Registry of percutaneous coronary interventions: changes over recent years (2010–2022)
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Abstract
In 2022, the number of coronary angiograms in Ukrainian clinics was 51 084, which is 27.6 % more than in 2019, the number of stented patients is 27 513 for all forms of coronary artery disease (scheduled and urgent patients), which is
19.7 % more than in 2019 year and 16 847 stenting were performed in STEMI patients in the first day from the onset of symptoms, which is 12.9 % more than in 2019.
During the period of the Register operation, the fact of creation of 66 reperfusion centers was recorded, which are the main part of Regional Reperfusion Networks (RRN) and strive to function in accordance with national unified protocols for the treatment of STEMI, NSTEMI and stable coronary syndromes.
Today, the distribution of patients by time from the onset of symptoms to mechanical reperfusion in Ukraine is distributed as follows: in the first 12 hours from the onset of STEMI symptoms, 85 % are present (15 % are «late» patients who are hospitalized at 12–24 hours from the onset of symptoms or later, often requiring urgent coronary angiography and possibly primary stenting). Patients arriving in the «ideal» period for reperfusion (in the first 2 hours) is about 15 %, the largest group of STEMI patients who arrived at the clinic in the first 2–4 hours from the onset of symptoms is 30 %, and the number of patients with AMI in the period of 4–6 hours from the onset of symptoms, the average is 25 %, and the 6–12-hour group completes the analysis by 15 %, respectively.
The number of procedures in STEMI patients increased annually, which led to a decrease in hospital mortality in reperfusion centers (55–60 % of patients in catheterization laboratories in Ukraine are STEMI patients) to an average of 4.7 %, and in the general group of AMI in Ukraine to 12.3 %. Unfortunately, 40–45 % of patients are currently hospitalized in clinics without the possibility of primary stenting.
A ten-year observation of the dynamics of primary stenting revealed changes, which we called the «reperfusion paradox», which occurred in 2015–2016, which fully confirmed the correct vector of technology development and determined the trend of its development. This phenomenon is the beginning of a natural decrease in the number of fibrinolytic procedures from 27 % (2010 year) to 4.6 % (2021 year), respectively, and an increase in the number of primary procedures in STEMI patients from 4.0 % (2010 year) to 56.4 % (2022 year), which is quite natural and confirms the processes of active development and systemic transformations in interventional cardiology in Ukraine and around the world.
As a result, it was found that we have increased 17 times the number of primary percutaneous interventions per million population over the last decade, while European countries have increased the number of similar procedures by only
14 %. This fact indicates the correct direction of development and the speed of movement in this direction.
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References
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