Original article

Coronary and structural heart interventions in Switzerland 2019

DOI: https://doi.org/10.4414/smw.2021.20495
Publication Date: 11.05.2021
Swiss Med Wkly. 2021;151:w20495

Wagener Maxa*, Twerenbold Raphaela*, Cook Stéphaneb, Gaemperli Oliverc, Meier Pascald, Muller Oliviere, Nietlispach Fabianf, Raeber Lorenzg, Weilenmann Danielh, Jeger Rabana

a Cardiology, University Hospital Basel, University of Basel, Switzerland

b Cardiology, Cantonal Hospital Fribourg, Switzerland

c HeartClinic, Hirslanden Hospital Zurich, Switzerland

d Cardiology, Cantonal Hospital Chur, Switzerland

e Cardiology, University Hospital Lausanne, University of Lausanne, Switzerland

f HerzGefäss Zentrum, Hirslanden Klinik im Park, Zurich, Switzerland

g Cardiology, University Hospital Bern, University of Bern, Switzerland

h Cardiology, Cantonal Hospital St Gallen, Switzerland

Summary

Since 1987 the Swiss Working Group Interventional Cardiology of the Swiss Society of Cardiology coordinates the assessment of invasive diagnostic and therapeutic heart interventions across Switzerland. The aim of this report is to summarise the data for the year 2019, which was collected using a standardised questionnaire. In 2019, 37 centres performed a total of 57,975 coronary angiographies. In 48.2% of these cases a subsequent percutaneous coronary intervention was performed. Among a broad spectrum of structural heart interventions, we have observed a constant growth of transcatheter aortic valve implantations, and a total of 1912 transcatheter aortic valve implantations were performed in 2019.

Introduction

Despite a decrease in mortality due to evolving therapeutic options and faster access to interventional treatment in past decades, cardiovascular disease still accounts for 45% of all deaths in Europe with about 20% being caused by coronary heart disease [1]. Current guidelines underline the importance of established international and national networks for the management of acute and chronic heart disease [2, 3]. The Working Group Interventional Cardiology of the Swiss Society of Cardiology (SSC) has coordinated the annual assessment of invasive diagnostic and therapeutic procedures across Switzerland since 1987 [4]. On an evolving, standardised questionnaire, the number of the different cardiovascular procedures are collected and published by the Swiss Working Group Interventional Cardiology of the SSC [59].

Methods

All interventional cardiology centres across Switzerland were asked to complete a standardised online questionnaire via the Survio® platform. In the event of technical difficulties with the online platform, the questionnaire was completed via a standardised .pdf file. Overall, 69 items were assessed, regarding general information of the catheterisation centres, the interventions for coronary artery and structural heart disease, the indications for the interventions, the material used, and outcome (if available). Details of the variables assessed are listed in the appendix.

Data were collected using Excel® for Windows® and only descriptive statistics are presented, without formal statistical analysis. As no patient information was assessed, and data collection and analysis for in-hospital mortality after interventional procedures were for quality assurance/control purposes only, no formal approval by local institutional review boards and/or written patient consent was required.

Results

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Figure 1
Summary of coronary interventions and their outcomes in Switzerland 2019.

In the year 2019, with the addition of one new institution in the canton of Zurich, Switzerland had 37 centres performing interventional cardiac procedures. The interventional centres consist of the 5 university hospitals, 16 non-university public hospitals and 16 private institutions that are distributed over 17 of 26 cantons across Switzerland. Sixteen (43%) of these centres have the possibility to perform cardiac surgery on site (table 1).

Table 1

Interventional cardiology centres in Switzerland 2019.

