Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. Kardiologie

Volker Mühlberger, QualityVolker Mühlberger, Quality

Österr.Kardiol.Gesellschaft 1990 Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie

Monitor (Auditor) Report: 2007/2008


European Society of CardiologyEuropean Society of Cardiology WG 10 – EAPCI (2006)WG 10 – EAPCI (2006)

AUSTRIA 1990 -2008AUSTRIA 1990 -2008

BERNBERNESCESC


Contact and References:Contact and References:

http://iik.i-med.ac.at (L.Kaltenbach, KP http://iik.i-med.ac.at (L.Kaltenbach, KP Pfeiffer)Pfeiffer)

www.kardiologie.insel.ch/2164.html (B www.kardiologie.insel.ch/2164.html (B Meier - St Cook – MT Maeder)Meier - St Cook – MT Maeder)

CARDS; EU Heart J. 2005;26: 308-313 CARDS; EU Heart J. 2005;26: 308-313 (ESC-WG 10; F.Weidinger)(ESC-WG 10; F.Weidinger)

www.herzbericht.de (E.Bruckenberger)www.herzbericht.de (E.Bruckenberger)


AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PCI- CENTERS 2007 +/- PCI- CENTERS 2007

4 Pediatric 4 Pediatric 34 Adult 34 Adult ((10 10 in Vienna)in Vienna)

Rooms (n=46)Rooms (n=46) http://iik.i-med.ac.athttp://iik.i-med.ac.at 2008: Waidhofen,Braunau, SMZ-Süd2008: Waidhofen,Braunau, SMZ-Süd


103 parameters were reported by all 103 parameters were reported by all 31/30/32 cathlabs 2003/2004/200531/30/32 cathlabs 2003/2004/2005

0

20

40

60

80

100

120

99,0

396

,12

93,2

90,2

987

,38

84,4

781

,55

78,6

4

75,7

372

,82

69,9

66,9

964

,08

61,1

758

,25

55,3

452

,43

49,5

146

,643

,69

40,7

837

,86

34,9

532

,04

29,1

3

26,2

123

,320

,39

17,4

814

,56

11,6

58,

745,

832,

91

% ausgefüllte Zeilen

% C

ath

lab

s

200320042005


AUSTRIA 2006/2007AUSTRIA 2006/2007

� Angiography 50.667 52.260Angiography 50.667 52.260

� PTCA=PCI 19.263 PTCA=PCI 19.263 19.342 19.342

� -stent-stent 90% 90% 90% 90%

� - - DES- - DES 69% 69% 64% 64%

� OP-CAD(Unger) 2.801 3.316OP-CAD(Unger) 2.801 3.316� OP-CAD (Bruckenberger)OP-CAD (Bruckenberger) 4.194 4.194

� OP- valve 2.700 2.691OP- valve 2.700 2.691� OP- valve (Bruckenberger)OP- valve (Bruckenberger) 2.127 2.127


Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants per One Million Inhabitants

0

2000

4000

6000

8000

10000

12000

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

AU 8.12/8.3CH 7.4D 82.4CZ 10.0NO 4.8


PCI Frequency per One Million PCI Frequency per One Million Inhabitants (Inhabitants (AUAU//CHCH//D/D/CZCZ/NO/NO))

0

500

1000

1500

2000

2500

3000

3500

4000

19

92

19

94

19

96

19

98

20

00

20

02

20

04

20

06

AU

CH

D

CZ

NO


% PCI/ CA 1992-2007 % PCI/ CA 1992-2007 ((AUAU//CHCH//DD))

0

5

10

15

20

25

30

35

40

45

50

ACHD


n= 32 centers - Austria 2005; according to incremental PCI/CA % quota (n=)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Zentrumsnummern geordnet nach Größenverhältnis PCI/CA aufsteigend

Ab

so

lute

An

za

hl

Anzahl KAG

GESAMT PCI


n= 32 centers - according to incremental PCI/CA % quota in Austria 2005; (%=)

