Original article

The SWISS PCI Survey – coronary and structural heart interventions in Switzerland 2020

This article was corrected and republished online on July 12, 2022. See Correction - July 12, 2022 (https://cardiovascmed.ch/article/doi/cvm.2022.w10174).

DOI: https://doi.org/10.4414/cvm.2022.w10133
Publication Date: 19.05.2022
Cardiovasc Med. 2022;25:w10133

Jasper Boeddinghausa, Oliver Gaemperlib, Pascal Meierc, Olivier Mullerd, Fabian Nietlispache, Lorenz Raeberf, Daniel Weilenmanng, Raban Jegera

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

b HeartClinic, Hirslanden Hospital Zurich, Switzerland

c Honorary Consultant, Royal Brompton and Harefield Trust, London, UK

d Department of Cardiology, University Hospital Lausanne, University of Lausanne, Switzerland

e HerzGefäss-Zentrum, Hirslanden Klinik im Park, Zurich, Switzerland

f Department of Cardiology, University Hospital Bern, University of Bern, Switzerland

g Department of Cardiology, Cantonal Hospital St Gallen, Switzerland

Summary

For almost 35 years, the Swiss Working Group for Interventional Cardiology of the Swiss Society of Cardiology has evaluated and assessed the invasive diagnostic and therapeutic heart interventions performed annually in Switzerland. The aim of this survey, which was completed by 36 centres using a standardised questionnaire, was to report the data for the year 2020. Overall, 53,088 coronary angiographies with 48.8% subsequent percutaneous coronary interventions, i.e., 8.6% less than in 2019, were performed. Regarding structural interventions, there were 1971 transcatheter aortic valve implantations, comparable with 2019. The decrease in coronary interventions was most likely due to the coronavirus disease (COVID-19) pandemic and its consequences on the Swiss healthcare system. 

Introduction

Despite major improvements in diagnostic and therapeutic options, such as broad and early access to coronary angiography, cardiovascular disease including acute myocardial infarction remains the leading cause of death worldwide, with 17.6 million people dying per annum [1]. Therefore, current international guidelines highlight the importance of established international and national networks for the management of acute and chronic heart disease [2, 3]. The Working Group for Interventional Cardiology of the Swiss Society of Cardiology (SSC) has coordinated the annual assessment of invasive diagnostic and therapeutic procedures performed in Switzerland since 1987 [4]. Based on a stan­dardised questionnaire, the number of diagnostic and therapeutic procedures are self-reported by each centre and published by the Swiss Working Group for Interventional Cardiology of the SSC [5–10]. In contrast to previous years, the performed procedures in 2020 were influenced by the evolving coronavirus disease (COVID-19) pandemic.

Methods

We contacted all interventional cardiology centres in Switzerland and asked them to complete the standardised online questionnaire via the Survio© platform. In the case of technical difficulties or according to their preference, the questionnaire was completed using a standardised pdf-file. In total, we assessed 69 items ­including basic information on the catheterisation centres, and more specific details on the type and indications of interventions, material used and outcome (if available). Detailed information on the assessed vari­ables is given in the online appendix.

Data were collected using Excel© for Windows© and we solely used descriptive statistics without formal statistical analysis. As no specific patient data were assessed, and as 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

In the year 2020, 36 of 38 (94.7%) Swiss centres with interventional cardiology available on site reported their numbers. Of note, the Herzklinik Hirslanden Zurich and HerzZentrum Hirslanden Zurich reported their numbers together as one centre. The Kantonsspital Baden and the Herz-Gefäss-Klinik Bethanien Zurich did not report any numbers. The participating centres consisted of 5 university hospitals, 15 non-university public hospitals and 16 private institutions. Centres from 17 of the 26 cantons of Switzerland participated. Sixteen (46%) of these centres have cardiac surgery on site with the possibility to perform procedures with surgical backup (table 1).

Table 1:

Interventional cardiology centres in Switzerland in 2020.