City, centreClinic typeCantonNumber of catheter labsCardiac surgery on sitePCI operators
20192018Difference
Aarau, Hirslanden Klinik*pAargau*Yes*14n.a.
Aarau, Kantonsspitaln-uAargau2No550
Baden, Kantonsspitaln-uAargau1No45−1
Basel, St. ClaraspitalpBasel-Stadt1No330
Basel, University HospitaluBasel-Stadt2Yes981
Bern, Hirslanden Klinik Beau-SitepBern2Yes770
Bern, LindenhofspitalpBern2No642
Bern, University Hospital (Inselspital)uBern4Yes11110
Biel, Spitalzentrumn-uBern1No45−1
Chur, Kantonsspital Graubündenn-uGraubünden2No440
Frauenfeld, Spital Thurgau AGn-uThurgau1No16−5
Fribourg, Hôpital Fribourgeoisn-uFribourg1No651
Genève, Hirslanden Clinique d. GrangettespGenève1No440
Genève, Hôpital de La TourpGenève2Yes880
Genève, University HospitalsuGenève2Yes752
Genolier, Clinique de GenolierpVaud1No440
Kreuzlingen, Herz-Neuro-Zentr. BodenseepThurgau1Yes67−1
Lachen, Spital Lachen AGn-uSchwyz1No36−3
Lausanne, CHUVuVaud2Yes660
Lausanne, Clinique de La SourcepVaud1No440
Lausanne, Hirslanden Clinique CecilpVaud2Yes19172
Liestal, Kantonsspital Basellandn-uBasel-Land1No220
Lugano, Fondazione Cardiocentro Ticinon-uTicino4Yes990
Luzern, Hirslanden Klinik St. AnnapLuzern1No45−1
Luzern, Kantonsspitaln-uLuzern4Yes752
Morges, Hôpital de Morgesn-uVaud1No440
Pfäffikon, Cardiance ClinicpSchwyz1No330
Sion, Centre de cardiologie du ValaispValais1No330
Sion, Hôpital de Sionn-uValais2Yes550
Solothurn, Bürgerspitaln-uSolothurn2No440
St. Gallen, Kantonsspitaln-uSt. Gallen3No981
Winterthur, Kantonsspitaln-uWinterthur2No550
Zürich, Herz-Gefäss-Klinik BethanienpZürich1No1--
Zürich, Hirslanden KlinikpZürich2Yes14122
Zürich, Klinik Im ParkpZürich3Yes761
Zürich, Stadtspital Triemlin-uZürich3Yes770
Zürich, University HospitaluZürich3Yes981
Total37176616214224−10

n.a. = not applicable; n-u = non-university community centre; p = private clinic; PCI = percutaneous coronary intervention; u = university centre
* No data provided

Diagnostic and interventional procedures for coronary heart disease

There were 214 percutaneous coronary intervention (PCI) operators performing a total of 57,975 coronary angiographies in 66 cathlabs. In 27,959 (48.2%) coronary angiography cases, a subsequent PCI was performed (fig. 1), with a PCI per angiography rate ranging between 20% and 73% among different centres (table 2). The average number of total cases/year and PCIs/year per operator were 271 and 131, respectively (tables 1 and 2). Figure 2 displays the numbers of diagnostic and interventional cases per centre, ranked by absolute number. Radial access was used in 66% of all cases, which represents a steep increase compared with 47% observed in 2018 [9]. Of note, radial access rate ranged widely from 15% to 98%, depending on site and operator preference (table 3).

Table 2

Coronary angiographies and percutaneous coronary interventions in Switzerland 2019.

