A tale of two systems: interventional cardiology practices in Germany and Switzerland in 2023

Background

Switzerland and Germany share a comparable epidemiological burden of coronary artery disease (CAD), yet their interventional practices differ substantially. According to the latest ESC Atlas in Interventional Cardiology, the rate of diagnostic coronary angiography (CA) in Switzerland is approximately two thirds of that reported per million inhabitants in Germany.1 Both countries provide annual national procedural insights - through SwissCaRe and the German Heart Report - enabling surveillance of CAD and revascularisation practices.2,3

Aim

To compare CAD-related hospitalisation and mortality, procedural volumes, use of intravascular imaging and physiology in Germany and Switzerland.

Methods

We conducted a descriptive comparative analysis of publicly available national datasets using SwissCaRe 2023 and the German Heart Report 2025, both reflecting procedural activity in 2023.

Results

In 2023, interventional activity was substantially higher in Germany than in Switzerland, with more than one million procedures reported nationally compared with approximately 19,000 procedures in SwissCaRe (Table 2). In Switzerland, data are derived from a voluntary registry and may therefore not capture all procedures nationwide. Percutaneous coronary interventions (PCI) accounted for roughly one third of procedures in Germany and nearly 40% in Switzerland.

Non-invasive ischaemia testing prior to CA was documented in approximately two thirds of cases in both countries. Use of coronary physiology during CA was comparable, whereas intravascular imaging during PCI was reported more frequently in Switzerland, with marked centre-level variability. Outcome reporting differed structurally. Switzerland reports procedural MACCE and mortality, whereas Germany provides 7-day, 30-day, and 1-year outcome metrics. Accordingly, MACCE rates were higher in Germany (Table 2).

Age distribution was comparable, peaking in the eighth decade. SwissCaRe additionally reported procedural metrics such as door-to-balloon time and post-procedural pharmacotherapy, which are not aggregated in the German Heart Report. The relatively low statin utilisation rates (69% in ACS, 63% in CCS) likely reflect immediate post-procedural data capture rather than discharge medication. In 2023, the median door-to-balloon time was 80 minutes in Switzerland versus 46 minutes in Germany, possibly reflecting differences in networks, triage protocols, and in-hospital workflow structures.4

Conclusions

Germany and Switzerland exemplify two high-quality interventional systems with complementary paradigms in interventional cardiology governance. Germany is characterised by volume-oriented, population-based surveillance, whereas Switzerland reflects quality-driven procedural benchmarking with higher reported adoption of adjunctive technologies. Integrating the strengths of both models may enhance transparency, comparability, and patient-centred cardiovascular care at a European level.