City, centreClinic ­descriptionCantonNumber of ­catheter labsCardiac surgery on siteNumber of PCI operators
20202019Diff.
Aarau, Hirslanden KlinikpAargau2Yes8
Aarau, Kantonsspitaln-uAargau2No550
Basel, St. ClaraspitalpBasel-Stadt1No330
Basel, University HospitaluBasel-Stadt2Yes990
Bern, Hirslanden Klinik Beau-SitepBern2Yes871
Bern, LindenhofspitalpBern2No56–1
Bern, University Hospital ­(Inselspital)uBern4Yes14113
Biel, Spitalzentrumn-uBern1No541
Chur, Kantonsspital Graubündenn-uGraubünden2No2.44–1.6
Frauenfeld, Spital Thurgau AGn-uThurgau1No110
Fribourg, Hôpital Fribourgeoisn-uFribourg2No660
Genève, Hirslanden Clinique d. GrangettespGenève1No541
Genève, Hôpital de La TourpGenève2Yes78–1
Genève, University HospitaluGenève2Yes770
Genolier, Clinique de GenolierpVaud1No440
Kreuzlingen, Herz-Neuro-Zentr. BodenseepThurgau1Yes56–1
Lachen, Spital Lachen AGn-uSchwyz1No532
Lausanne, CHUVuVaud2Yes862
Lausanne, Clinique de La SourcepVaud1No440
Lausanne, Hirslanden Clinique ­CecilpVaud2Yes419–15
Liestal, Kantonsspital Basellandn-uBasel-Land1No1.52–0.5
Lugano, Fondazione Cardiocentro Ticinon-uTicino4Yes990
Luzern, Hirslanden Klinik St. AnnapLuzern1No440
Luzern, Kantonsspitaln-uLuzern4Yes871
Morges, Hôpital de Morgesn-uVaud1No541
Pfäffikon, Cardiance ClinicpSchwyz1No23-1
Sion, Centre de cardiologie du ­ValaispValais1No330
Sion, Hôpital de Sionn-uValais1Yes45–1
Solothurn, Bürgerspitaln-uSolothurn2No440
St. Gallen, Kantonsspitaln-uSt. Gallen3No880
Winterthur, Kantonsspitaln-uWinterthur2No651
Zürich, Hirslanden Klinik/­Herzzentrum HirslandenpZürich2Yes14140
Zürich, Klinik Im ParkpZürich3Yes770
Zürich, Stadtspital Triemlin-uZürich3Yes770
Zürich, University HospitaluZürich2Yes79–2
Baden, Kantonsspitaln-uAargau1No4
Zürich, Herz-Gefäss-Klinik ­BethanienpZürich1No1
Total36176516204.9208–3.1

Diff. = difference; “–“ = not applicable; u = university centre; n-u = non-university community centre; p = private clinic; PCI = percutaneous coronary intervention. The last two centres (in italics) did not participate. 

Diagnostic and interventional procedures for coronary heart disease

Overall, 205 percutaneous coronary intervention (PCI) operators performed 53,088 coronary angiographies (CAGs) in 65 catheterisation laboratories at 36 centres. Of note, we observed a relative reduction in CAG cases of 8.4% compared with2019. In 25,933 (48.8%) CAG cases, a subsequent PCI was performed (fig. 1), with a PCI per CAG rate ranging between 24% and 68% among different centres (table 2). The average number of total cases/year and PCIs/year per operator were 255 and 124, respectively (tables 1 and 2). The overall numbers of diagnostic and interventional cases per centre, ranked by absolute numbers, are shown in figure 2. Similarly to 2019 [10], radial access was used in 66% of all cases. However, we still observed a wide range from 18% to 98%, depending on site and operator preference (table 3).

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Figure 1:

Central Illustration

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Figure 2:

Coronary angiographies and interventions during the year 2020 in Switzerland.

Table 2:

Overall cases performed in 2020 versus 2019 and specific indications for percutaneous coronary interventions.

