Coronary revascularization in DACH: 1991-2002

Abstract

Background: The changes in coronary revascularization in Europe in general and in the DACH countries (Deutschland, Austria, Switzerland) in particular between 1991 - 2002 were studied.

Methods: The databases of different national surgical societies, registries, and governments and international organizations and collegial responses were analyzed.

Results: The population of Europe (excluding Russia, CIS, and Turkey) increased by 2.29 % from 1991 to 521.84 million in 2002 and by 4.7 %, 3.4 %, and 7.4 % in Austria (AT), Germany (DE), and Switzerland (CH), respectively. The DACH countries contributed 18.76 % to the European population in 2002. During this period the cardiac surgery (CS) output increased in Europe, AT, DE, CH by 108 % to 428 477 (821/million population), by 72 % to 7035 (859/million), by 244 % to 125 341 (1521/million), and 61 % to about 8600 (1175/million), respectively. Coronary artery surgery (CAS) output increased by 108 % to 241 567 (463/million), by 83 % to 4559 (557/million), by 159 % to 73 929 (897/million), and by 37 % to about 5000 (684/million), respectively. DACH contributed 34.6 % of CAS volume in Europe in 2002. CAS average volume/center/year rose from 301 in 1991 to 392 in 2002 in Europe, 312 --> 506 in AT, 538 --> 936 in DE, and changed to 331 --> 278 in CH. The percentage of CAS in CS hardly changed from 56.2 % in 1991 to 56.4 % in 2002 in Europe but changed from 61 % --> 64.8 % in AT, 67.5 % --> 58.98 % in DE, and 68.1 % --> 58.2 % in CH. Acceptance of OPCAB remains low at 5 - 18 % of CAS. The increase in percutaneous coronary interventions (PCI) volume was more impressive: the 2002 average of PCI/million was 1244 in Europe, 1659 in AT, 2524 in DE, and 1708 in CH; 36 % of the total number of European PCI was done in DACH. In 2002, coronary stenting was done in 83 % of PCI in Europe: with 1039/million in Europe, 1399/mill (84 %) in AT, 1994/mill (79 %) in DE, and 1435/mill (84 %) in CH. The average European total coronary revascularization activity (PCI + CAS) increased from 1991 by 257 % to 1707/million in 2002; in DACH it increased by 261 % to 3243/million.

Conclusions: Coronary revascularization productivity in Europe during the last decade has continued to grow (mostly in the PCI sector) but has lagged behind that in the USA. The pattern of coronary artery surgery remains fairly consistent in DACH while CAS productivity is far ahead of the rest of Europe despite recent plateauing. The trend towards PCI was equally pronounced in AT, DE, and CH.