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Zentrumsnummern geordnet nach Größenverhältnis PCI/CA aufsteigend

PC

I/C

A i

n P

roze

nt

(%)

PCI/CA 2001

PCI/CA 2002

PCI/CA 2003

PCI/CA 2004

PCI/CA 2005


PCI during Diagnostic Angio PCI during Diagnostic Angio (%)(%) in in AustriaAustria//SwitzerlandSwitzerland//EUEU

0

10

20

30

40

50

60

70

80

90

100

1992 1994 1996 1998 2000 2002 2004 2006

AU

CH

EU


%-multivessel PCI %-multivessel PCI AustriaAustria//EUEU

0

2

4

6

8

10

12

14

16

18

20

2002 2003 2004 2005 2006 2007

AUSTRIAEU


Ratio of (CABG-OP+PCI) Ratio of (CABG-OP+PCI) per Angiography in per Angiography in AUAU CHCH DD

0

10

20

30

40

50

60

1992 1994 1996 1998 2000 2002 2004 2006

AU

CH

D


PCI Hospital-Mortality (%) in PCI Hospital-Mortality (%) in AustriaAustria, , SwitzerlandSwitzerland,,GermanyGermany, , EUEU

0

0,5

1

1,5

2

2,5

1992 1994 1996 1998 2000 2002 2004 2006

AU

CH

D

EU


Elective (non-acute)Elective (non-acute) and and OverallOverall – – PCI-Hospital-Mortality (%) in AustriaPCI-Hospital-Mortality (%) in Austria

0

0,2

0,4

0,6

0,8

1

1,2

1992 1994 1996 1998 2000 2002 2004 2006

Overall

Elective


Non-acute Non-acute and and Overall Overall - - PCI PCI Hospital-Mortality (%) in AustriaHospital-Mortality (%) in Austria

0

0,2

0,4

0,6

0,8

1

1,2

1992 1994 1996 1998 2000 2002 2004 2006

Non-acute

Rest%

Overall


Ratio of STENTING per PCI Ratio of STENTING per PCI (%) in (%) in AUAU//CHCH//DD

2,4 4,38,9

27

47

58

6874 76

81 84 87 8791 90 90

0

10

20

30

40

50

60

70

80

90

100

1992 1994 1996 1998 2000 2002 2004 2006

AU

CH

D

CZ


Ratio of emergency CABG due to Ratio of emergency CABG due to PCI (%): PCI (%): AustriaAustria//SwitzerlandSwitzerland,,EUEU

0

0,2

0,4

0,6

0,8

1

1,2

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

AU

CH

EU


EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI (%): MORTALITY in AustriaPCI (%): MORTALITY in Austria

3,3

8,3

18,2

28,6

8,3

15,4 16

25

32

1210,5

18,2

13,6

23,1

36,4

0

5

10

15

20

25

30

35

40

1992 1994 1996 1998 2000 2002 2004 2006


Infarction as Complication (%) after Infarction as Complication (%) after PCI in PCI in AustriaAustria, , CHCH, , DD, , EUEU

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

AU

CH

D

EU


STEMI PCI / acute PCI % STEMI PCI / acute PCI % Austria 2007 - all Centers Austria 2007 - all Centers

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

28 meldende Zentren (NR 12=Mittelwert)

PC

I STE

MI/P

CI a

kut

%


acute/nonacute PCI % acute/nonacute PCI % Austria 2004 - all Centers Austria 2004 - all Centers

0

50

100

1. Qrtl. 2. Qrtl. 3. Qrtl. 4. Qrtl.

Ost

West

Nord

0

5

10

15

20

25

30

35

40

MIT 24h Dienst (n=15) OHNE 24h Dienst (n=14)

% P

PC

I v

on

PC

I


Mortality with/without „backup“ Mortality with/without „backup“ Austria 2006Austria 2006

0

5

10

15

20

25

30

35

40

45

50

back up unter einem Dach kein backup


acuteacute PCI (% of total PCI) in PCI (% of total PCI) in Austria,Austria, Switzerland,Switzerland, EUEU