CentreTotal number of casesDiagnostic cases onlyPCIPCI in % of totalPCI for
20192018Diff.20192018Diff.20192018Diff.20192018Diff.N-ST
ACS
STEMICardio-genic shockCTOAnte-grade CTORetro-grade CTO% emergency PCI
Aarau, Hirslanden Klinik*  582n.a.377n.a.205n.a.35n.a.
Aarau, Kantonsspital19352226−2919881249−261  947977−304944526223352
Baden, Kantonsspital645  550954571234−777  188166222930−162201515034
Basel, St. Claraspital457  500−43287301−14  170199−293740−32317099024
Basel, University Hospital264924891601425128114412241208164649−23143026188721655
Bern, Hirslanden Klinik Beau-Site13191582−263791884−93  528698−1704044−40
Bern, Lindenhofspital148213958769265537  7907405053530985720
Bern, University Hospital (Inselspital)65676483843877373214526902751−614142−14685006115938
Biel, Spitalzentrum1074  90317161252488  4623798343421909063425940
Chur, Kantonsspital Graubünden1317112719055347479  764653111585801921581479562348
Frauenfeld, Spital Thurgau AG713  69122381386−5  3323052747442115331515036
Fribourg, Hôpital Fribourgeois21692187−1810901111−211079107635049184113390
Genève, Hirslanden Clinique d. Grangettes693  56812533025575  363313505255−333303126510
Genève, Hôpital de La Tour771  820−49434508−74  3373122544386622732418627
Genève, University Hospitals18211893−729881001−13833892−594647−12552504250321866
Genolier, Clinique de Genolier491  4405121219913  27924138575521090
Kreuzlingen, Herz-Neuro-Zentr. Bodensee12311235−4687578109  544657−1134453−9587543634225
Lachen, Spital Lachen AG169  190−21126130−44360−172532−63002207
Lausanne, CHUV24912249242146812332351023101674145−44413092357421576
Lausanne, Clinique de La Source10311040−9519522−3  512518−6505003400494907
Lausanne, Hirslanden Clinique Cecil20602098−3811191234−115  9418647746414
Liestal, Kantonsspital Baselland1001  93368381406−25  620527936256515755127536
Lugano, Fondazione Cardiocentro Ticino23522402−5010291037−813231365−425657−12372173744311337
Luzern, Hirslanden Klinik St. Anna13451196149436453−17  90974316668625823835548714
Luzern, Kantonsspital32563279−2317471858−1111509142188464333883391031901573455
Morges, Hôpital de Morges389  473−84217255−38  172218−464446−268301313041
Pfäffikon, Cardiance Clinic433  3953821719324  216202145051−136302624218
Sion, Centre de cardiologie du Valais723  336387347196151  376140236524210510353502
Sion, Hôpital de Sion1621143618582374974  798687111494812131451650351547
Solothurn, Bürgerspital15371391146609648−39  9287431856053720212635
St. Gallen, Kantonsspital293127401911510143674142113141074848128121515141835836
Winterthur, Kantonsspital1331129338507523−16  8247705462602226234484237562
Zürich, Herz-Gefäss-Klinik Bethanien131  n.a.n.a.36n.a.96n.a.73n.a.100121201
Zürich, Hirslanden Klinik25202591−7112811320−3912391271−32494909479164038215
Zürich, Klinik Im Park120211119163460628  5685056347452545282116020
Zürich, Stadtspital Triemli29492971−22159915574213501414−644648−2395375456160
Zürich, University Hospital31693514−34516081746−13815611768−2074950−12632751254342
Total57,97557,30966630,01730,851−83427,95927,31864148.247.70.6605343176451505924  230 

CTO = chronic total occlusions; n.a. = not applicable; N-ST-ACS = non-ST-segment elevation acute coronary syndrome; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction
* No data provided; † estimated numbers

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Figure 2
Coronary angiographies and interventions in Switzerland 2019 – centres ranked by total number of cases.

Table 3

Percutaneous coronary intervention details.

