Atlas of interventional cardiology 2023: European Society of Cardiology and European Association of Percutaneous Coronary Interventions

Abstract

Aims: To provide the most comprehensive assessment to date of interventional cardiology practices across ESC national society member countries, with a focus on infrastructure, procedural volumes, temporal trends (2013-2022), regional disparities, and adherence to guideline-recommended care.

Methods: The third edition of the ESC-EAPCI Atlas presents data from 50 ESC national society member countries, collected through a dedicated 2023 survey of national cardiac societies and interventional working groups. Data were subjected to a rigorous multi-step quality control process to ensure consistency and accuracy.Key metrics include interventional resources, such as the number of hospitals with catheterization laboratories, trained personnel, and the proportion of women in the interventional workforce; procedural volumes and types, including percutaneous coronary intervention (PCI), primary PCI, transcatheter aortic valve implantation (TAVI), transcatheter mitral valve procedures (TMVP), transcatheter tricuspid valve procedures (TTVP), as well as procedural characteristics, including arterial access site, use of intracoronary imaging, physiological lesion assessment, and sex-specific data on patient care delivery.

Results: Despite the ongoing expansion of structural heart transcatheter interventions, PCI remains the dominant procedure, accounting for over 90% of all percutaneous cardiovascular interventions. PCI volumes showed limited variation across ESC member countries and demonstrated no significant association with gross national income per capita (GNI). In contrast, important regional disparities were observed in the use of TAVI, TMVP and TTVP with procedure rates strongly correlated with GNI (r=0.86, r=0.63 and r=0.64). Workforce data revealed that while women constitute 39% of all cardiologists, they represent only 10% of interventional cardiologists across ESC member countries. Although interventional cardiology has helped reduce female disparity in access compared with cardiac surgery, inequalities persist, e.g. less than 30% of PCI recipients are women, despite women representing more than 40% of patients with ischemic heart disease. Temporal trend analysis showed a narrowing gap in PCI and primary PCI volumes between regions, reflecting improved access across all economic strata. However, growth in structural valve interventions remained disproportionately concentrated in wealthier countries.

Conclusions: The third edition of the ESC-EAPCI Atlas highlights significant progress in percutaneous cardiovascular interventions across Europe but also underscores persistent disparities. These findings reinforce the need for balanced investment strategies, harmonized training, greater sex equity, and enhanced data infrastructures to support more equitable and evidence-based cardiovascular care.

Keywords: ESC Atlas; Europe; Interventional cardiology; PCI; TAVI; disparities; structural interventions; workforce.