The activity of the Interventional Cardiology Centers in Romania: a 2015 overview

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Marin Postu1, Lucian Predescu1,2, Stefan Mot3


1 “CC Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania
2 “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3 Heart Institute, Cluj-Napoca, Romania


Abstract: The article summarizes the activity of interventional cardiology centers of Romania during 2015. Data collection was based on the direct reports from the centers, representing all geographic regions of the country. The report highlights the differences in total number of PCIs, procedures, stents and drug eluting stents between 2014 and 2015. Keywords: interventional cardiology, percutaneous coronary interventions, stents

The activity of the interventional cardiology centers from Romania is continuously increasing, requiring clear data to understand the entire phenomenon. This report summarizes the data from 2015 provided, at the request of the Interventional Cardiology Working Group (ICWG), by 33 out of 35 public and private interventional cardiology centers of Romania (Table 1). It is a prospective observational registry study which enrolls all consecutive patients in cardiac catheterization laboratories in Romania in 2015. All public and private interventional cardiology centers have received from ICWG a questionnaire to answer specific questions about the activity in the local cath lab. The focus of the requested elements was to determine the status of the logistics (number of departments, cathlabs and interventional cardiologists), the volume of the procedures and the type of percutaneous interventions (elective or urgent, coronary or peripheral). The results collected from each center are presented in Table 1. A direct comparison of 2014 with 2015 was done, that highlight the continuous increase in the activity of the interventional cardiology centers from Romania. Figure 1, 2 and 3 highlight the total number of procedures, total number of PCIs and total number of primary PCI in STEMI patient performed in each interventional cardiology center from Romania. Currently, there are 35 public and private centers in Romania. In 33 centers that provided the reports, works 86 independent interventional cardiologists and 55 specialists in training. During 2015, in these laboratories were performed a total of 51697 diagnostic and therapeutic percutaneous procedures, including 17446 Percutaneous Coronary Interventions (PCI);
7841 cases of primary PCI (pPCI) were performed on patients with ST segment elevation myocardial infarction (STEMI). Comparing 2014 with 2015, in 2015 there was a 28.2% increase in total number of procedures (diagnostic and therapeutic procedures) (Figure 4), a 35% increase in total number of PCIs (Figure 5), a 111.2% increase in total number of drug eluting stents used (Figure 6) and a 31.2% increase in total number of stents implanted (Figure 7).  Although, the total number of procedures in 2015 increased with a 28.2%, when compared to the Figures from the neighboring countries, the number of procedures in Romania is significantly lower. Thus, in 2011 the number of pPCI per million population in Bulgaria was 6501, while in 2014 in Romania there were only 3252; the number of angioplasties per million population in 2011 in Poland was 25503,4, while in 2014 in Romania – 7502. In these countries, a sound evidencebased approach using National Registry data is applied to monitor and improve interventional cardiology services5. An important achievement in 2015 was the development of a new programme for TAVI (transcatheter
aortic valve implantation) in public hospital. The most active centers were CC Iliescu from Bucharest, Heart Institute from Cluj Napoca and Cardiovascular Diseases Institute from Iasi. The data analysis in this study is limited to those  centers that actively responded to the request from the ICWG; There are centers that did not participate or provided poor quality data not feasible for the
analysis. We emphasizes the importance of participation and providing a real and good quality data from all interventional cardiology centers in Romania in order to have a better picture of the phenomenon. The registry can help monitor the activity of different cath labs, to identify country regions not well covered by STEMI programme or with poor interventional facilities, to monitor the outcomes according to the volume of the center, number of operators and number of interventional cardiologists in training. Another key aspect is that providing clear data of the development achieved in interventional cardiology in total number of procedures, PCIs, DES and stents can have an important impact on further funding and it can be the basis for new national programmes.
In conclusion, implementation of a Mandatory Interventional Cardiology National Registry, capable of monitoring objectively these key health care services in a standard manner, can be the avenue to guide further development of the interventional cardiology in Romania. Conflict of interest: none declared.

References
1. Mandelzweig L, Battler A, Boyko V et al. Euro Heart Survey Investigators. The second Euro Heart Survey on acute coronary syndromes: Characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004. Eur Heart J. 2006; 27: 2285-2293
2. Postu M, Usurelu C, Predescu L, et al. Romanian interventional cardiology centers, 2014-2015: an overview. Romanian Journal of Cardiology, Vol 25, No 2, 2015.
3. Siudak Z, Ochała A, Lesiak M et al., Temporal trends and patterns in percutaneous treatment of coronary artery disease in Poland in the years 2005-2011, Kardiol Pol. 2015 Mar 3
4. Dudek D, Legutko J, Siudak Z et al. Interventional cardiology in Poland in the year 2011. Summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society. Kardiol Pol. 2013; 71: 1213-1219. doi: 10.5603/KP.2013.0313
5. European Perspectives, Cardiology in Practice in Europe 2011: Acute ST Elevation Myocardial Infarction, Circulation. 2011;124:f85-f90

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