CentreTotal number of CARadial accessType of stent usedDEB
n%BMSDESSelf-expandable (DES or BMS)Bioabsorbable scaffoldsBifurcation dedicated stents 
Aarau, Hirslanden Klinik
Aarau, Kantonsspital19351449750  834000
Baden, Kantonsspital645516   803  18303015
Basel, St. Claraspital4576815  15412
Basel, University Hospital26491925   730  1126140098
Bern, Hirslanden Klinik Beau-Site1319
Bern, Lindenhofspital14821275   860  7900012020
Bern, University Hospital (Inselspital)65674070621  24680151
Biel, Spitalzentrum1074850   790  4550003
Chur, Kantonsspital Graubünden1317881   670  7640005
Frauenfeld, Spital Thurgau AG713548770  33110010
Fribourg, Hôpital Fribourgeois2169506230  106200063
Genève, Hirslanden Clinique d. Grangettes693650   940  34800015
Genève, Hôpital de La Tour771683   890  30900019
Genève, University Hospitals1821830   466  74405060
Genolier, Clinique de Genolier491323   660  23500030
Kreuzlingen, Herz-Neuro-Zentrum1231701   570  54400012
Lachen, Spital Lachen AG169139   820430000
Lausanne, CHUV2491176871  961365
Lausanne, Clinique de La Source1031711   6911  48100029
Lausanne, Hirslanden Clinique Cecil20601451706000
Liestal, Kantonsspital Baselland1001936940  620030027
Lugano, Fondazione Cardiocentro23521899810  1220129055
Luzern, Hirslanden Klinik St. Anna1345715   530  852010172
Luzern, Kantonsspital32562637810  1490100024
Morges, Hôpital de Morges389149380  163009
Pfäffikon, Cardiance Clinic433220   510  2150001
Sion, Centre de cardiologie du Valais723712980  344000
Sion, Hôpital de Sion16211264   780  79220
Solothurn, Bürgerspital1537523340  75600030
St. Gallen, Kantonsspital29312638   900  1255730373
Winterthur, Kantonsspital1331780591  77300045
Zürich, Herz-Gefäss-Klinik Bethanien*131100760920003
Zürich, Hirslanden Klinik25201227490  114510089
Zürich, Klinik Im Park1202722600  43600083
Zürich, Stadtspital Triemli29492299780  1340000
Zürich, University Hospital31691373   430  12250088
Total57,97537,538  66%282455034741201626
 0.1%99.0%0.1%0.3%0.5% 

BMS = bare metal stent; CA = coronary angiography; DEB = drug-eluting balloon; DES = drug-eluting stent; PCI = percutaneous coronary intervention
* Estimated numbers

Thirty-four centres provided complete data on reason for PCI (n = 26,490). Among emergency PCIs (42% of total PCIs) non-ST-elevation acute coronary syndromes (ACS), ST-elevation myocardial infarction (STEMI) and cardiogenic shock accounted for 55%, 39% and 6% of cases, respectively (tables 2 and 4). Interventions for chronic total occlusions accounted for 6% of PCIs performed, with an antegrade approach used in 61%. Among all coronary interventions, drug-eluting stents were the most commonly used stent type, used in 99% of all cases, with other stent types playing just a minor role (bare metal stents 0.1%, self-expandable stents 0.1%, bioabsorbable scaffolds 0.3%, bifurcation dedicated stents 0.5%) (table 3).

Table 4

Indication for percutaneous coronary intervention.

PCIs with data on PCI indication provided (34 centres)26,490
Emergency PCIs11,015  42%  Of total PCIs
Non-ST-ACS6053  55%  Of emergency PCIs
STEMI4317  39%
Cardiogenic shock  645  6%

Non-ST-ACS = non-ST-segment elevation acute coronary syndrome; PCI = percutaneous coronary intervention; STEMI = ST-segment-elevation myocardial infarction

Additional techniques for lesion preparation other than balloon angioplasty were used in 1405 (5%) of PCI cases. In 6253 cases (10.8% of total cases) the degree of coronary artery stenosis was quantified by fractional flow reserve (42.3%), instantaneous wave-free ratio (28.7%), intravascular ultrasound (10.0%) or optical coherence tomography (19.0%). With a total of 554 cases (1%), left ventricular assist devices were rarely needed (table 5).

Table 5

Auxiliary coronary revascularisation techniques, quantification methods of coronary stenosis and left ventricular assist devices.

