Macedonia: coronary and structural heart interventions from 2010 to 2015

Abstract

The aim of this report is to describe invasive cardiology procedural practice in Macedonia during the period from 2010 to 2015. Details of all consecutive 39,899 patients who underwent cardiovascular, peripheral or structural heart procedures during the period from 2010 until 2015 were examined. Clinical and procedure characteristics, access site, procedural success and complications were analysed. The number of coronary angiographies increased from 5,540 in 2010 to 8,550 in 2015. Transfemoral access (TFA) was present in 4% of coronary angiographies in 2010 and had decreased to 1% in 2015. The number of primary percutaneous coronary interventions (PCI) for acute ST-segment elevation myocardial infarction increased from 763 to 1,175 and both chronic total occlusion and left main coronary artery interventions also increased over time. In 2015, the drug-eluting stent penetration rate was 65%. Structural heart interventions, including transcatheter aortic valve implantations (TAVI) were introduced in 2014 and 23 TAVI cases have since been performed. Transradial access was performed in 38,455 (96%) of all patients. Wrist access adoption in the majority of cardiovascular interventions is possible in all PCI centres in Europe if an appropriate national strategy is developed.

Risk Factor Distribution and Long-Term Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention in Macedonia

“…Our hospital is a high volume transradial center (80% of all PCI interventions in the country) and the main referral center for primary PCI and complex procedures. Transradial approach has been the default approach in our center since 2008 21 , which is in accordance with the ESC guidelines for treatment of PCI patients [22][23][24] , and most probably has contributed to the low MACCE and mortality in our results [7][8][9] .…”

“…Pre-procedural retrograde radial arteriography was performed in all patients to define the radial artery anatomy from mid forearm to ulnobrachial anastomosis and to delineate ulnar artery anatomy as well, thus generating the access roadmap [6][7][8][9][10] .…”

Benefit of routine preprocedural radial artery angiography in STEMI patients

“…According to our experience [10][11][12] and results from this observational study preprocedural RA angiography reduces overall procedural time and major access site bleeding complications. Also we noted a significant decrease in primary TRA access site crossover after introducing RA angiography.…”

“…A solution of 3 ml of contrast diluted with 7 ml of blood was injected through the cannula or through the side arm of the sheath under fluoroscopy in the posterior‐anterior projection. If there was some variation or tortuosity/spasm of the radial artery, it was negotiated under fluoroscopy control (Figure ).…”

Ipsilateral transulnar artery approach catheterizations after failure of the radial approach—Are two sheaths in the same arm safe?

“…Attempts were made to negotiate anatomic variations of the RA, including tortuosity, loops, and spasm, under fluoroscopic guidance. [20][21][22][23] If the radial artery could not be successfully crossed, the radial sheath was left in place and ipsilateral ulnar artery puncture and cannulation were performed.…”