Volker Mühlberger, Quality AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2015 AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2015 n n = 34 locations n n = 52 rooms

Volker Mühlberger, Quality

AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2015

n = 34 locations

n = 52 rooms update 2015-09-08

Monitor (Auditor) Report: 1989 – 2015 (update 2015-09-07)

www.iik.i-med.ac.at Lalit Kaltenbach, Hanno Ulmer www.ptca.ch Marco Roffi – Genf, Bernhard Meier,

Gregor Fahrni, Micha T. Maeder www.herzstiftung.de Martin Vestweber

www.herzbericht.de E.Bruckenberger bis 2011

„Österreichische Spezialregister“Volker Mühlberger, Quality

http://www.ptca.ch/

http://www.herzbericht.de/

ANCALAR AustrianNationalCAthLAbRegisty

to describe practice patternsand trends, to identify outliers and to detect safety signals Lauer MS, D´Agostino RB NEJM 2013; 369:1579-81



AUSTRIA 2013 / 2014

� Angiography 54.566 56.062� PCI 21.698 23.044� - stent 92% 91%� - - DES 85% 92%


Coronary Angiography Frequency per Million Inhabitants 1992-2014

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

0

2000

4000

6000

8000

10000

12000

AU 8.12-8.43-8.58CH 7.4 - 7.95D 82.2-81.8CZ 10.0-10.5


% PCI/ CA 1992 - 2014 (AU/CH/D/CZ)

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

05

101520253035404550

AUCHDCZ


PCI per One Million Inhabitants (AU/CH/D/CZ/USA) 1992-2014

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

0

500

1000

1500

2000

2500

3000

3500

4000

4500

USA

AU

CH

D

CZ

Volker Mühlberger, Quality Silber 2005 / DiMario 2006;

ESC

Number of tables and CENTERS with > 36 STEMI - PCI / year + center

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

10

20

30

40

50

60

2427

24

34

52

centers

tables

>36 STEMI-PCI/y+c


PCI Frequency in Austria 2006-2014acute or non-acute Indications

2006 2007 2008 2009 2010 2011 2012 2013 20140

5000

10000

15000

20000

25000

5009 6014 6686 6783 6466 6946 7026 7148 7791

14254 13328 13041 13073 13828 13349 13517 1455015253

19263 19342 19727 19856 20294 20295 2054321698

23044

NICHT AKUTAKUT PCI


Acute PCI/ STEMI PCI / % (n=) Austria 2007 – 2014

2007 2008 2009 2010 2011 2012 2013 20140

1000

2000

3000

4000

5000

6000

7000

8000

55 %51%

STEMI

"acute"

STEMI % x10


ACUTE minus STEMI PCI (% of total PCI) in AU, CH, CZ, EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

0

5

10

15

20

25

30

35

40

45

AU acuteCH STEMIEUCZCH acuteAU STEMI

Non- femoral (radial) approach (% of procedure) AUT 2011/2012 /2013/2014

ANGIO 20

1120

1220

1320

14

PCI 201

120

1220

1320

14

PCI elek

tiv 20

1120

1220

1320

14

PCI aku

t 201

120

1220

1320

1405

1015202530354045

2011201220132014


Non- femoral (radial) approach : Switch to femoral during /before PCI

2014 20140123456789

10

% ALL% reporting



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

2014

2015

0

10

20

30

40

50

60

70

AUCHfrench CHgerman CHCZ

Severe bleeding (% of …reporting only) AUT 2010 / 2011 / 2012 / 2013/ 2014


% of CA bleeding % of PCI nonacute % of PCI acute0

5

10

15

20

25

30

35

40

Bifurcation PCI, left main stent Austria (% of PCI… reporting centers only )

2008 2009 2010 2011 2012 2013 20140.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0



% GP IIb/IIIa for PCI (AU/CH) % ThrombinInhibitor (TI-AU)

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

0

5

10

15

20

25

30

AUCHAU-TI


Ratio of emergency CABG due to PCI (%): Austria/Switzerland/EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