CentreRevascularisation techniques, other than balloon angioplasty, by number of casesQuantification methods of the degree of stenosisLeft ventricular assist devices
RotablShock waveThromb aspFiltersFFRiFRIVUSOCTIABPImpella®ECMOOther
Aarau, Hirslanden Klinik*
Aarau, Kantonsspital12146102211920
Baden, Kantonsspital00167  780000000
Basel, St. Claraspital1014054401
Basel, University Hospital3206301030191804226
Bern, Hirslanden Klinik Beau-Site1900000000000
Bern, Lindenhofspital712000000000
Bern, University Hospital3461786301251373755230
Biel, Spitalzentrum190211  420540700
Chur, Kantonsspital Graubünden11051007272201500
Frauenfeld, Spital Thurgau AG0200  18910240000
Fribourg, Hôpital Fribourgeois130780  91013945230
Genève, Clinique d. Grangettes5101  9700310000
Genève, Hôpital de La Tour7092  7601303010
Genève, University Hospitals11145850218634541272
Genolier, Clinique de Genolier60011511510300000
Kreuzlingen, Herz-Neuro-Zentrum0026011148400020
Lachen, Spital Lachen AG0000  1001000000
Lausanne, CHUV167572502111574
Lausanne, Clinique de La Source00501560000000
Lausanne, Hirslanden Clinique Cecil200000000
Liestal, Kantonsspital Baselland152111  3600210600
Lugano, Fondazione Cardiocentro5107211  54216483851080
Luzern, Hirslanden Klinik St. Anna80150  683500400
Luzern, Kantonsspital1212162019113157430
Morges, Hôpital de Morges220  3881
Pfäffikon, Cardiance Clinic0010540300000
Sion, Centre de cardiologie d. Valais000011500150000
Sion, Hôpital de Sion1812416124
Solothurn, Bürgerspital321011390000000
St. Gallen, Kantonsspital1541912001834914043188280
Winterthur, Kantonsspital50161332603800
Zürich, Herz-Gef.-Klinik Bethanien302043760000
Zürich, Hirslanden Klinik6337428731710910
Zürich, Klinik Im Park4042231933011210
Zürich, Stadtspital Triemli2101216405318910
Zürich, University Hospital013213212652533150
Total423104878692647179262411901253161058
   1.5%  0.4%  3.1%  0.2%42.3%28.7%10.0%19.0%22.6%57.0%19.0%1.4%
5.0% 10.8%1.0%
     % of PCI Cases% of TOTAL Cases

ECMO = extracorporeal membrane oxygenation; FFR = fractional flow reserve; IABP = intra-aortic balloon pump; iFR = instantaneous wave-free ratio; IVUS = intravascular ultrasound; OCT = optical coherence tomography; Rotabl = rotablator; thromb asp = thrombus aspiration
* No data provided; † estimated numbers; ‡ cardiology department only

Interventions for structural heart disease

As described previously [9], after the steep rise in the early years after its introduction in 2007 there is still a constant growth in case numbers for transcatheter aortic valve implantation (TAVI, fig. 3), reflecting the implementation of TAVI in current guidelines for valvular heart disease [10]. In 2019, 1912 TAVIs were performed, with femoral access being used in 95.5% of implantations (table 6). Figure 4 displays the numbers of TAVIs with transfemoral or alternative access routes per centre, ranked by absolute number.

Table 6

Transcatheter aortic valve implantations in Switzerland 2019.

Centre   Aortic valvuloplasty without percutaneous valve replacementTotal number of TAVIsTAVI accessUse of embolic protection device during TAVI
20192018Diff.Trans-femoralTrans-apical  Trans- subclavianDirect aorticTrans-carotidTrans-caval
Aarau, Hirslanden Klinik*
Aarau, Kantonsspital07572030000
Baden, Kantonsspital
Basel, St. Claraspital
Basel, University Hospital016511847152850001
Bern, Hirslanden Klinik Beau-Site0835231
Bern, Lindenhofspital
Bern, University Hospital440329910439810004
Biel, Spitalzentrum
Chur, Kantonsspital Graubünden
Frauenfeld, Spital Thurgau AG
Fribourg, Hôpital Fribourgeois2
Genève, Clinique d. Grangettes
Genève, Hôpital de La Tour13324932010003
Genève, University Hospitals866818851000080
Genolier, Clinique de Genolier
Kreuzlingen, Herz-Neuro-Zentrum02830–227001000
Lachen, Spital Lachen AG
Lausanne, CHUV212010020109202703
Lausanne, Clinique de La Source
Lausanne, Hirslanden Clinique Cecil06467–3
Liestal, Kantonsspital Baselland
Lugano, Fondazione Cardiocentro07679–351140110014
Luzern, Hirslanden Klinik St. Anna
Luzern, Kantonsspital911610791160000076
Morges, Hôpital de Morges
Pfäffikon, Cardiance Clinic
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion
Solothurn, Bürgerspital
St. Gallen, Kantonsspital
Winterthur, Kantonsspital1
Zürich, Herz-Gefäss-Klinik Bethanien
Zürich, Hirslanden Klinik0150157–7149001003
Zürich, Klinik Im Park275601574001000
Zürich, Stadtspital Triemli078101–2369810000
Zürich, University Hospital03603582349110000140
Total2119121620292168335201674320
% of total 95.4%  2.0%  1.1%  0.9%  0.4%  0.2% 

