BCIS Audit Returns of Interventional Procedures 1999

BCIS Returns 1999 (Oct 2000)

BCIS Audit Returns of BCIS Audit Returns of Interventional ProceduresInterventional Procedures

19991999

Blackpool, October 2000

Mark de Belder

(Audit Secretary, BCIS)

on behalf of Council of the British Cardiovascular Intervention Society


UK Intervention CentresUK Intervention CentresYear No. Centres1991 521992 521993 531994 541995 541996 531997 581998 611999 63


UK Interventional & Diagnostic UK Interventional & Diagnostic Centres 1999Centres 1999

No. No Data(%)

Caths(% oftotal)

PCIs*(% oftotal)

NHSInterventional

48 13(27%)

72,133(68%)

19,276(92%)

PrivateInterventional

15 4(27%)

7449(7.9%)

1678(8%)

Diagnosticonly

71 23(32%)

23,273(24%)

0

TOTAL 134 - 102,855 20,954

3.8 caths for every 1 PCI in Intervention centres (1.5-21)4.1 caths for every PCI overall assuming other diagnostic centres = 485/yr

* No of PCIs in Centres also reporting No of Caths


Centres providing NO DATACentres providing NO DATA

St Bartholomew’s


Centres providing NO DATACentres providing NO DATAon Centre Description Form (A)on Centre Description Form (A)

Harefield Edinburgh Royal Infirmary The Royal Infirmary, Glasgow Freeman Hospital, Newcastle St Bartholomew’s (Ayrshire & Arran) HCI Glasgow Bristol BUPA


Centres providing Centres providing NO OR MINIMAL DATANO OR MINIMAL DATA

on Minimum Data Form (B)on Minimum Data Form (B)No data Harefield St Bartholomew’s

Minimal Data Guy’s/St Thomas’s London Chest (Ayrshire & Arran) HCI Glasgow Bristol BUPA


Centres with Centres with MINIMAL OR NO DATAMINIMAL OR NO DATAon Outcome Form (C)on Outcome Form (C)

Guy’s & St Thomas’sHarefieldLondon ChestSouthamptonSt Bartholomew’s


Centres with no Centres with no HOSPITALHOSPITAL Outcome Data Outcome Data

Cath Lab Data Only Aberdeen Yorkshire Heart Centre Glasgow Western Infirmary Glasgow Royal Infirmary Manchester Royal Infirmary St Mary’s Hairmyres Morriston, Swansea BMI Alexander, Manchester London Bridge Hospital BUPA Leicester Cromwell St Anthony’s The Priory, Birmingham HCI, Glasgow Harley Street Clinic

Unspecified Data Belfast City Belfast Royal Victoria Birmingham City Hospital Birmingham QE Blackpool Hammersmith Cardiff Walsgrave Hospital, Coventry Edinburgh Royal Infirmary London Chest Wythenshawe, Manchester Middlesex Hospital Freeman, Newcastle John Radcliffe, Oxford Royal Brompton Glenfield, Leicester Northern General, Sheffield Plymouth Derriford Eastbourne

Unspecified DataWellingtonBUPA LeedsRoss Hall IndependentLondon IndependentBUPA BristolHeart Hospital


Volume of procedures in NHS CentresVolume of procedures in NHS CentresTotal number of procedures per annumTotal number of procedures per annum

0123456789

<10

0

-200

-300

-400

-500

-600

-700

-800

-900

-100

0

>10

00

1997

1998

1999

(assumes St Bartholomew’s performedsimilar numbers of PCIs as in 1997)


Total UK PCI ProceduresTotal UK PCI ProceduresYear Centres Total

ProceduresRate permillion

%increase

1991 52 9,933 174

1992 52 11,575 203 16.5

1993 53 12,937 227 11.8

1994 54 14,624 256 13.0

1995 54 17,344 304 18.6

1996 53 20,511 359 18.1

1997 58 22,902 402 11.7

1998 61 24,899 437 8.7

1999 63 28,133 494 13

Assumes St Bartholomew’s activity = 1997


PCI Rates per million population PCI Rates per million population (UK)(UK)

050

100150

200250

300350

400450500

'85

'88

'90

'92

'94

'96

'98


PCI: UK 1996-1999 PCI: UK 1996-1999 vs Rest of Europe 1996/1998vs Rest of Europe 1996/1998