CentreTotal number of casesDiagnostic cases onlyPCIPCI in % of totalPCI for
20202019Diff.20202019Diff.20202019Diff.20202019Diff.NSTE-ACSSTEMICardiogenic shockCTOAntegrade CTORetrograde CTO% Emergency PCI
Aarau, Hirslanden Klinik13376856524917711645
Aarau, ­Kantonsspital13591935–576596988–392763947–184564972031372014645
Basel, ­St. Claraspital429457–28269287–18160170–1037370201401212021
Basel, University Hospital23652649–28412171425–20811481224–76w494622913034165521355
Bern, Hirslanden Klinik Beau-Site1535131921688479193651528123424021224203330325
Bern, ­Lindenhofspital13711482–111608692-84763790–27565321615102522328
Bern, University Hospital ­(Inselspital)59596567–60836763877–20122832690–4073841–3127
Biel, ­Spitalzentrum9711074–103424612–188547462855643131631011243271650
Chur, Kantonsspital Graubünden10571317–260371553–182686764–7865587167162123932750
Frauenfeld, Spital Thurgau AG722713942038139302332–304247–5105601412237
Fribourg, Hôpital Fribourgeois20512169–1189701090–12010811079253503396208317671559
Genève, Hirslanden Clinique d. ­Grangettes74269349340330104023633954522831602725225
Genève, Hôpital de La Tour697771–74372434–62325337–1247443684021815334
Genève, University Hospital14721821–349773988–215699833–134474622411965850401071
Genolier, Clinique de Genolier449491–42187212–25262279–175857220212011
Kreuzlingen, ­Herz-Neuro-Zentr. Bodensee11511231–80630687–57521544–234544145107174037332
Lachen, Spital Lachen AG137169–32104126–223343–102425–10002200
Lausanne, CHUV21872491–30411821468–28610051023–1846415576322124234891
Lausanne, ­Clinique de La Source8441031–187483519–36361512–1514350–738004848011
Lausanne, ­Hirslanden ­Clinique Cecil20142060–4610481119–7196694125484620
Liestal, Kantonsspital Baselland9311001–70377381–4554620–666062–22594357555
Lugano, Fonda­zione Cardio­centro Ticino22912352–61105310292412381323–855456–24162374643301356
Luzern, Hirslanden Klinik St. Anna11621345–183377436–59785909–12468680625173734315
Luzern, Kantonsspital29073256-34914501747–29714571509-525046467627649108783069
Morges, Hôpital de Morges54038915131121794229172574244–2794077036
Pfäffikon, ­Cardiance Clinic450433172202173230216145150138502219319
Sion, Centre de cardiologie du Valais640723–83313347-34327376–495152–1000232300
Sion, Hôpital de Sion14381621–183735823–88703798-9549490180131103028246
Solothurn, ­Bürgerspital12861537–251570609–39716928–2125660–5252146191414058
St. Gallen, ­Kantonsspital25402931–39112681510–24212721421–149504823012253105842162
Winterthur, ­Kantonsspital11851331–146457507–50728824–9661620246210393025568
Zurich, Hirslanden Klinik/ Herzzentrum Hirslanden22782520–24211261281–15511521239–8751491114981445331220
Zürich, Klinik Im Park11121202–90536634–985765688524750
Zürich, Stadtspital Triemli28772949–7214931599–1061384135034484624314006460
Zürich, University Hospital26023169–56716301608229721561–5893749–12209246263649
Total52,66857,199–453127,15929,524–236525,50927,675–216648.448.40.0611938954031341868171 

Diff. = difference; PCI = percutaneous coronary intervention; NSTE-ACS = non-ST-elevation acute coronary syndrome; STEMI = ST-elevation myocardial infarction; CTP = chronic total occlusion.

Table 3:

Access route, stent types and balloons used.

