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Live from EuroPCR 2010: Update on European Interventional cumulative registry by Prof Bernard Meier

From the EAPCI General Assembly on 25 May 2010.

Yesterday, Bernard Meier presented during the EAPCI General Assembly, an update European Interventional cumulative registry.

View his presentation Here 

For how long have you been collecting European registry data on interventional cardiology?

I first collected European data in 1992 with the help of a national coordinator of each country. This coordinator distributed a simple 1-page questionnaire to all invasive centers in the respective country. This provided me with country summaries which were used for the European report. Data quality was assured by presenting the aggregated national data back to the individual sources before using them. Likewise, the European aggregated data were sent back for scrutiny the national representatives before publication.

Which type of information are you gathering?

Basic information about the number of cases of the year reported are gathered. They include the numbers of active centers per country and interventional cardiologists per center, the existence of an electronic data bank, the numbers of diagnostic coronary angiographies, percutaneous coronary interventions (PCI), (drug-eluting) stent implantations, other coronary diagnostic or therapeutic invasive devices, and puncture site closure techniques. In addition, the use of some important medications such glycoprotein IIb/IIIa inhibitors and other anticoagulants were asked for. Further questions are whether PCI was performed acutely for ongoing infarction, whether multiple vessels were treated in one session (multivessel PCI), about radial approach, use of left ventricular assist devices, and coronary protection techniques.

Other structural interventions were also asked for, such as alcohol ablation for obstructive septal hypertrophy, aortic, mitral, and pulmonary valvuloplasty, transcatheter aortic or pulmonary valve replacement, and transcatheter mitral valve repair, as well as closure of patent foramen ovale, atrial septal defect, ventricular septal defect, patent ductus arteriosus, and most recently, left atrial appendage.

Add to this, some peripheral interventions such as carotid, renal, and coarctation angioplasty. Regarding the basic questions aksed about complications (death, myocardial infarction, need for emergency surgery), a voluntary registry underestimates real life.

What is the aim of collecting this information?

Ideally, every case of interventional cardiology performed anywhere in Europe should be registered with all its details. As this is a gargantuan task, it is approached from two sides. This registry provides the best available information about rough numbers and their trends over years. Data quality is far from perfect but the yearly publications ascertain that the data stay within reasonable boundaries as outliers would be reprimanded. The other approach is the Euro Heart Survey which is an in depth case-per-case analysis of a few selected centers spread across Europe.

What are the salient information that have emerged from the first 15 years of this registry?

Comparing countries, the initial dominance per capita of affluent countries like Switzerland was quickly caught up and superseded by other industrialized countries such as Belgium and, in particular, Germany with the most frequent and comprehensive invasive approach to heart disease. Another trend of interest was the disparate manner of Eastern European countries to increase their yearly numbers. It seemed to correlate with their economic upsurge. The acceptance of drug-eluting stents was initially quite rapid but then slowed down by the concern about late thrombosis in 2006. This, however, created slower growth rather than a downturn as anticipated at the time. Multivessel interventions, a favorite topic to brag about for interventional cardiologists, have stayed below the 20% margin over all these years. Although this percentage is likely to be kept low by remuneration reasons in many countries, it also depicts the judicious approach to PCI of cardiovascular medicine in Europe. PCI is a powerful tool to treat coronary artery disease but it has and will have its limits when it comes to the diffuse form of it.