Objective: To describe the diffusion of cardiac catheterization
technologies and time trends of their use according to setting and geographic
region in Germany during a 13-year period. It is hypothesized that the cardiac
catheterization technology has matured from an experimental state to a broadly
Methods: Data come from the annual survey of the German Society
for Cardiovascular Research. All German cardiac catheterization units are
requested to provide data on volume and type of catheterization procedures.
Data are available from 1984 to 1996. Number and type of procedure, type of
unit, diagnoses, and complications are all recorded. The overall response rate
is 90%, on average.
Results: The total number of catheterization units was 324 in
1996, or an average of 3.69 units per 1 million population. In 1996, all of
the East German Länder and districts were below average. Utilization of
cardiac catheterization procedures increased exponentially during the study
period. The number of angiographies rose from about 45,000 in 1984 to more
than 450,000 in 1996; the number of angioplasties increased almost by a factor
of 50 to 125,000 procedures in 1996. Inverse correlations between the rates
per million population of either coronary angiographies or PTCAs and mortality
rates from ischemic heart disease were observed at the level of the German
Conclusion: Further studies taking patient characteristics,
long-term outcomes, and other factors in account are necessary to clarify the
large geographic variations and the negative relationship between utilization
rates and coronary heart disease mortality found in this study.