CentreTotal number of cases (CAG+PCI)Radial accessType of stent usedDCB
Absolute%BMSDESSelfexpandable (DES or BMS)Bioabsorbable scaffoldsBifurcation ­dedicated stents
Aarau, Hirslanden Klinik1337062000022
Aarau, Kantonsspital135910127407090019
Basel, St. Claraspital42979181492
Basel, University Hospital23651801760109400047
Bern, Hirslanden Klinik Beau-Site153545330061100024
Bern, Lindenhofspital13711218897111120
Bern, University Hospital (Inselspital)5959375863020130178
Biel, Spitalzentrum9717587804910003
Chur, Kantonsspital Graubünden10577787405560008
Frauenfeld, Spital Thurgau AG72261785030220020
Fribourg, Hôpital Fribourgeois205195747095300086
Genève, Hirslanden Clinique d. Grangettes7426448737621
Genève, Hôpital de La Tour6976559403080007
Genève, University Hospital147267046062600067
Genolier, Clinique de Genolier44935579015600022
Kreuzlingen, Herz-Neuro-Zentrum115186375052100035
Lachen, Spital Lachen AG137117850330000
Lausanne, CHUV218717398088990
Lausanne, Clinique de La Source84465778036100034
Lausanne, Hirslanden Clinique Cecil201465833682700
Liestal, Kantonsspital Baselland931884950517012025
Lugano, Fondazione Cardiocentro2291189082110610300243
Luzern, Hirslanden Klinik St. Anna116251845069100 81
Luzern, Kantonsspital290717366011295500161
Morges, Hôpital de Morges54024746021400015
Pfäffikon, Cardiance Clinic4502004402300000
Sion, Centre de cardiologie du Valais64062798029500015
Sion, Hôpital de Sion1438119283068300020
Solothurn, Bürgerspital128669054066300036
St. Gallen, Kantonsspital254022108701097000143
Winterthur, Kantonsspital118577966069800030
Zürich, Hirslanden Klinik/­Herzzentrum Hirslanden22781306570109100070
Zürich, Klinik Im Park1112
Zürich, Stadtspital Triemli287723828301310000
Zürich, University Hospital26021265490972
Total5,308833,49865%823,123742111544
    0.1%99.7%0.1%0.2%0.1% 

CAG = coronary angiography; PCI = percutaneous coronary intervention; BMS = bare metal stent; DES = drug eluting stent; DCB = drug coated balloon.

Thirty-two centres provided complete data on PCI indications. Among emergency PCIs (39% of total PCIs), non-ST-elevation acute coronary syndrome (NSTE-ACS), ST-elevation myocardial infarction (STEMI) and cardiogenic shock accounted for 59%, 37% and 4% of cases, respectively (table 2). Interventions for chronic total occlusions (CTOs) accounted for 5.3% of PCIs and were primarily performed using an antegrade approach (65%). Among all coronary interventions, drug-eluting stents (DES) were the most used stent type at 99.7% of cases (bare metal stents 0.1%, self-expandable stents 0.1%, bioabsorbable scaffolds 0.2%, and bifurcation dedicated stents 0.1%; table 3). The use of drug-coated balloons (DCBs) remained stable at 2.9% versus 2.8% of all cases in 2020 and 2019, respectively.

Lesion preparation using techniques other than balloon angioplasty were applied in 1937 cases (7.5% of all PCIs). Rotational atherectomy, intravascular lithotripsy, and thrombus aspiration were used in 345 (1.3%), 318 (1.2%), and 1274 (4.9%) cases, respectively (table 4). The degree of coronary artery stenosis was further assessed in 6783 cases (12.9%) and quantified by fractional flow reserve (38.9%), instantaneous wave-free ratio (27.7%), intravascular ultrasound (10.9%) or optical coherence tomography (22.5%). Left ventricular assist devices were used in 468 cases (0.9% of all cases; table 4).

Table 4:

Revascularisation techniques, quantification methods, and use of left ventricular assist devices.

