View
23
Download
0
Category
Tags:
Preview:
DESCRIPTION
AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2012. n = 34 locations n = 50 rooms. Monitor (Auditor) Report: 1989 – 2013. http://iik.i-med.ac.at L.Kaltenbach, H. Ulmer, C.Kobel www.kardiologie.insel.ch/2164.html - PowerPoint PPT Presentation
Citation preview
Volker Mühlberger, Quality
AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2012
n = 34 locations
n = 50 rooms
Monitor (Auditor) Report: 1989 – 2013
http://iik.i-med.ac.at
L.Kaltenbach, H. Ulmer, C.Kobel www.kardiologie.insel.ch/2164.html
B Meier, Micha T. Maeder, Gregor Fahrni – Basel www.ptca.ch www.herzbericht.de E.Bruckenberger –
T.Meinertz – Herzstiftung ab 2011 „Österreichische Spezialregister“
Volker Mühlberger, Quality
(„Versorgungsforschung “)
to describe practice patterns and trends, to identify outliers and to detect safety signals
Lauer MS, D´Agostino RB NEJM 2013; 369:1579-81
Volker Mühlberger, Quality
Volker Mühlberger, Quality
AUSTRIA 2011 / 2012
� Angiography 53.808 53.064� PCI 20.295 20.543� - stent 91% 90%� - - DES 78% 85%� OP-CAD (Bruckenberger : 2008=4.248) Schistek 2.737
� OP- valve (Bruckenberger: 2008=2.280) Schistek 2.583
Volker Mühlberger, Quality
NUMBER OF CENTERS with<400 CA /year vs. <200 PCI/year vs. CA/y(*t)
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
2
4
6
8
10
12
0
1
2
3
4
5
6
7
<400 CA/y+c
<200 PCI/y+c
CA/y x thousand
Volker Mühlberger, Quality Silber 2005 / DiMario 2006;
ESC
Number of tables, CENTERS and Centers with > 36 STEMI - PCI / year
2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
10
20
30
40
50
60
19 18 2024
20 22 23 23 2327
centerstablesSeries3Series4>36 STEMI-PCI/y+c
Volker Mühlberger, Quality
Coronary Angiography Frequency per Million Inhabitants 1992-2012
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
2000
4000
6000
8000
10000
12000
AU 8.12-8.43CH 7.4 - 7.95D 82.2-81.8CZ 10.0-10.5SL 5.5 -5.4
Volker Mühlberger, Quality
% PCI/ CA 1992 - 2012 (AU/CH/D/CZ)
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
5
10
15
20
25
30
35
40
45
50
AU
CH
D
CZ
Volker Mühlberger, Quality
PCI per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2012
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
500
1000
1500
2000
2500
3000
3500
4000
4500
USA
SL
AU
CH
D
CZ
Bifurcation PCI, left main stent Austria (% of PCI… reporting centers only -2012)
2008 2009 2010 2011 20120.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
left main stentbifurcation pci
Volker Mühlberger, Quality
Volker Mühlberger, Quality
PCI Frequency in Austria 2006-2011acute or non-acute Indications
2006 2007 2008 2009 2010 2011 20120
5000
10000
15000
20000
25000
5009 6014 6686 6783 6466 6946 7026
14254 13328 13041 13073 13828 13349 13517
19263 19342 19727 19856 20294 20295 20543
NICHT AKUTAKUT PCI
Volker Mühlberger, Quality
Acute PCI/ STEMI PCI / % (n=) Austria 2007 – 2012
2007 2008 2009 2010 2011 20120
1000
2000
3000
4000
5000
6000
7000
8000
55 % 50 %
STEMI
"acute"
STEMI % x10
Volker Mühlberger, Quality
ACUTE PCI (% of total PCI) in
AU, CZ, EU, CH (=STEMI only)
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
5
10
15
20
25
30
35
40
45
50
AU acuteCH STEMIEUCZCH acuteAU STEMI
Volker Mühlberger, Quality
% GP IIb/IIIa for PCI (AU/CH) % dir.ThrombinInhibitor (TI-AU)
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
5
10
15
20
25
30
AUCHAU-TI
Volker Mühlberger, Quality
PCI Hospital-Mortality (%) in Austria, Switzerland,Germany, EU
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
0.5
1
1.5
2
2.5
AU
CH
D
EU
PCI -Mortality (%) in Austria 2011 /2012
0
5
10
15
20
25
Volker Mühlberger, Quality
Volker Mühlberger, Quality
PCI -Mortality (ref.=overall-% mortality in Austria)(non-acute / without /with shock)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0.00
0.20
0.40
0.60
0.80
1.00
1.20
non-acute PCI bezogen auf Gesamt PCI
PCI for MI without Shock bezogen auf Gesamt PCI
PCI for MI with Shock bezogen auf Gesamt PCI
Intra – aortic balloon pump for PCI in Austria 2006 -2012 (CH 2012)
2005 2006 2007 2008 2009 2010 2011 20120
50
100
150
200
250
300
350
400
450
500
AUTCH
Volker Mühlberger, Quality (R. Zweiker)
Volker Mühlberger, Quality
