Every year, the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) prepares an annual report on the clinical activity of interventional cardiology laboratories in Spain.1–34 One of the primary functions of the board of directors of the ACI-SEC is to collect, filter, and disseminate these data. Although participation is voluntary, the considerable impact and interest in this activity registry mean that most centers participate, both public and private, and in all regions. This information permits analysis of the overall state of interventional cardiology in Spain and allows comparisons among autonomous communities. The report also serves as a reference for all centers and regions to identify areas for improvement and resource optimization. One limitation is that the registry data are not audited. Nevertheless, with more than 30 years of registry data and extensive participation, the registry holds enormous value.

The registry is updated annually, and variables are periodically revised to reflect ongoing advances and innovations in the field of interventional cardiology. The Spanish cardiac catheterization and coronary intervention registry is one of the most important initiatives of the ACI-SEC. It exemplifies the collaborative spirit, unity, and openness of interventional cardiology professionals throughout Spain. Its findings are utilized by public and private administrators, the technology industry, and health care professionals. The results of this work were presented on June 6, 2025, at the ACI-SEC Congress held in Santiago de Compostela and comprise the 2024 (34th) report on interventional cardiology activity in Spain.

The ACI-SEC activity registry is based on interventional cardiology data voluntarily submitted by most publicly funded and private health care centers in Spain. Each hospital submits information on its annual activities, resource use, and outcomes to an online database managed by an external company (pInvestiga, Spain). None of the variables are mandatory, and each center voluntarily provides the available data. However, special emphasis is placed on certain key variables or those deemed particularly relevant. The data are analyzed by the external company in collaboration with an ACI-SEC board member. Inconsistent or particularly unusual data are reviewed and cross-checked. In such cases, the centers involved, and sometimes the suppliers, are contacted to verify the information and ensure its accuracy. Finally, the data are analyzed, compared with those of previous years, and disseminated in a publicly available report. As in previous years, the data by autonomous community were adjusted to the population figures published on the Spanish National Institute of Statistics website to allow for a more commensurate analysis.35 The population of Spain was estimated to be 49 077 984. Both absolute (No.) and relative (%) data are reported. In the case of missing variables, percentages were calculated using only the number of centers that supplied data for the variables in question.

The main findings of the 2024 Spanish cardiac catheterization and coronary intervention registry of the ACI-SEC are as follows: a) after several years without change, suggesting that a plateau had been reached, diagnostic and coronary intervention activity increased; b) the use of intracoronary imaging techniques rose notably, and there was renewed use of coronary physiology assessment; c) the use of DCBs increased while stent implantation decreased; d) for myocardial infarction, the use of primary PCI grew again, with fibrinolysis rarely used in Spain; e) structural interventions continued their annual growth, with no signs of slowing, given the 2-fold increase in tricuspid valve interventions in 2024; and f) all of this growth has resulted in the opening of numerous new catheterization laboratories, as well as the highest number of staff dedicated to interventional cardiology (figure 8 and figure 9).

Figure 8.

Overview of coronary procedures in 2024 vs 2022 and 2023. AMI, acute myocardial infarction; DCB, drug-coated balloon; IVUS, intravascular ultrasound; OCT, optical coherence tomography; PCI, percutaneous coronary intervention.

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Figure 9.

Overview of noncoronary procedures in 2024 vs 2023 and 2022. PE, pulmonary embolism; PFO, patent foramen ovale; TAVI, transcatheter aortic valve implantation; TEER, transcatheter edge-to-edge repair.

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Having confirmed the complete recovery from the impact of COVID-19 in previous years, 2024 can be considered an inflection point in the resurgence of interventional cardiology, which has resumed the growth rate characteristic of the pre-COVID era. The increase in both diagnostic and interventional procedures has been widespread. The number of catheterization laboratories rose by 10%, adding 27 new facilities. Strikingly, there was an increase of just 13 interventional cardiologists for these laboratories (a 2.4% increase), suggesting an imbalance in human resources. Proportionally, these new appointments were more likely to be women vs previous years, which slightly increased the percentage of female interventional cardiologists (from 24.3% in 2023 to 24.7% in 2024). A new informative document addressing the various aspects of work during pregnancy in relation to ionizing radiation could facilitate a more equitable incorporation of women into interventional roles.37

In recent years, the evidence on the prognostic benefit of intracoronary imaging techniques, even in terms of survival, has been clearly established. This has led to their inclusion, with high levels of recommendation, in recent clinical practice guidelines on the use of intracoronary imaging in interventional cardiology, particularly for uncertain diagnoses and complex PCIs.38,39 Given the high standards achieved in interventional cardiology, optimizing outcomes is challenging, with the use of intracoronary imaging as guidance for PCI being one of the clearest areas for improvement. The increased use of intracoronary imaging in Spain in 2024 (a 16% increase in IVUS and an 11% increase in OCT) reflects professionals’ efforts to improve prognosis in the daily practice of catheterization laboratories.

Another technique that is becoming established and expanding in interventional cardiology is the use of DCBs: an increasing number of PCIs are being performed exclusively with this technology and without a final stent placement. In addition, having obtained these data for the first time this year, a considerable number of PCIs were conducted using a hybrid strategy. Overall, DCBs were used in an estimated 14.3% of PCIs in Spain in 2024. This trend has led to a decreased use of stents, which, despite more centers reporting their data in 2024, failed to match the figures of previous years.

The growth in structural procedures appears unstoppable: there were 18.4% more TAVIs, 12.1% more mitral transcatheter edge-to-edge repairs, 54% more tricuspid interventions, and 19.5% more atrial appendage closures. The scientific evidence supporting the outcomes of these procedures and broadening their indications grows annually. The demand for these procedures is expected to be increased by recent publications reporting favorable outcomes for TAVI in asymptomatic patients with severe aortic stenosis, as well as for transcatheter edge-to-edge mitral valve repair in moderate-to-severe mitral regurgitation. This growing interest extends beyond interventional cardiologists to include clinical cardiologists.40,41 A testament to this increasingly fruitful collaboration is the consensus document addressing the use of edge-to-edge mitral valve repair for acute mitral regurgitation.42 For the first time this year, this scenario is included in the activity survey. It accounts for a small percentage of procedures, but growth is likely in the coming years. Similarly, the scope of the technique is expanding: the proportion of functional mitral regurgitation cases treated using transcatheter edge-to-edge repair is decreasing every year, making way for more cases involving organic or mixed valve damage (54.3% in 2024 vs 44% in 2023).

Finally, and as observed in 2023, one of the areas with the most significant growth and expansion is intervention for acute pulmonary embolism. In addition, there is also a shift toward greater standardization and systematization of the procedure, reflected in the ever-increasing use of dedicated devices and highlighted in the recently published consensus document.43 While we await results from large clinical trials that further support the use and even broader adoption of this technique, it is already arousing strong multidisciplinary interest.

The Spanish cardiac catheterization and coronary intervention registry demonstrates overall growth, with new catheterization laboratories opening across the country. There was clear recovery in the rates of increase in coronary interventions, while structural interventions continued their unstoppable expansion.

This article has not received funding.

The present analysis of the ACI-SEC activity registry was conducted in accordance with the principles of the Declaration of Helsinki and ensures the confidentiality of the collected data, in compliance with relevant legislation.

No artificial intelligence was used in the preparation of this article.

All authors have contributed to the drafting and critical revision of the article.

D. Arzamendi has performed consultancy work and is a proctor for Abbott and Edwards. J. Martín-Moreiras is a proctor for Boston Scientific and World Medica. The remaining authors have no conflicts of interest to declare.