volker mühlberger, quality austria´s angiography and pci - centres 2015 austria´s angiography and...
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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
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
Volker Mühlberger, Quality
Volker Mühlberger, Quality
AUSTRIA 2013 / 2014
� Angiography 54.566 56.062� PCI 21.698 23.044� - stent 92% 91%� - - DES 85% 92%
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
% PCI/ CA 1992 - 2014 (AU/CH/D/CZ)
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
05
101520253035404550
AUCHDCZ
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
Non- femoral (radial) approach : Switch to femoral during /before PCI
2014 20140123456789
10
% ALL% reporting
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
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
Volker Mühlberger, Quality
% 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
Volker Mühlberger, Quality
Volker Mühlberger, Quality
% 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
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
2015
0
0.2
0.4
0.6
0.8
1
1.2
1.4
AUCHEU
Volker Mühlberger, Quality
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
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
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
Volker Mühlberger, Quality
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
2014
2015
0102030405060708090
100
EU EU
CZAUCHDEUCZ
Volker Mühlberger, Quality
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)
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
AUT 2012 / 2013/ 2014 (n)
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
50
100
150
200
250
300
350
400
450
2012 2013 2014
Volker Mühlberger, Quality
AUT 2012 (%) CH
PTSMA %
bioabSTENT %
CTO %FFR %
IVUS %
OCT %
shock
PCI %0
2
4
6
8
10
12
14
AUT
CH
Volker Mühlberger, Quality
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
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
100
200
300
400
500
600
700
800
900
AUT
CH
Volker Mühlberger, Quality
AUT 2013 (n) CH
Volker Mühlberger, Quality
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
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
Volker Mühlberger, Quality
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
Austria 2013 / 2014 reporting centres Ablation (n) for AFib / for VTac
2013 20140
500
1000
1500
2000
2500
3000
3500
Ablation Afib Vtac
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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
Volker Mühlberger, Quality
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