TAVI = transcatheter aortic valve implantation
* No data provided

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Figure 3
Summary of transcatheter aortic valve implantations in Switzerland 2019.
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Figure 4
Transcatheter aortic valve implantations in Switzerland 2019 – centres ranked by total number of cases.

Compared with 2018 there was a decrease in mitral edge-to-edge procedures from 382 to 362 [9]. As for other interventions for structural heart disease, the numbers of left atrial appendix closures decreased from 406 to 317. Interventional closure of patent foramen ovale increased by 33 to 866. Interventions for pulmonary embolism did not differ much compared with 2018 (105 vs 98 cases) (tables 7 and 8)

Table 7

Interventional valve interventions other than TAVI in Switzerland 2019.

Centre  Occlusion of paravalvular leakageMitral valve interventionsTranscath. tricuspid valve intervention      Pulmonary artery/valve interventions
Percut. transvenous valvuloplastyEdge-to-edge repair devicesDirect annuloplasty (e.g., Cardioband®)Indirect mitral annuloplasty (e.g., Carillon®)Transcath.
valve replacement (TMVI, e.g., Tendyne)
PTA / stenting pulmonary arteryTranscatheter pulmonary valvuloplastyTPVI
(e.g., Melody®)
Aarau, Hirslanden Klinik*
Aarau, Kantonsspital228
Baden, Kantonsspital
Basel, St. Claraspital
Basel, University Hospital16411
Bern, Hirslanden Klinik Beau-Site
Bern, Lindenhofspital
Bern, University Hospital (Inselspital)8366510365
Biel, Spitalzentrum
Chur, Kantonsspital Graubünden
Frauenfeld, Spital Thurgau AG
Fribourg, Hôpital Fribourgeois8
Genève, Clinique des Grangettes
Genève, Hôpital de La Tour311
Genève, University Hospitals19318
Genolier, Clinique de Genolier
Kreuzlingen, Herz-Neuro-Zentrum1
Lachen, Spital Lachen AG
Lausanne, CHUV52181227
Lausanne, Clinique de La Source
Lausanne, Hirslanden Clinique Cecil
Liestal, Kantonsspital Baselland
Lugano, Fondazione Cardiocentro2202
Luzern, Hirslanden Klinik St. Anna2
Luzern, Kantonsspital123521
Morges, Hôpital de Morges
Pfäffikon, Cardiance Clinic1
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion
Solothurn, Bürgerspital1
St. Gallen, Kantonsspital17
Winterthur, Kantonsspital
Zürich, Herz-Gefäss-Klinik Bethanien
Zürich, Hirslanden Klinik14461
Zürich, Klinik Im Park41183
Zürich, Stadtspital Triemli4410
Zürich, University Hospital1180192
Total32173625010365787

PTA = percutaneous transluminal angioplasty; TMVI = transcatheter mitral valve implantation; TPVI = transcatheter pulmonary valve implantation
* No data provided

Table 8

Non-valvular structural heart and catheter-based pulmonary/renal interventions in Switzerland 2019.

