AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011
description
Transcript of AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011
Volker Mühlberger, Quality
AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011
4 Pediatric 36 Adult (11 in Vienna)
Rooms (n=49) http://iik.i-med.ac.at
Monitor (Auditor) Report: 1990 – 2012
http://iik.i-med.ac.at
L.Kaltenbach, H. Ulmer, C.Kobel www.kardiologie.insel.ch/2164.html
B Meier - St Cook, "personal communication Micha T. Maeder, later [email protected]“
www.herzbericht.de E.Bruckenberger Georg Norman (SC) „Subregister“ = „true registry“
Volker Mühlberger, Quality
Volker Mühlberger, Quality
AUSTRIA 2010 / 2011
�Angiography 55.138 53.808�PTCA=PCI 20.294 20.295�-stent 92% 91%�- - DES 75% 78%� OP-CAD (Bruckenberger : 2008=4.248) Schistek 2.737
� OP- valve (Bruckenberger: 2008=2.280) Schistek 2.583
Volker Mühlberger, Quality
Coronary Angiography Frequency per Million Inhabitants 1992-2011
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
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
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 20110
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
Case load per physicianPCI / CA (AU / CH)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
50
100
150
200
250
PCI - AU
PCI - CH
CA - AU
CA - CH
Volker Mühlberger, Quality
% PCI/ CA 1992 - 2011 (AU/CH/D/CZ)
1991
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
AU
CH
D
CZ
Volker Mühlberger, Quality
PCI during Diagnostic Angio (%) in Austria / Switzerland / EU
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
10
20
30
40
50
60
70
80
90
100
AUCHEU
Volker Mühlberger, Quality
% -multivessel PCI Austria / EU / CH
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
5
10
15
20
25
30
35
AUCHEU
Bifurcation PCI, left main stent Austria (% of… reporting centers only -2011)
2008 2009 2010 20110.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
left main stentbifurcation pci
Volker Mühlberger, Quality
Volker Mühlberger, Quality
PCI per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2011
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
500
1000
1500
2000
2500
3000
3500
4000
4500
USA
SL
AU
CH
D
CZ
Volker Mühlberger, Quality
PCI Frequency in Austria 2006-2011acute or non-acute Indications
2006 2007 2008 2009 2010 20110
5000
10000
15000
20000
25000
5009 6014 6686 6783 6466 6946
14254 13328 13041 13073 13828 13349
19263 19342 19727 19856 20294 20295
NICHT AKUTAKUT PCI
Volker Mühlberger, Quality
STEMI PCI / acute PCI/ STEMI % (n=) Austria 2007 – 2011
2007 2008 2009 2010 20110
1000
2000
3000
4000
5000
6000
7000
55 % 48%
STEMI
"acute"
STEMI % x10
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 20110
10
20
30
40
50
60
24 23
centers
tables
>36 STEMI-PCI/y+c
Volker Mühlberger, Quality
PCI Hospital-Mortality (%) in Austria, Switzerland,Germany, EU
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
0.5
1
1.5
2
2.5
AU
CH
D
EU
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
PCI -Mortality (%) in Austria 2011
PCI gesamt PCI nicht-akut PCI akut PCI akut ohne Schock
PCI akut + Schock
0
2
4
6
8
10
12
14
16
18 2011
Volker Mühlberger, Quality
Intra – aortic balloon pump for PCI in Austria 2006 -2011
2005 2006 2007 2008 2009 2010 2011 20120
50
100
150
200
250
Ballonpumpe
Ballonpumpe
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
0.00
0.20
0.40
0.60
0.80
1.00
1.20
non-acute PCI
PCI for MI without Shock
PCI for MI with Shock
PCI –Mortality acute PCI with shock in Austria (ref.= reporting centers only)
20032004200520062007200820092010201120120
5
10
15
20
25
30
35
40
mort. PCI shock %
mort. PCI shock %
Volker Mühlberger, Quality
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
ACUTE PCI (% of total PCI) in
AU, CZ, EU, CH (=STEMI only)
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
5
10
15
20
25
30
35
40
AU acute
CH STEMI
EU
CZ
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
0
5
10
15
20
25
30
AUCHAU-TI
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
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
Volker Mühlberger, Quality
Ratio of emergency CABG due to PCI (%): Austria/Switzerland/EU
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
0.2
0.4
0.6
0.8
1
1.2
1.4
AUCHEU
Volker Mühlberger, Quality
Ratio of STENTING per PCI (%) in AU/CH/D/CZ
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
10
20
30
40
50
60
70
80
90
100
AU
CH
D
CZ
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
0
10
20
30
40
50
60
70
80
90
EU EU
CZAU
CH
D
EU
Volker Mühlberger, Quality
DRUG ELUTING stents (DES/PCI) versus Re-Stenosis/PCI in Austria (%)
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
1020304050607080
6.6 5
DES % REDO % (reporting Centers only)
Volker Mühlberger, Quality
STENT REDO : Thrombus (n/%), chronic Restenosis (n)
2007 2008 2009 2010 20110
100200300400500600700800900
1000
8,5%15,2%
11,9%
Thrombus Restenose Thrombus x10% reporting centres
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
0
10
20
30
40
50
60
70
80
AUCH
Puncture site closing devices (% of…..)
% of PCI % of CA % of PCI nonacute
% of PCI acute0
10
20
30
40
50
60
70
802011
Volker Mühlberger, Quality
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
0
10
20
30
40
50
60
70
AUCHfrench CHgerman CHCZ
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
OLD and NEW DEVICES I Austria 2002-2011
Volker Mühlberger, Quality
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
50
100
150
200
250
300
350
PTSMAREnalDenervNOGA mappingThrombin lokalMitraClip
Volker Mühlberger, Quality
OLD and NEW DEVICES II Austria 2002-2011
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
500
1000
1500
2000
2500
3000
3500
4000
PTSMAREnalDenervNOGA mappingThrombin lokalOCTDefektverschl.DE Balloonclot catcher
Volker Mühlberger, Quality
OLD and NEW DEVICES III Austria 1992 -2011
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
5000
10000
15000
20000
25000
30000
35000
40000
STENTDESIIb/IIIai.c.PRESSUREIVUSROTABLDCALASER
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
Austria e.g. LAA closure 2002– 2011 („loser“) v.s. CH 2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
20
40
60
80
100
120
AUCH0
Volker Mühlberger, Quality
Myocardial Biopsies in Austria 2006 -2011
2006 2007 2008 2009 2010 20110
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 20110
500
1000
1500
2000
2500
3000
72%97%
Ablation Diagnostics A/D % x10 Implantation
Volker Mühlberger, Quality
Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2011
2005 2006 2007 2008 2009 2010 20110
100
200
300
400
500
600
0 0
397
501Balloon onlyTransapical ValveTransarterialAU- TAVIEdwards SapienCorValveCH- TAVI
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
Volker Mühlberger, Quality
Wunschliste AUDIT 2013
AKH Wiener Privatklinik Innsbruck Graz Uniklinik