Interventional cardiology in Poland in 2023. Annual summary report of the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and Jagiellonian University Medical College

The ORPKI database is endorsed by the Association of Cardiovascular Interventions of the Polish Cardiac Society (AISN PTK) and is operated by the Jagiellonian University Medical College, with currently 158 interventional cardiology centers in Poland actively reporting. On 31 December 2023 there were 620 percutaneous coronary interventions (PCI) operators certified by AISN PTK in Poland [1–4].

According to the current analysis of the ORPKI database, in comparison to 2022, there was a substantial (3%) increase in the total number of coronary angiography (CAG) procedures in Poland in 2023 [1]. There were 157,430 CAGs, which corresponds to 4061 per 1 million inhabitants per year in 2023. The distribution of primary diagnoses as indications for CAG was: 9% ST-elevation myocardial infarction (STEMI), 12% non-ST-elevation myocardial infarction (NSTEMI), 24% unstable angina (UA), 42% stable angina (SA) and 13% other. The radial approach was utilized in 92% of all CAG cases. Complications of coronary angiography in 2023 were rare and corresponded to the rates reported in the previous year (Table I).

The total number of PCI procedures was 91,381, which is 0.5% higher (2357 PCIs per 1 million inhabitants per year) than reported in the ORPKI database from 2022. The majority of the procedures were done in the setting of the acute coronary syndromes (ACS): 35% acute myocardial infarction (17% STEMI and 18% NSTEMI), 22% unstable angina and the remaining 43% for stable angina. There were 15,293 PCIs in STEMI (a slight decrease as of 2022) and 16,350 in NSTEMI (no change). Drug-eluting stents (DES) are used in the majority of all PCI cases, which corresponds to 95% of stents. Rotablation was used in 1754 procedures, which is a 7% increase in comparison to 2022 (1.9% of all PCIs). Aspiration thrombectomy was used in 2,170 STEMI (approx. 14% of all PCIs in STEMI) cases. We observed a similar use of ticagrelor as an adjunct pharmacotherapy both for STEMI (24%) and NSTEMI (23%) with the use of prasugrel less than 9% in either indication. In terms of complex procedures, the number of chronic total occlusion (CTO) procedures was 5265, approaching 6% of all PCIs (almost a 3-fold increase compared to 2022) with final TIMI 3 flow achieved in 67% of cases. PCI complications are still rare; they are presented in Table II. Per cutaneous mechanical circulatory support (MCS) was performed in 385 complex high-risk PCIs or in patients presenting with cardiogenic shock including 368 Impella devices (Abiomed, USA) and 17 IVAC2L pumps (Pulsecath, The Netherlands). A substantial increase in the use of adjunctive imaging and diagnostic tools during CAG and PCI (mainly IVUS) was observed in 2023 vs. 2022 (Table III).

Structural procedures are a growing part of interventional cardiology in Poland, and they are mainly performed by certified interventional cardiologists. Following recommendations of the European Society of Cardiology, 29 multidisciplinary heart teams involving 45 certified interventional cardiologists were established in all 29 transcatheter aortic valve implantation (TAVI) centers (including 4 new ones that started a TAVI program in 2021). There were 4048 TAVI procedures performed in 30 centers (more than 95% from femoral access). Evolut/Evolut Pro (Medtronic, USA) was implanted in 1806 patients, Sapien 3/Sapien 3 Ultra (Edwards Lifesciences, USA) in 1056 patients, Acurate Neo/Neo 2 (Boston Scientific, USA) in 650, Portico/Navitor (Abbott, USA) in 386 patients, Hydra (SMT, India) in 110 patients and MyValve (Merill, India) in 40 patients. The total number of TAVI significantly increased by 1119 (38%) procedures when compared to 2022; Poland, with a number of 106.5 TAVI procedures per million inhabitants in 2023, is still below the European average.

There were 45 procedures of pulmonary valve implantation, including Melody (Medtronic, USA) in 34 patients, Sapien 3 (Edwards Lifesciences, USA) Venus Valve in 6 patients (Venus Medtech, China) and Pulsta Valve (TaeWoong Medical) in 5 patients. Transcatheter edge-to-edge procedures (TEER) on mitral valves were performed in 16 centers in 520 patients with the use of MitraClips (Abbott, USA) in 433 patients and Pascal (Edwards Lifesciences, USA) in 87 patients. Also 6 transcatheter mitral valve implantations were conducted – 3 Highlife and 3 AltaValve devices. TEER procedures were also performed in 35 patients on tricuspid valves using the TriClip system (Abbott, USA) in 32 patients, MitraClip (Abbott, USA) in 3 patients and Pascal (Edwards Lifesciences, USA) in 3 patients. There were also 2 Tricvalve Transcatheter Bicaval system implantations (OrbusNeich, USA) in a patient with severe tricuspid regurgitation. Although the year-to-year growth in TEER procedures is significant, it should be mentioned that the rate in Poland, at about 13,7 TEER procedures per million inhabitants, is far below the clinical needs. Both TEER and tricuspid interventions may improve the prognosis of patients with heart failure and require better funding. 934 left atrial appendage closure procedures were performed in 28 centers, including 476 Watchman FLX (Boston Scientific, USA), 442 Amulet (Abbott, USA) and 16 Lambre (Lifetech, China). 897 atrial septal defect II (ASD) percutaneous closures were performed, including 413 Amplatzer Septal Occluders (Abbott, USA), 339 Occlutech ASD occluders (Occlutech, Switzerland), 89 Cera or CeraFlex ASD occluders (Lifetech, China) and 56 Cocoon atrial septal occluders (SMT, India). 1945 patent foramen ovale (PFO) percutaneous closures were performed with 717 Amplatzer Talisman PFO occluders (Abbott, USA), 747 Occlutech PFO occluders (Occlutech, Switzerland), 356 Cera or CeraFlex PFO occluders (Lifetech, China), 103 Cocoon PFO occluders (SMT, India) and 22 Nit-Occlud PFO (PFM Medical, Germany). Moreover, single new structural heart procedures were also performed in 2023, including implantation of 72 (95% increase) Coronary Sinus Reducers (Neovasc, Canada) in patients with refractory angina and 13 Atrial Flow Regulators (AFR) (Occlutech, Switzerland) in patients with heart failure or pulmonary hypertension (Figures 1–5).

Figure 1

The number of transcatheter aortic valve implantation (TAVI) procedures in last 9 years

Figure 2

The number of MitraClip procedures in last 9 years

Figure 3

The number of left atrial appendage occlusion (LAAO) procedures in last 9 years

Figure 4

The number of atrial septal defect (ASD) closure procedures in last 9 years

Figure 5

The number of patent foramen ovale (PFO) closure procedures in last 9 years

The ORPKI database has been the source material for 6 manuscripts published in PubMed in 2023. In summary, we have observed an increase in both the number of CAGs and PCIs but especially in the coronary imaging and physiology assessment techniques. The numbers of most of the structural procedures showed a significant increase in 2023. Financial constraints remain the main factor in preventing more widespread use of novel interventional cardiology devices and techniques.