CentreTASHPericardial drainage (ad hoc or scheduled)Catheter-based therapy
of pulmonary embolism
Catheter-based renal sympathetic denervation for treatment of hypertension   Coronary sinus reductionClosure devices
PFOASDVSDLAA
Aarau, Hirslanden Klinik*
Aarau, Kantonsspital1160119
Baden, Kantonsspital35
Basel, St. Claraspital9
Basel, University Hospital13221240319
Bern, Hirslanden Klinik Beau-Site13
Bern, Lindenhofspital410
Bern, University Hospital53670515727102
Biel, Spitalzentrum1163
Chur, Kantonsspital Graubünden1541
Frauenfeld, Spital Thurgau AG12
Fribourg, Hôpital Fribourgeois11062285
Genève, Hirslanden Clinique des Grangettes12
Genève, Hôpital de La Tour8122
Genève, University Hospitals319373
Genolier, Clinique de Genolier134
Kreuzlingen, Herz-Neuro-Zentrum Bodensee312
Lachen, Spital Lachen AG33
Lausanne, CHUV21533314110
Lausanne, Clinique de La Source63
Lausanne, Hirslanden Clinique Cecil1
Liestal, Kantonsspital Baselland1751823
Lugano, Fondazione Cardiocentro Ticino1251423619
Luzern, Hirslanden Klinik St. Anna210113
Luzern, Kantonsspital72868725
Morges, Hôpital de Morges3
Pfäffikon, Cardiance Clinic211223
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion182133
Solothurn, Bürgerspital71257
St. Gallen, Kantonsspital2163237
Winterthur, Kantonsspital26
Zürich, Herz-Gefäss-Klinik Bethanien5
Zürich, Hirslanden Klinik15136730
Zürich, Klinik Im Park7104454110
Zürich, Stadtspital Triemli5172701225
Zürich, University Hospital245521433
Total3835610520168661238317

ASD = atrial septal defect; LAA = left atrial appendix; PFO = patent foramen ovale; VSD = ventricular septal defect
* No data provided; † estimated data

Outcome

Only few centres (n = 14) reported data on in-hospital mortality, thus the percentages may not be representative. With interventions for chronic coronary artery disease, non-ST-elevation ACS, STEMI, and cardiogenic shock, there was an in-hospital mortality of 0.1%, 1.8%, 5.4%, and 25.1%, respectively, which was comparable to the previous year. In patients undergoing a TAVI procedure, an in-hospital mortality of 1.0% was observed.

Limitations

The main limitation of this study is the result of its design, with data being submitted on a voluntary basis by the individual centres. By sending a standardised questionnaire to all the involved centres we tried to minimise this effect. Unfortunately, not all centres were able to retrospectively collect and submit answers to all items of the questionnaire (missing information from Kardiologie Mittelland/Hirslanden Klinik Aarau, and Herz-Gefäss-Klinik Bethanien, Zürich). Definition of chronic coronary artery disease, non-ST-elevation ACS, STEMI, and cardiogenic shock was based on international guidelines but not predefined by the registry, and therefore may differ among the centres

Conclusion

The current national numbers show an increase in interventional procedures for coronary and structural heart disease, specifically for TAVI. Regarding coronary angiography and PCI, the rate of radial access shows a further increase to currently 66%, whereas TAVI procedures are performed by the transfemoral route in 96% of cases. Other structural interventions such as mitral edge-to- edge repair, and patent foramen ovale and left atrial appendix occlusions seemed to stabilise at a high level. Overall, the information gathered shows performance numbers in interventional cardiology for Switzerland comparable to its European neighbours [1114].

As a result of a tight and functional national network of the Swiss Working Group for interventional Cardiology, nationwide data on interventions for coronary and structural heart disease were collected. National data collection and registries remain an important tool to assess performance of a healthcare system and confirm the outcomes and safety of procedures in interventional cardiology [15, 16].

Disclosure statement

Note added after publication

LR reports grants to the institution from Abbott, Sanofi, Regeneron, Medis, Biotronik, Boston Scientific and speaker or consultation fees by Abbott, AstraZeneca, Amgen, Occlutech, Canon, Sanofi and Vifor. FN has served as consultant for Edwards Lifesciences and Abbott. The other authors report no financial support and no other potential conflict of interest relevant to this article.