DRUG ELUTING stents (DES) in AU,CH,D,EU-CZ (% of stents)
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
10
20
30
40
50
60
70
80
90
100
EU EU
CZAUCHDEUCZ
Volker Mühlberger, Quality
REDO for all chronic Restenoses vs. Thrombus reporting centres (n/%)
2007 2008 2009 2010 2011 20120
100200300400500600700800900
1000
8,5%15,2%
11,9%15,1 %
Thrombus Restenose Thrombus x10% reporting centres
Volker Mühlberger, Quality
DES/stent and chronic Re-Stenosis REDO reporting Centres (% of stent)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
102030405060708090
6.6 6.3 5 5.04
DES % REDO % (reporting Centers only)
Volker Mühlberger, Quality
Ratio of emergency CABG due to PCI (%): Austria/Switzerland/EU
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
0.2
0.4
0.6
0.8
1
1.2
1.4
AUCHEU
Puncture site closing devices (% of…..) AUT 2011 / 2012
% of PCI % of CA % of PCI nonacute
% of PCI acute0
10
20
30
40
50
60
70
80
Volker Mühlberger, Quality
Severe bleeding (% of ..bleeding reporting only) AUT 2010 / 2011 / 2012
Volker Mühlberger, Quality (J. Dörler)
% of CA % of PCI nonacute % of PCI acute0
5
10
15
20
25
30
35
40
Non- femoral Approach 2011/2012 (% of procedure) in Austria
0
5
10
15
20
25
2011
2012
Volker Mühlberger, Quality (J.Schuler)
Volker Mühlberger, Quality
Non-femoral Approach (% of PCI) in AU/ french or german-CH
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
10
20
30
40
50
60
70
AUCHfrench CHgerman CHCZ
Volker Mühlberger, Quality (F.Weidinger)
% -multivessel PCI Austria / EU / CH
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
5
10
15
20
25
AUCHEU
AUT 2012 CH
PTSMA %
bioab
STENT %
CTO %
FFR %
IVUS %
OCT %
shock
PCI %
0
2
4
6
8
10
12
AUT
CH
Volker Mühlberger, Quality (G.Friedrich; G.Delle Karth; R.Berger))
AUT 2012 CH
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
100
200
300
400
500
600
700
800
900
AUTCH
Volker Mühlberger, Quality (W. Tkalec; M.Knoflach)
Austria vs. CH 2002– 2012 LAA closure
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
20
40
60
80
100
120
140
160
180
200
AUCH0
Volker Mühlberger, Quality
OLD and NEW DEVICES (<350/a)
Austria 2002-2012
Volker Mühlberger, Quality
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
50
100
150
200
250
300
350
400
MitraClipThrombin lokalNOGA mappingREnalDenervPTSMA
Volker Mühlberger, Quality
OLD and NEW DEVICES (<3500/a)
Austria 2002-201220
02
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
500
1000
1500
2000
2500
3000
3500
(„Catheter Thrombectomy“ or
DE Balloon
Defektverschl.
Volker Mühlberger, Quality
OLD and NEW DEVICES (35.000/a)
Austria 1992 -201219
9219
9319
9419
9519
9619
9719
9819
9920
0020
0120
0220
0320
0420
0520
0620
0720
0820
0920
1020
1120
12
0
5000
10000
15000
20000
25000
30000
35000
40000
STENTDESSeries4IVUSROTABLi.c.PRESSURE
Myocardial Biopsies in Austria 2006 -2012
2006 2007 2008 2009 2010 2011 20120
50
100
150
200
250
300
350
400
450myocardial biopsies
Volker Mühlberger, Quality
Volker Mühlberger, Quality
Ablation (n) / Electrophysiology (n; %) in CathLab Implantations / Austria
2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
500
1000
1500
2000
2500
3000
3500
72%100 %
Ablation Diagnostics A/D % x10 Implantation
Volker Mühlberger, Quality (E.Maurer; W.Wisser)
Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2012
2005 2006 2007 2008 2009 2010 2011 20120
100
200
300
400
500
600
700
0 0
397 432501
650Balloon onlyTransapical ValveTransarterialAU- TAVIEdwards SapienCorValveCH- TAVI
Österr.Kardiol.Gesellschaft 1989–2013 Arbeitsgruppe Intervent. Kardiologie
As presented, discussed and accepted at the
ÖKG - Meeting in LINZ,
November 22nd 2013
Thank You
DANKE SEHR
Volker Mühlberger, Quality
Volker Mühlberger, Quality
PCI during Diagnostic Angio (%) in Austria / Switzerland / EU
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
10
20
30
40
50
60
70
80
90
100
AUCHEU
PCI –Mortality acute PCI with shock in Austria (ref.= reporting centres only until 2011)
20032004200520062007200820092010201120120
5
10
15
20
25
30
35
40
mort. PCI shock %
mort. PCI shock %
Volker Mühlberger, Quality
Volker Mühlberger, Quality
Ratio of STENTING per PCI (%) in AU/CH -2011/D/CZ
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
0