1720

2629

0

5

10

15

20

25

30

35

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

AU

CH

EU

CZ


PCI (n) for acute & subacute PCI (n) for acute & subacute Myocardial Infarction in AustriaMyocardial Infarction in Austria

0

1000

2000

3000

4000

5000

6000

1998 2000 2002 2004 2006

PCI MIwithshock

PCI MIwithoutshock


MORTALITY (%) after PCI for acute & MORTALITY (%) after PCI for acute & subacute Myocardial Infarction in Austriasubacute Myocardial Infarction in Austria

27

2,5

31

2,8

35

2,6

30

2,1

17

2

17,2

2,2

21,8

1,6

22,8

1,5

25,3

1,2

32,4

1,2

0

5

10

15

20

25

30

35

1998 2000 2002 2004 2006

PCI forMI+Shock

PCI for MIwithoutShock


% GP IIb/IIIa for PCI (% GP IIb/IIIa for PCI (AUAU//CHCH))

0

5

10

15

20

25

1996 1998 2000 2002 2004 2006

AU

CH


DRUG ELUTING STENTS (%of stents) DRUG ELUTING STENTS (%of stents)

(DES) in (DES) in 34 Austrian Centers 34 Austrian Centers 2006/20072006/2007

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

n= 34 Zentren (Mittelwert = Nr 18)

DE

S/s

ten

t%

Jahr 2007

Jahr 2006


DRUG ELUTING STENTSDRUG ELUTING STENTS (DES) in (DES) in AU,AU,CH,CH,D,D,EUEU (% of stents) (% of stents)

0

10

20

30

40

50

60

70

80

90

2001 2002 2003 2004 2005 2006 2007

Austria

CH

D

EU


DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n)in Austria (n)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2002 2003 2004 2005 2006 2007

Paclitaxel

Sirolimus

Zotarolimus

others/n.a.

Tacrolimus

Everolimus


DRUG ELUTING STENTS DRUG ELUTING STENTS (DES)(DES) versus versus REDOREDO in Austria (%) in Austria (%)

0

10

20

30

40

50

60

70

2002 2003 2004 2005 2006 2007

DES % REDO % (reporting Centers only)


Puncture site closing devices Puncture site closing devices (% of PCI in (% of PCI in AUAU//CHCH))

0

10

20

30

40

50

60

70

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

AU

CH


Brachial and Radial Approach Brachial and Radial Approach (% of PCI in (% of PCI in AUAU//CHCH))

0

1

2

3

4

5

6

7

8

9

1999 2000 2001 2002 2003 2004 2005 2006 2007

AUCH


OLD and NEW DEVICES, AustriaOLD and NEW DEVICES, Austria

LASER

IVUS

STENT

0

5000

10000

15000

20000 LASER

DCA

ROTABL

IVUS

IIb/IIIa

DES

STENT


NEW DEVICES NEW DEVICES Austria 2002 – 2007 („winner“)Austria 2002 – 2007 („winner“)

Gerinnselentferner 148/173/213/380/580/Gerinnselentferner 148/173/213/380/580/950950 Stammzelltherapie m.Katheter 21/16/23/12/Stammzelltherapie m.Katheter 21/16/23/12/4040 NOGA MappingNOGA Mapping 16/26/26/21/ 16/26/26/21/6565 Alkoholablation = PTSMA 4/4/6/15/11/Alkoholablation = PTSMA 4/4/6/15/11/1616 Defektverschlüsse 162/243/269/Defektverschlüsse 162/243/269/332332/214/202/214/202 Thrombininjektion bei lokaler Gefäßkomplikation Thrombininjektion bei lokaler Gefäßkomplikation

-/ 88/143/ -/ 88/143/115115/77/77 Optical coherence tomography (OTC) -/-/-/-/ -/-/-/-/ 6060