The originally published version of this article contained an incorrect version of figure 1. This has been corrected.

Correspondence

Prof. Raban Jeger, MD, Department of Cardiology, University Hospital Basel, Petersgraben, CH-4031 Basel, raban.jeger[at]usb.ch

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Appendix

Data collected within the registry

General information of the catheterisation centre (hospital and city), catheter labs (number), number of percutaneous coronary interventions (PCIs) operators, number of diagnostic operators (no PCI), centre with cardiac surgery (yes or no) and name of catheterisation database.

Interventions for coronary artery disease:

  • coronary angiography (total number of cases)
  • diagnostic cases only (number of cases)
  • PCI (total number of cases)
  • PCI for non-ST-elevation acute coronary syndrome (NST-ACS)
  • PCI for ST-elevation myocardial infarction (STEMI)
  • PCI for cardiogenic shock
  • PCI for chronic total occlusions (CTO)
  • antegrade recanalisation (attempted or succeeded)
  • retrograde recanalisation (attempted or succeeded)
  • radial access for coronary angiography (numbers)
  • bare metal stents (BMS) (number of cases, not number of stents)
  • drug-eluting stents (DES) (number of cases, not number of stents),
  • self-expandable stents (DES or BMS) (number of cases, not number of stents)
  • bioabsorbable scaffolds (Absorb®/Magmaris®/etc.) (number of cases, not number of stents)
  • bifurcation dedicated stents (number of cases, not number of stents)
  • drug-coated balloon only (number of cases, not number of balloons),
  • rotablator (number of cases), shockwave balloon (number of cases)
  • thrombus aspiration (number of cases)
  • distal protection device (filters), distal protection device (filters)
  • instant wave free ratio (iFR), intravascular ultrasound (IVUS)
  • intravascular optical coherence tomography (OCT)
  • intra-aortic balloon counterpulsation (IABP), Impella®, extracorporeal membrane oxygenation (ECMO)
  • other left ventricular assist devices (e.g., Tandem Heart®) Interventions for structural heart disease:
  • aortic valvuloplasty without percutaneous valve replacement
  • transcatheter aortic valve implantation (TAVI)
  • transfemoral TAVI,transapical TAVI, transsubclavian TAVI, direct aortic TAVI, transcarotid TAVI, transcaval TAVI
  • use of embolic protection device during TAVI
  • occlusion of paravalvular leakage
  • percutaneous transvenous mitral valvuloplasty
  • mitral edge-to-edge repair devices (e.g., Mitraclip®)
  • transcatheter direct mitral annuloplasty (e.g., Cardioband®)
  • transcatheter indirect mitral annuloplasty (e.g., Carillon®)
  • transcatheter mitral valve replacement (TMVI, e.g., Tendyne®)
  • transcatheter tricuspid valve intervention
  • PTA/stenting pulmonary artery
  • transcatheter pulmonary valvuloplasty
  • transcatheter pulmonary valve implantation (TPVI) (e.g., Melody®)
  • alcohol ablation for septal hypertrophy (TASH)
  • pericardial drainage (ad hoc or scheduled)
  • catheter based therapy of pulmonary embolism
  • catheter–based renal sympathetic denervation for treatment of hypertension
  • coronary sinus reduction
  • closure of patent foramen ovale (PFO)
  • atrial septal defects (ASD)
  • ventricular septal defects (VSD)
  • left atrial appendix (LAA) closure

Data on outcome (if available):

  • in-hospital mortality – overall after any intervention (coronary and not-coronary, number of cases)
  • in-hospital mortality – overall after any PCI (number of cases)
  • in-hospital mortality – after PCI for stable coronary artery disease (number of cases)
  • in-hospital mortality – after PCI for NSTE-ACS (number of cases)
  • in-hospital mortality – after PCI for STEMI (number of cases)
  • in-hospital mortality – after PCI for cardiogenic shock / cardiac arrest (number of cases)
  • in-hospital mortality – after TAVI (number of cases)

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