presented less frequently in tertiary centres or that pandemic-related delays for elective procedures have led to later presentations as acute coronary syndromes. This trend of mostly declining cardiac procedures in catheterization laboratories for the whole year was not expected and studies on details and on future clinical impact are warranted.
ABSTRACT
Cardiac Catheterization, Coronary Angiography (CA) and Percutaneous Coronary Interventions (PCI) in Austria during the Year 2019 (Registry Data including AUDIT 2020). Background: The Austrian National Catheterization Laboratory Registry ANCALAR is an observational registry that collects data on cardiac catheterization in Austria, annually, generating bench marks for PCI capable health centres, data has been collected yearly since 1992. New data from 2019 now available describe practice patterns and trends, identify outliers and detect safety signals in cardiac catheterization in Austria using traditional comparisons (pooled data) with Germany and Switzerland. The presentation is also available at http://iik.i-med.ac.at Results and Discussion: In Austria 33 PCIclinics with a total of 55 Cardiac catheterization laboratory (CathLab) tables in 2019 were active and between them in 2019 n = 60, 760 diagnostic Coronary Angiographies (CAG) and n= 26, 103 Percutaneous Coronary Interventions (PCI) took place. All 33 were contacted, and n=32 centres responded and data of one missing centre were extrapolated to reach a 100% response as in the years before. Practice Patterns and Trends: In Austria until 2019 and Switzerland until 2018, the absolute numbers of CA are comparable and more or less constant between 2014 and 2018;Germany including the year 2017 has consistently higher rates of CA and PCI. Concerning acute and non-acute PCI use in Austria the number of elective cases in 2019 (n = 15, 349 non-acute PCIs) remained almost identical to more than 10 years ago (n = 14, 254 cases in 2006). However, the number of patients undergoing acute, non-routine PCI (which interrupt daily planned PCI) is increasing year on year. Furthermore, an increase of complex interventions is evidenced. The number of multivessel PCI (ad hoc in one session) increased from 19.1 (2015) to 22.5% of all PCI in 2019. There was also an increase of PCI for left main stents from 2.0% (2011) to 3.7% (2019) and in bifurcations of large side branches from 6.7% (2012) to 12.4% (2017) declining to 10.5/10.1% in 2018/2019 with more multivessel PCI in 2019 at the same time. Trends in puncture techniques in Austria show that non-femoral (mostly radial) puncture techniques in diagnostic CA increased in absolute terms to n = 44, 081 (2019). In total, 76.8% of all therapeutic PCI cases are initiated or continued using a non-femoral approach (58.7% during 2018). But at the same time the number of "ad hoc" PCIs during diagnostic CA continues to decline (84.4 % in 2014 to 75.5% in 2019) and with additional 6.9 % of those radial PCI cases requiring a switch from radial to femoral during the procedure in 2019, mostly in acute cases. A phenomenon evidenced in Austria are cases with intracoronary (IC) devices but without subsequent therapeutic intervention (13.6% of PCI during 2019 are n = 2, 301 cases) such as pressure wire with or without adenosine (FFR), IC ultrasound (IVUS), or optical coherence tomography (OCT) without subsequent therapeutic intervention. These numbers of diagnostics without therapy within Cathlabs do not decrease (13.1% during 2015). Electrophysiology in Austria continued to increase in 2019 in all 24 performing centres. Electrophysiological Ablations (n = 4, 431;total) are increasing, of which n =1, 935 were for atrial fibrillation (AF) and n = 291 for ventricular arrhythmias (VT;decreasing compared to n = 396 in 2017). Of the n =2, 476 pacemaker implantations within the Cath Labs the "Leadless Pacemaker" (n = 151 in 2019) is a real innovation pioneered in 2014 at an Austrian centre spreading worldwide since. Concerning numbers of diagnostic electrophysiology and ablations per million population Austria is comparable with the European mean. Percutaneous valve implantations in Austria, particularly n = 1, 426 transarterial aortic valve procedures (TAVI/TAVR) in all 10 performing Austrian centres in 2019, as well as n = 231 cases of Mitral Clipping are reported. For TAVI Austria place just under the middle range nations in Europe, is increasing year n year in Austria per 1 million inhabitants, and was 160 per million in 2019. Concerning defect occlusions with closure procedures of PFO, PDA, ASD or VSD during the year 2016 Switzerland was in front with n = 767 cases compared to Austria with n = 218 interventions. Austria coming up with n = 368 procedures in 2019. Outliers and Safety Signals: Mortality due to acute PCI during cardiogenic shock was reported in 25-35% of cases during 2017-2019 with some fluctuations, numbers are small, however, and within cardiac registries, like ANCALAR, there are several areas in which qualitative issues in definition and reporting make statistical analysis of mortality increasingly complex. In addition, concerning recommended reduction in applications of intraaortic balloon pumps and catheter thrombectomies (thrombus aspiration) Austria started early and has then been protracted compared to Guidelines respective the use continued, on a low level, similarly in Glycoprotein IIb/IIIa (GP-) Blockers due to special indications in 2019. On the other hand, balloon pump is replaced by other techniques utilizing left ventricular assist devices (LVAD). The impact of reported periprocedural myocardial infarction and injury (1.0% during 2017-2019) due to elective PCI in Austria is dependent upon the definition use by reporting centres. Emergency surgery in context with PCI or "iatrogenic left main dissection" are rare complications. Neurologic complications are rare as well, but irreversible stroke is still present. The incidence of local bleeding- and the incidence of local puncture-complications is declining during diagnostics and therapy in spite of increasing case load 2018-2019. GPBlockers (3.6% of PCI) or Thrombin Inhibitors (TI;0.6 % of PCI) are barely used any more. ANCALAR and International Guidelines: Austria very early reacted to new guidelines and/or to new evidence as shown in the examples for: Glycoprotein IIb/IIIa (GP-) Blocker, Thrombin Inhibitor (TI), Catheter Thrombectomy (Thrombus aspiration/clot catcher), Intraaortic balloon pump for PCI. Austria remains rather hesitant in using new devices and avoids hypes like other countries as shown in the examples for: Biostent (biodegradable vascular scaffolds, BVS), or intracoronary diagnostic devices like FRR, IVUS and OCT or Defect Closure Procedures. Conclusions: An independent registry like ANCALAR represents all capable facilities over the years and shows special additional values as a basic instrument for future comparisons especially in case of an unexpectable development like the COVID-19-Pandemics enabling immediate targeted concise analytics in acute situations without conflict of interest. J Kardiol 2021;28 (1-2 Online).
ABSTRACT
Using methods on cardiac catheterization from ANCALAR we compared data from March 2020 to data from March 2019 by conducting a "snapshot"-survey. 11 centres voluntarily provided data for comparative analyses. During the COVID-19 pandemic in 2020 cardiac catheterisation procedures markedly decreased. The rate of diagnostic angiographic procedures declined by 26%, non-acute PCI by 29%, and interventions for acute coronary syndromes by 14% [(STEMI-PCI (-18%) and NSTEMI-PCI (-15%)]. As expected, this trend of declining cardiac procedures in catheterisation laboratories may influence outcomes and further decision making. Further studies are warranted to confirm this trend and future clinical impact.