10
20
30
40
50
60
70
80
90
100
AU
CH
D
CZ
Volker Mühlberger, Quality
Puncture site closing devices (% of PCI in AU/CH)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
10
20
30
40
50
60
70
80
AUCH
Volker Mühlberger, Quality
EMERGENCY CABG AFTER PCI (%): MORTALITY in Austria
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
5
10
15
20
25
30
35
40
45
50
03.3
8.3
18.2
28.6
8.3
15.4 16
25
32
12 10.5
18.2
13.6
23.1
36.4
46.7
36.4
26.1
6.25 5.3
Volker Mühlberger, Quality
OLD and NEW DEVICES („loser“)
Austria 2002-2011
Brachytherapie 163/101/28/3/0/0/0/0/0/0 Ultraschalltherapie 1/0/0/0/0/0/0/0/0/0 Transmyokardialer Laser 16/0/13/0/0/0/0/0/0/0 Spinal Cord Stimulation 4/0/0/0/0/0/0/0/0/0 Herzohrverschluss links 7/4/13/0/0/0/0/?/? Stammzellth. -Katheter 1/16/23/12/40/3/0/0/0
stereotaktische Drahtnavigation -/-/-/-/-/33 /13/4/0
Non- femoral Approach 2010/2011 (% of procedure) in Austria
Series1
14
14.5
15
15.5
16
16.5
17
17.5
18
18.5
15,7
KAG 2011
PCI 2010
PCI 2011
PCI akut 2011
PCI elektiv 2011
Volker Mühlberger, Quality
Intention to audit a center
Volker Mühlberger, Quality
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
CA
PCI
benchmarking: over the years
Volker Mühlberger, Quality
2000 2002 2004 2006 2008 2010 20120.000
0.500
1.000
1.500
2.000
2.500
Gesamt PCI Mortalität % AT Gesamt PCI Mortalität %
benchmarking: over the centres 2010
Volker Mühlberger, Quality
0 5 10 15 20 25 30 35 400
0.5
1
1.5
2
2.5
3
PCI Mortalität
benchmarking: over the centres 2010
Volker Mühlberger, Quality
0 5 10 15 20 25 30 350
20
40
60
80
100
120
akut PCI mit Schock Mortalität
PCI Hospital-Mortality (%) in Austria – true vs. traditional
2008 2009 2009 2010 20110
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
allemeldende
Volker Mühlberger, Quality
PCI Hospital-Mortality (%) 2010 vs 2011 - Austria – all centers
Volker Mühlberger, Quality
0 0.5 1 1.5 2 2.5 30
0.5
1
1.5
2
2.5
3
PCI Mortalität
2010
20
11
More Centres, more Tables, but not more Angios in Austria 2005-2011
2005 2006 2007 2008 2009 2010 20110
10
20
30
40
50
60
70
Angiocenterstables
Volker Mühlberger, Quality
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (non-acute PCI) *ref.= only
1997
*
1998
*
1999
*
2000
*
2001
*
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40non-acute PCI
Volker Mühlberger, Quality
Number of PCI (n) for Myocardial Infarction in AU, CH
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
1000
2000
3000
4000
5000
6000
7000
PCI MI with shock
PCI MI without shock
CH with shock
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (acute / non-acute PCI) ref.=overall-mortality
1997
*19
98*
1999
*20
00*
2001
*20
0220
0320
0420
0520
0620
0720
0820
0920
1020
11
0.00
0.20
0.40
0.60
0.80
1.00
1.20
acute PCInon-acute PCI
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (acute =without /with shock PCI) ref.=overall-acute-mortality
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
1
2
3
4
5
6
7
8
9
PCI for MI with Shock
PCI for MI without Shock
Volker Mühlberger, Quality
Ratio of: CABG-OP+PCI / per Angiography in AU CH D
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
10
20
30
40
50
60
AUCHD
Volker Mühlberger, Quality
Infarction as Complication (%) after PCI in Austria, CH, D, EU
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
AUCHDEU
Volker Mühlberger, Quality
DRUG ELUTING STENTS (DES) in Austria (n) 2002 – 2008
2002 2003 2004 2005 2006 2007 20080
500
1000
1500
2000
2500
3000
3500
4000
4500
5000 Paclitaxel
Sirolimus
Zotarolimus
others/n.a.
Tacrolimus
Everolimus
Volker Mühlberger, Quality
Brachial/Radial Approach (n=) 37 Centers Austria 2008
0
100
200
300
400
500
600
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 36 37
Akut PCI Mortalität 2011
Volker Mühlberger, Quality
0 5 10 15 20 25 30 350
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
Akut PCI Mortalität
Volker Mühlberger, Quality
Case load per physicianPCI / CA (AU / CH)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
50
100
150
200
250
PCI - AU
PCI - CH
CA - AU
CA - CH
Operator´s invasiver Lebenslauf
Volker Mühlberger, Quality
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
100
200
300
400
500
600SUMME CA SUMME PCI
Recommended