CentreRevascularisation techniques, others than ­balloon angioplasty by number of casesQuantification methods of the degree of stenosisLeft ventricular assist devices
Rotabl.Shockwave Thromb-asp FiltersFFRiFRIVUSOCTIABPIm-pellaECMOOthers
Aarau, Hirslanden Klinik90120767604301210
Aarau, Kantonsspital51765474251711700
Basel, St. Claraspital680050206
Basel, University Hospital141268099010904423
Bern, Hirslanden Klinik ­Beau-Site201302600100010
Bern, Lindenhofspital12376
Bern, University Hospital2613712220484814527
Biel, Spitalzentrum61770790000200
Chur, Kantonsspital Graubünden533005593401000
Frauenfeld, Spital Thurgau AG000013740200000
Fribourg, Hôpital Fribourgeois10187621311013468630
Genève, Clinique d. Grangettes734486225
Genève, Hôpital de La Tour1232138301305200
Genève, University Hospital6126020180847591330
Genolier, Clinique de Genolier60001441440150000
Kreuzlingen, Herz-Neuro-­Zentrum50250153652500020
Lachen, Spital Lachen AG000017000000
Lausanne, CHUV127623255248925
Lausanne, Clinique de La Source02401030000000
Lausanne, Hirslanden Clinique Cecil0000000
Liestal, Kantonsspital Baselland174904201230500
Lugano, Fondazione ­Cardiocentro932831276233444202650
Luzern, Hirslanden Klinik St. Anna02110971911001000
Luzern, Kantonsspital18383004107365214970
Morges, Hôpital de Morges62025220150000
Pfäffikon, Cardiance Clinic0020055100000
Sion, Centre de cardiologie d. Valais08829
Sion, Hôpital de Sion001428500152040
Solothurn, Bürgerspital0321201390000000
St. Gallen, Kantonsspital11552121115781321478280
Winterthur, Kantonsspital445150500500
Zürich, Hirslanden Klinik/ ­Herzzentrum Hirslanden926564216291081110
Zürich, Klinik Im Park2110113
Zürich, Stadtspital Triemli1307152330531330
Zürich, University Hospital1310610693672912
Total34531812744526381881737152798306613
 1.3%1.2%4.9%0.2%38.9%27.7%10.9%22.5%20.9%65.4%13.0%0.6%
7.5% 12.9%0.9%
 % of PCI ases % of total c

Rotabl. = rotablation; Thrombasp. = thrombusaspiration; FFR = fractional flow reserve; iFR = instantaneous wave-free ratio; IVUS = intravascular ultrasound; OCT = optical coherence tomography; IABP = intra-aortic balloon pump; ECMO = extracorporeal membrane oxygenation

Interventions for structural heart disease

We observed a comparable number of interventions (figs 3 and 4). In 2020, 1971 TAVIs were performed with femoral access being used in 94% and trans-apical access in 2.7% of all implantations (table 5).

Figure 3:

Trend in transcatheter aortic valve implantations and access routes

Figure 4:

Transcatheter aortic valve implantations (TAVIs) during the year 2020 in Switzerland.

Table 5:

Transcutaneous aortic valve implantations (TAVIs) in 2020 with details on access route and use of embolic protection devices.

CentreAortic valvuloplasty without percutaneous valve replacement Total number of TAVIsTAVI accessUse of embolic protection device during TAVI
20202019Diff.Trans-femoralTrans-apicalTrans- ­subclavianDirect aorticTrans-­carotidealTrans-caval
Aarau, Hirslanden Klinik0145142030000
Aarau, Kantonsspital0075–750000000
Basel, St. Claraspital0
Basel, University Hospital117016551605500068
Bern, Hirslanden Klinik Beau-Site06983-1469000000
Bern, Lindenhofspital
Bern, University Hospital3388403–15363154042
Biel, Spitalzentrum000000000
Chur, Kantonsspital ­Graubünden000000000
Frauenfeld, Spital Thurgau AG000000000
Fribourg, Hôpital ­Fribourgeois200000000
Genève, Clinique d. ­Grangettes
Genève, Hôpital de La Tour03933636020016
Genève, University ­Hospital05886-28580000056
Genolier, Clinique de ­Genolier000000000
Kreuzlingen, Herz-Neuro-Zentrum02328–523000000
Lachen, Spital Lachen AG000000000
Lausanne, CHUV13112011113111611
Lausanne, Clinique de La Source000000000
Lausanne, Hirslanden ­Clinique Cecil075641170100400
Liestal, Kantonsspital ­Baselland000000000
Lugano, Fondazione ­Cardiocentro0787625412011109
Luzern, Hirslanden Klinik St. Anna000000000
Luzern, Kantonsspital4123116712300000109
Morges, Hôpital de­ ­Morges000000000
Pfäffikon, Cardiance Clinic000000000
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion000000000
Solothurn, Bürgerspital000000000
St. Gallen, Kantonsspital000000000
Winterthur, Kantonsspital000000000
Zürich, Hirslanden Klinik/ Herzzentrum Hirslanden11511501150010004
Zürich, Klinik Im Park47175–4
Zürich, Stadtspital Triemli01097831971200008
Zürich, University Hospital0341360–190158000020
Total1519711912591616461512255271
% of total    94.0%2.7%0.9%0.7%1.5%0.3% 

No details provided by Klinik im Park (n = 1719 for access route calculation).