0200400600800

100012001400160018002000

PCIs/million

Po

r

Ita

UK

96

UK

97

UK

98

UK

99

Sp

a

Fin

Gre

De

n

Sw

e

No

r

Au

st

Ne

th

Fra

Sw

i

Be

lg

Ge

r

1996

1998


All PCI Procedures MortalityAll PCI Procedures MortalityYear Data From: Total Mortality % Range %

1991 9,071(9,933)

0.48

1992 43/52 10,483(11,575)

0.71 0-3.5

1993 44/53 11,859(12,937)

0.59 0-2.7

1994 44/54 12,598(14,624)

0.60 0-2.7

1995 35/54 11,365(17,344)

0.69 0-3.4

1996 37/53 14,476(20,511)

0.72 0-3.2

1997 41/58 17,577(22,902)

0.91 0-10

1998 44/61 16,946(24,899)

0.80 0-9.1

1999 48/63 20,975(28,133)

0.61 0-4


All PCI proceduresAll PCI proceduresYear Total Vessels/

caseSuccess

%MI % Em.

CABGMortality

%1991 9,933 86 1.6 2.6 0.48

1992 11,575 1.17 88 1.4 2.0 0.71

1993 12,937 1.09 89 1.1 1.9 0.59

1994 14,624 1.15 90 1.0 1.6 0.60

1995 17,344 1.17 89 1.4 1.9 0.69

1996 20,511 1.17 90 1.4 1.7 0.72

1997 15,667(22,902)

1.16 92 1.2 1.1 0.89

1998 18,560(24,899)

1.24 92 0.8 0.7 0.80

1999 19,889(28,133)

1.11 90 0.57 0.48 0.61


Stent proceduresStent procedures

0

10

20

30

40

50

60

70

80

% of all PCIs

'92 '93 '94 '95 '96 '97 '98 '99

Year


Stenting in different centres Stenting in different centres 19991999

02468

1012141618

No. of Centres

31-40 41-50 51-60 61-70 71-80 81-90 >90

% Stented

1998

1999


Impact of Stenting 1992-1999Impact of Stenting 1992-1999Year % Stented % PCI for

Restenosis% needingEm.CABG

1992 2.7 11.6 2.0

1993 5.6 12.3 2.0

1994 13.5 11.4 1.8

1995 27.6 9.6 1.9

1996 45.9 9.4 1.5

1997 60 7.4 1.1

1998 69 5.2 0.6

1999 79 4.8 0.48


Stenting and the need for Stenting and the need for emergency CABG emergency CABG (1999 data from 46 centres)(1999 data from 46 centres)

0

10

20

30

40

50

60

70

80

90

'92 '93 '94 '95 '96 '97 '98 '99

Year

%

0

0.5

1

1.5

2

2.5

%

% Stent

% Em.CABG


Stenting and procedures for Stenting and procedures for restenosis restenosis

(1999 data from 32 centres)(1999 data from 32 centres)

0

10

20

30

40

50

60

70

80

90

'92 '93 '94 '95 '96 '97 '98 '99

Year

%

0

2

4

6

8

10

12

14

%

% Stent

% Restenosis


PTCA for Restenosis 1999PTCA for Restenosis 1999(data from 31 centres)(data from 31 centres)

0

2

4

6

8

10

12

14

16

No. of Centres

0-5 5.1-10 10.1-15

% for Restenosis

1998

1999


Stent Procedures 1999Stent Procedures 19991992 1993 1994 1995 1996 1997 1998 1999

Elective 179 341 834 2,595 2,373 3,170(45%)

(7.5-100)

3,376(56%)(0-100)

7,244(64%)

(19-100)

Sub-optimal 2,166 2,759(39%)(0-98)

2,238(37%)(0-100)

3,909(31%)(0-83)

Bail-out 140 286 1,086 1,269 429 975(14%)(0-52)

410(6.8%)(0-27)

538 (4.8%)(0-35)