NEW DEVICES NEW DEVICES Austria 2002 – 2007 („loser“)Austria 2002 – 2007 („loser“) Brachytherapie 163/101/28/3/0/0Brachytherapie 163/101/28/3/0/0 Ultraschalltherapie 1/0/0/0/0/0Ultraschalltherapie 1/0/0/0/0/0 Transmyokardialer Laser 16/0/13/0/0/0Transmyokardialer Laser 16/0/13/0/0/0 Spinal Cord Stimulation 4/0/0/0/0/0Spinal Cord Stimulation 4/0/0/0/0/0 Herzohrverschluss linksHerzohrverschluss links 7/4/13/0/0 7/4/13/0/0


„„NEW DEVICES“ III NEW DEVICES“ III Austria 2003 - 2007Austria 2003 - 2007

PCI wg. instent-Restenose PCI wg. instent-Restenose 737/921/905/1359/1003737/921/905/1359/1003

- wegen akuter Stentthrombose -/-/-/-/ 85- wegen akuter Stentthrombose -/-/-/-/ 85 - wegen STEMI -/-/-/-/ 3342 - wegen STEMI -/-/-/-/ 3342 DES 620/2938/6430/11209/DES 620/2938/6430/11209/1203712037/ 11217/ 11217 stereotaktische Drahtnavigationstereotaktische Drahtnavigation -/-/-/-/ ? AKH-/-/-/-/ ? AKH perkutaner Aortenklappenersatzperkutaner Aortenklappenersatz –/-/-/-/ –/-/-/-/3030


Case load per physicianCase load per physicianPCIPCI CACA

0

50

100

150

200

250

1998PC I

1999PC I

2000PC I

2001PC I

2002PC I

2003PC I

2004PC I

2005PC I

2006PC I

2007PC I

0 1998C A

1999C A

2000C A

2001C A

2002C A

2003C A

2004C A

2005C A

2006C A

2007C A

AU

CH


NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR LOW CASE LOAD FOR CACA DURING 2000/06 DURING 2000/06

0

2

4

6

8

10

12

14

16

<400 CA peryear and

center

400-1000 1000-2000 >2000 CA

AU 2000AU 2001AU 2002AU 2003AU 2004CH 2004AU 2005AU 2006CH 2006AU 2007


NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR LOW CASE LOAD FOR PCIPCI DURING 2000/06 DURING 2000/06

0

5

10

15

20

25

<200 PCI per yearand center

200-400 >400 PCI

AU 2000AU 2001AU 2002AU 2003AU 2004CH 2004AU 2005AU 2006CH 2006AU 2007


CASE LOAD FOR CASE LOAD FOR PCI PCI // CA CA DURING 2007 DURING 2007 ACCORDING TO REGIONS OF AUSTRIAACCORDING TO REGIONS OF AUSTRIA

0

2000

4000

6000

8000

10000

12000

14000

Bundesländer / Äqivalente

CA

od

er

PC

I /

Mio

WB

KAG/MioWB

PCI/MioWB


CASE LOAD FOR CASE LOAD FOR PCI PCI // CA CA DURING 2007 DURING 2007 ACCORDING TO REGIONS OF AUSTRIAACCORDING TO REGIONS OF AUSTRIA

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

TKBVST OÖSWNÖ

CA

od

er

PC

I/M

io W

B b

zw P

CI/

CA

%x

10

0

CA/MioWB

PCI/MioWB

PCI/CA%x100


Diskussion in Linz amDiskussion in Linz am 28.11.2008 28.11.2008

warum CA + PCI rückläufig?warum CA + PCI rückläufig? warum Unterschiede PCI/CA ?warum Unterschiede PCI/CA ? PCI/CA als Qualitätskriterium?PCI/CA als Qualitätskriterium? REDO „trotz“ DESREDO „trotz“ DES ANTWORT: kommen wir in AUT nicht an die ANTWORT: kommen wir in AUT nicht an die

„culprit lesions“ heran? Patient? Zuweiser? „culprit lesions“ heran? Patient? Zuweiser? Finanz? Wir?Finanz? Wir?

Documents

Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. Kardiologie