Compared with previous years, we observed a further decrease in mitral edge-to-edge repair procedures from 362 in 2019 to 314 in 2020 (–13.3%, table 6a) [9, 10]. Similarly, numbers of left atrial appendage (LAA) closures decreased from 317 to 305 (3.8%), and interventional persistent foramen ovale (PFO) closure procedures from 866 to 782 (–9.7%). Catheter-based therapy of pulmonary embolism was used more commonly in 2020 than in 2019 (125 versus 98 cases; tables 6a and 6b).

Table 6a:

Mitral and tricupid valve interventions.

CentreOcclusion of paravalvular leakageMitral valve interventionsTranscath. tricuspid valve interventionPulmonary 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 Klinik00390001000
Aarau, ­Kantonsspital0080000000
Basel, St. Claraspital
Basel, University Hospital11171051000
Bern, Hirslanden Klinik Beau-Site00130000000
Bern, Lindenhofspital
Bern, University Hospital ­(Inselspital)42590071843 10
Biel, Spitalzentrum0000000000
Chur, Kantonsspital Graubünden0000000000
Frauenfeld, Spital Thurgau AG0000000000
Fribourg, Hôpital Fribourgeois0080000000
Genève, Clinique des Grangettes
Genève, Hôpital de La Tour0000000000
Genève, University Hospitals02130000700
Genolier, Clinique de Genolier0000000000
Kreuzlingen, Herz-Neuro-­Zentrum0010000000
Lachen, Spital Lachen AG0000000000
Lausanne, CHUV71511942
Lausanne, ­Clinique de La Source0000000000
Lausanne, Hirslanden Clinique Cecil000000000
Liestal, Kantonsspital Baselland0000000000
Lugano, Fonda­zione Cardiocentro00150002000
Luzern, Hirslanden Klinik St. Anna0050000000
Luzern, ­Kantonsspital13400007010
Morges, Hôpital de Morges0000000000
Pfäffikon, ­Cardiance Clinic0000000000
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion0000000000
Solothurn, ­Bürgerspital2000000000
St. Gallen, ­Kantonsspital0070000000
Winterthur, ­Kantonsspital0000000000
Zürich, Hirslanden Klinik/­Herzzentrum ­Hirslanden10340002000
Zürich, Klinik Im Park36280001000
Zürich, Stadt­spital Triemli0260010000
Zürich, University Hospital10160000
Total201731410143359512

TMVI = transcatheter mitral valve implantation; PTA = percutaneous transluminal angioplasty; TPVI = transcatheter pulmonary valve implantation.

Table 6b:

Specific interventional therapy and data on closure devices.

CentreTASHPericardial ­drainage (ad hoc or scheduled)Catheter based therapy of pulmonary embolismCatheter-based renal sympathetic denervation for treatment of hypertensionCoronary sinus reductionClosure devices
PFO ASD VSD LAA 
Aarau, Hirslanden Klinik100023539
Aarau, Kantonsspital01700044203
Basel, St. Claraspital7
Basel, University Hospital1282702471018
Bern, Hirslanden Klinik Beau-Site420001604
Bern, Lindenhofspital461
Bern, University Hospital54264813728070
Biel, Spitalzentrum0600014100
Chur, Kantonsspital ­Graubünden00014001
Frauenfeld, Spital Thurgau AG0000019000
Fribourg, Hôpital ­Fribourgeois15320233011
Genève, Hirslanden ­Clinique des Grangettes331
Genève, Hôpital de La Tour0600012002
Genève, University ­Hospitals4260003031
Genolier, Clinique de ­Genolier000105001
Kreuzlingen, Herz-Neuro-Zentrum Bodensee050003000
Lachen, Spital Lachen AG040005000
Lausanne, CHUV3132331127
Lausanne, Clinique de La Source020004000
Lausanne, Hirslanden ­Clinique Cecil0000
Liestal, Kantonsspital ­Baselland016100014106
Lugano, Fondazione ­Cardiocentro Ticino03610320204
Luzern, Hirslanden Klinik St. Anna020006212
Luzern, Kantonsspital8920123911022
Morges, Hôpital de Morges010000000
Pfäffikon, Cardiance Clinic1502012104
Sion, Centre de cardiologie du Valais
Sion, Hôpital de Sion0150006302
Solothurn, Bürgerspital071610220012
St. Gallen, Kantonsspital02520037308
Winterthur, Kantonsspital0800010100
Zürich, Hirslanden Klinik/Herzzentrum Hirslanden017000247017
Zürich, Klinik Im Park4158528
Zürich, Stadtspital Triemli521000577120
Zürich, University Hospital2914924
Total373611251818782995305