% Bail-out 44 46 44 33 16 14 6.8 4.8

Total StentProcedures

319 660 1,937 4,574 9,165 7,096of

11,905

6,024of

12,507

11,691of

19,769


ReoPro in different centres ReoPro in different centres 19991999

0

2

4

6

8

10

12

14

No. of Centres

0_5

6_10

11_1

5

16_2

0

21_2

5

26_3

0

31-3

5

36_4

0

41_4

5

% ReoPro

ReoPro used in 11% of cases overall (3pts Aggrastat)


Other procedures 1999 - 1Other procedures 1999 - 1

PTCRA DCA TEC Laser CB Thromb

Centres 13-

5-

4-

2=

26+

8+

No. 114-

23-

5-

7-

313++

16+

Mean 8.8-

4.6=

1.24-

3.5 12 2+

Range 1-36 -

1-8 -

1-2 -

1-6 1-72 +

-1-5 +

+, =, - : increase, no change or decrease compared to 1998


Other procedures 1999 - 2Other procedures 1999 - 2

BrachyRx P(D)MR IVUS Groinclosure

Centres 1=

2+

30++

31+

Number 4-

9+

421-

3145++

Mean - 4.5+

14-

101+

Range - 2-7 +

1-56 -

1-418 -

+, =, - : increase, no change, or decrease compared to 1998


Other Procedures 1999 - 3Other Procedures 1999 - 3

MVplasty AVplasty PVplasty TVPlasty Coart/Re-coarct

Centres 31+

8+

11+

1-

3-

No. 254+

15+

15+

1-

3-

Mean 8.2+

1.9+

1.4-

- 1

Range 1-31 -

1-5 +

1-3 -

- 1



Other Procedures 1999 - 4Other Procedures 1999 - 4PDA ASD* PFO* VSD

Centres 4+

19+

2=

0-

No. 6=

105+

5=

0-

Mean 1.5-

5.5=

2.5=

-

Range 1-3 =

1-13 -

1-4 +

-

+, =, - : increase, no change or decrease compared to 1998* Some centres give combined data for ASD/PFO closure


Other Procedures 1999 - 5Other Procedures 1999 - 5

Renal Sub-clavian

Pulm.artery

Aorta SVC Carotid

Centres 1=

1=

1=

1=

2+

0

No. 4=

1=

2+

1=

4+

0

Mean - - - - 2 -

Range - - - - 1-3 -



Other procedures 1999 - 6Other procedures 1999 - 6FB

removalEmboln. Pericard. Pressure

WireAngio-Guard

SeptalAbln.

MustardBaffle PTA

Centres 7-

4--

1 2 1 1 0

Number 11-

14-

3+

44 5 1 0

Mean 1.6-

3.5+

- 22 -

Range 1-3 -

1-4 +

- 22 -



Centres providing complete or Centres providing complete or near complete data onnear complete data on

Hospital Outcome 1999 (16-) Hospital Outcome 1999 (16-)

Birmingham Heartlands Bristol Royal Infirmary Hull Royal Infirmary King’s College Hospital Papworth Edinburgh Western General Liverpool CTC Royal Free Hospital Stoke City General

South Cleveland Hospital Nottingham City Hospital Royal Devon & Exeter KE VIIth, Midhurst Sandwell Hospital Royal Sussex County, Brighton

Yorkshire Clinic, Bradford


HospitalHospital Outcome 1999 Outcome 1999Elective patientsElective patients

No.(centres)

Success PartialSuccess

RepeatPCI

CABG MI Death(Range)

StableSingle Ves(no CTO)

2924(16)

94% (83-100)

0.8% (0-4.2)

0.4%(0-1.9)

0.5%(0-1.9)

0.3%(0-0.9)

0.2%(0-0.8)

StableMultivessel(no CTO)

738(16)

91%(63-100)

6.2%(0-38)

0.5%(0-2.6)

0.5%(0-15)

0.4%(0-1.8)

0.4%(0-3.3)

Single VesCTO *

479(16)

69%(50-97)

2.1%(0-15)

0.4%(0-6.9)

0.4%(0-7.7)

0.4%(0-2.3)

0%

MultivesselInc. CTO *

407(16)

85%(33-100)

11%(0-67)

0.7%(0-6.3)

0% 0.2%(0-3.1)

0.2%(0-0.6)

* does not account for clinical syndrome


HospitalHospital Outcome 1999 Outcome 1999Elective patientsElective patients

No.(centres)


