AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2012

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“


http://www.kardiologie.insel.ch/2164.html

http://www.herzbericht.de/

(„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



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


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


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


% 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


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



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


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


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


% 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


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



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)


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


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


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)


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


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)


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


OLD and NEW DEVICES (<350/a)

Austria 2002-2012


2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

50

100

150

200

250

300

350

400

MitraClipThrombin lokalNOGA mappingREnalDenervPTSMA


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.


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



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



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 %



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


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


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


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


Intention to audit a center


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


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


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


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


PCI Hospital-Mortality (%) 2010 vs 2011 - Austria – all centers


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



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


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


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


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


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


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


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


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


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


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


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

AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2012

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