0

0.2

0.4

0.6

0.8

1

1.2

1.4

AUCHEU


PCI Hospital-Mortality (%) in Austria, Switzerland,Germany, EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

2015

0

0.5

1

1.5

2

2.5

AUCHDEU

PCI -Mortality (% of procedure)

Austria 2011 / 2012 / 2013 / 2014

0

5

10

15

20

25

30

35

1.05 0.162.8

1

31.2



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

2013

2014

0.00

0.20

0.40

0.60

0.80

1.00

1.20

non-acute PCI bezogen auf Gesamt PCIPCI for MI without Shock bezogen auf Gesamt PCIPCI for MI with Shock bezogen auf Gesamt PCI

Intra – aortic balloon pump for PCI in Austria 2005 -2014 (CH 2012/13)

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

50100150200250300350400450500

AUTCH



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

2014

2015

0102030405060708090

100

EU EU

CZAUCHDEUCZ


DES/stent and re-stenosis REDOreporting Centres (% of stent)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

20

40

60

80

100

6.6 6.35 5.1 4.2

DES % REDO % (reporting Centers only)


REDO for all chronic restenoses vs. thrombus reporting centres (n/%)

2007 2008 2009 2010 2011 2012 2013 20140

100200300400500600700800900

1000

8,5%15,2%

11,9%15,1 % 16,6 %

Thrombus Restenose Thrombus x10% reporting centres

AUT 2012 / 2013/ 2014 (%)

bioab-STENT %

CTO % FFR % IVUS % OCT % shock PCI %

0

2

4

6

8

10

12

14

2012

2013

2014


AUT 2012 / 2013/ 2014 (n)

Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0

50

100

150

200

250

300

350

400

450

2012 2013 2014


AUT 2012 (%) CH

PTSMA %

bioabSTENT %

CTO %FFR %

IVUS %

OCT %

shock

PCI %0

2

4

6

8

10

12

14

AUT

CH


AUT 2013 (%) CH

Volker Mühlberger, QualityPTSMA %

bioabSTENT %

CTO %FFR %

IVUS %

OCT %

shock

PCI %0

2

4

6

8

10

12

14

AUT

CH

AUT 2012 (n) CH


100

200

300

400

500

600

700

800

900

AUT

CH


AUT 2013 (n) CH



100

200

300

400

500

600

700

800

900

AUT

CH

Austria vs. CH 2002– 2014 LAA closure (n)

20022003200420052006200720082009201020112012201320140

50

100

150

200

250

300

AUCH0



OLD and NEW DEVICES (n<40.000/a) Austria 1992 -2014

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

05000

100001500020000250003000035000400004500050000

STENTDESSeries4IVUSROTABLi.c.PRESSURE


OLD and NEW DEVICES (n<3000/a) Austria 2002-2014

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

500

1000

1500

2000

2500

3000

3500

Defektverschl. DE Balloon

Catheter Trombectomy/clot catcher

OLD and NEW DEVICES (n<400/a) Austria 2002-2014


2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

50

100

150

200

250

300

350

400

MitraClipThrombin lokalNOGA mappingREnalDenervPTSMA

Myocardial biopsies (n) in Austria 2006 -2014

2006 2007 2008 2009 2010 2011 2012 2013 20140

50100150200250300350400450

myocardial biopsies



Ablation (n) / Electrophysiology (n; %) & CathLab Implantations / Austria

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

500

1000

1500

2000

2500

3000

3500

72%

95%Ablation Diagnostics A/E % x10 Implantation


Austria 2013 / 2014 reporting centres Ablation (n) for AFib / for VTac

2013 20140

500

1000

1500

2000

2500

3000

3500

Ablation Afib Vtac


Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH - 2014

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

100

200

300

400

500

600

700

800

Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH - 2014


2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

100

200

300

400

500

600

700

800

78

AU taoAU- TAVICH tapCH taoCH- TAVI

Österr.Kardiol.Gesellschaft 1989–2015 Arbeitsgruppe Intervent. Kardiologie

Danke sehr

.

THANK YOU


Documents

Volker Mühlberger, Quality AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2015 AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2015 n n = 34 locations n n = 52 rooms