RepeatPCI

CABG MI Death(Range)

CABG pts * 573(16)

93%(50-100)

1.2%(0-50)

0.5%(0-3.1)

0.2%(0-1)

0.2%(0-2.9)

0.3%(0-3.1)

Restenosis * 276(16)

95%(88-100)

1.1%(0-3)

0% 0% 0.4%(0-2.4)

0.4%(0-5.3)

* does not account for clinical syndrome


HospitalHospital Outcome 1999 Outcome 1999Unstable anginaUnstable angina

No.(Centres)


RepeatPCI

CABG Q MI Death(Range)

Single VesUA

1708(16)

94%(67-100)

0.8%(0-7)

0.6%(0-2)

0.4%(0-11)

0.6%(0-1.6)

0.4%(0-1.9)

MultivesselUA

348(16)

89%(75-100)

8.9%(0-25)

0.6%(0-5.6)

0.6%(0-13)

0.3%(0-5.6)

0.3%(0-2.8)


HospitalHospital Outcome 1999 Outcome 1999Acute closureAcute closure

No.(Centres)


RepeatPCI

CABG Q MI Death(Range)

Acuteclosure

50(15)

64%(0-90)

2%(0-33)

0% 4%(0-33)

6.0%(0-100)

10%(0-33)


HospitalHospital Outcome 1999 Outcome 1999Acute MI patientsAcute MI patients

No.(Centres)


RepeatPCI

CABG re-MI Death(Range)

PrimaryPTCA

145(12)

92%(83-100)

3.4 %(0-9.1)

0.7%(0-6.3)

0.7%(0-4.5)

4.8%(0-100)

3.4%(0-17)

SalvagePTCA

183(13)

79%(69-100)

1.1%(0-5.3)

1.6%(0-5.6)

0.5%(0-1.3)

4.4%(0-100)

7.1%(0-15)

Re-MIPTCA

43(3)

98%(97-100)

0% 0% 0% 2.3%(0-3.2)

0%

Shock 183(12)

36%(0-75)

2.9%(0-33)

1.4%(0-17)

2.9%(0-33)

10%(0-100)

47%(0-100)


HospitalHospital Outcome 1999 Outcome 1999Post MI patientsPost MI patients

No.(Centres)


RepeatPCI

CABG Re-MI

Death(Range)

Post MI UA 457(10)

96%(88-100)

0.3%(0-6.3)

0.9%(0-3.2)

0.7%(0-2.8)

0.9%(0-3.2)

0.7%(0-6.3)

Post MIStable/+ETT

413(9)

89%(86-100)

1.2%(0-4.4)

0.7%(0-5.3)

0% 0.2%(0-1.1)

0%

ALL MIPatients

864(15)

87%(67-100)

6.5%(0-17)

0.9%(0-5.9)

0.6%(0-2.1)

1.3%(0-17)

5.9%(0-17)


Potential for comparison of your own Potential for comparison of your own centre with the benchmarkscentre with the benchmarks

0 1 2 3 4 5

In-hospital mortality for elective 1V, non CTO lesion


Potential for comparison of your own Potential for comparison of your own centre with the benchmarkscentre with the benchmarks

0 20 40 60 80 100

In-hospital mortality for cardiogenic shock


BCIS/CCAD UpdateBCIS/CCAD UpdateCCADCCAD

Pilot ProjectDoH decision IT systems (NHS + Trusts)NSF/Clinical Governance


BCIS/CCAD UpdateBCIS/CCAD UpdateData SetData Set

A = Centre B = Bean Count C = Outcome data by Syndrome


BCIS New Technologies BCIS New Technologies Group - RegistriesGroup - Registries

BrachytherapyEndicor X-sizer


BCIS/CCAD UpdateBCIS/CCAD UpdateConclusionsConclusions

Continued growth in PTCA (79% stented) but still far behind European/American centres

Data collection still disappointing in many centres - further efforts to achieve compliance

Departments must sort out IT and Audit requirements Database compatibility with BCIS/CCAD still

essential Current analysis by Syndrome can provide “Bench-

marks” New Technologies Registries will help, not hinder

Documents

BCIS Audit Returns of Interventional Procedures 1999