TASH = transcoronary ablation of septal hypertrophy; PFO = persistent foramen ovale; ASD = atrial septal defect; VSD = ventricular septal defect; LAA =  left atrial appendage

Outcome

Among all participating centres, only 24 (69%) reported data on in-hospital mortality, thus making our findings less representative. Regarding interventions for chronic coronary artery disease, NSTE-ACS, STEMI, and cardiogenic shock, there was an in-hospital mortality of 0.08%, 1.6%, 4.1%, and 52%, respectively. The overall in-hospital mortality of patients undergoing a TAVI procedure was 2% (data reported by five centres only).

Limitations

There are some limitations that need to be highlighted: First, the main limitation results from the study ­design, with data being submitted on a voluntary basis by the individual centres without monitoring. We aimed to minimise this effect by sending a standardised questionnaire to all involved centres. Second, ­unfortunately not all centres replied and provided complete data. Due to missing data, some findings of this study are not representative, and their generalis­ability is limited. Third, definitions of chronic coronary artery disease, NSTE-ACS, STEMI, and cardiogenic shock were based on international guidelines but not predefined by the registry, and therefore may have differed among the centres. Fourth, when comparing the findings of 2020 with those from 2019 one has to consider that only 36 and not 37 centres participated. However, this had no impact on reported TAVI procedures as all Swiss TAVI centres participated in both years.

Conclusion

The national numbers of 2020, as collected by the Swiss PCI Survey, show a decrease in coronary interventions. Interestingly, TAVI cases were comparable to the preceding year. Similarly, compared with 2019, we observed an 8.4% reduction in CAG and PCIs. These findings are well in line with several international studies that found a severe impact of the COVID-19 pandemic on the entire field of interventional cardiology and the number of heart interventions compared with preceding years [11–16]. Fortunately, although we have observed a reduction, it was not as dramatic as reported elsewhere [11–16]. Despite international recommendations, the number of cases with radial access remained stable at only 66%. Especially in times of the COVID-19 pandemic, radial access as the preferred route, which is known to be ­associated with lower complication rates and shorter hospital stays, might help to reduce the in-hospital resource use. Similarly, local versus general anaesthesia for TAVI could be beneficial, even though previous studies did not show a relevant reduction in the length of hospitalisation [17]. In order to further relieve strained hospital resources, a more liberal approach in identifying patients eligible for PCI or TAVI might be promising. Regarding TAVI procedures, the transfemoral approach was the commonly used access (98.2%). Numbers of other structural interventions, such as the mitral edge-to-edge repair, PFO and LAA occlusions ­remained stable on a high level. Despite the observed decrease in overall cases due to the COVID-19 pandemic, the presented data still show a comparable performance in interventional cardiology for Switzerland compared with its European neighbours [18–21].

As a result of a well-organised and functional national network of the Swiss Working Group for Interventional Cardiology, nationwide data were collected on interventions for coronary and structural heart disease. ­National registries and standardised data collection as well as publication remain a key tool to assess the performance of a healthcare system and confirm outcomes and safety of procedures in interventional cardiology [22, 23].

Disclosure statement

No financial support and no other potential conflict of interest relevant to this article was reported.

Correspondence

Prof. Raban Jeger, MD

Department of Cardiology

University Hospital Basel

Petersgraben 4

CH-4031 Basel

raban.jeger[at]usb.ch

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Appendix: Data collected within the registry

The appendix is available in the online version of the article at https://cardiovascmed.ch/article/doi/CVM.2022.w10133.

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