austria´s angiography and pci - centres 2013
DESCRIPTION
AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2013. n = 34 locations n = 50 rooms. Monitor (Auditor) Report: 1989 – 2014. www.iik.i-med.ac.at Lalit Kaltenbach, Hanno Ulmer www.ptca.ch Gregor Fahrni, Christoph Kaiser – Basel Bernhard Meier, Micha T. Maeder - PowerPoint PPT PresentationTRANSCRIPT
Volker Mühlberger, Quality
AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2013
n = 34 locations
n = 50 rooms
Monitor (Auditor) Report: 1989 – 2014
www.iik.i-med.ac.at
Lalit Kaltenbach, Hanno Ulmer www.ptca.ch
Gregor Fahrni, Christoph Kaiser – Basel
Bernhard Meier, Micha T. Maeder www.herzstiftung.de Martin Vestweber
www.herzbericht.de E.Bruckenberger bis 2011
„Österreichische Spezialregister“Volker Mühlberger, Quality
ANCALAR („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
Volker Mühlberger, Quality
Volker Mühlberger, Quality
AUSTRIA 2012 / 2013
� Angiography 53.064 54.566� PCI 20.543 21.698� - stent 90% 92%� - - DES 85% 85%� 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 1992-2013
19911993
19951997
19992001
20032005
20072009
20112013
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
% PCI/ CA 1992 - 2013 (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
Volker Mühlberger, Quality
PCI per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2013
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
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 2012 20130
10
20
30
40
50
60
19 18 2024
20 22 23 23 2327
23centers
tables
>36 STEMI-PCI/y+c
Volker Mühlberger, Quality
PCI Frequency in Austria 2006-2013acute or non-acute Indications
2006 2007 2008 2009 2010 2011 2012 20130
5000
10000
15000
20000
25000
5009 6014 6686 6783 6466 6946 7026 7148
14254 13328 13041 13073 13828 13349 13517 14550
19263 19342 19727 19856 20294 20295 2054321698
NICHT AKUT
AKUT PCI
Volker Mühlberger, Quality
Acute PCI/ STEMI PCI / % (n=) Austria 2007 – 2013
2007 2008 2009 2010 2011 2012 20130
1000
2000
3000
4000
5000
6000
7000
8000
55 %50%
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
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
ANGIO 2
011
2012
2013
PCI 201
120
1220
13
PCI ele
ktiv
201
120
1220
13
PCI aku
t 201
120
1220
130
5
10
15
20
25
30
35
40
2011
2012
2013
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
0
10
20
30
40
50
60
70
AUCHfrench CHgerman CHCZ
Severe bleeding (% of …reporting only) AUT 2010 / 2011 / 2012 / 2013
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 20130.0
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) % dir.ThrombinInhibitor (TI-AU)
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
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
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
0
0.5
1
1.5
2
2.5
AU
CH
D
EU
PCI -Mortality (% of procedure)
in Austria 2011 / 2012 / 2013
0
5
10
15
20
25
30
0.85 0.12.4
1
25.9
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
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 2005 -2013 (CH 2012/13)
2005 2006 2007 2008 2009 2010 2011 2012 20130
50
100
150
200
250
300
350
400
450
500
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
0
10
20
30
40
50
60
70
80
90
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 20130
102030405060708090
6.6 6.3 55.1
DES % REDO % (reporting Centers only)
Volker Mühlberger, Quality
REDO for all chronic restenoses vs. thrombus reporting centres (n/%)
2007 2008 2009 2010 2011 2012 20130
100200300400500600700800900
1000
8,5%15,2%
11,9%15,1 % 16,8 %
Thrombus Restenose Thrombus x10% reporting centres
AUT 2012 CH
PTSMA %
bioab
STENT %
CTO %
FFR %
IVUS %
OCT %
shock
PCI %
0
2
4
6
8
10
12
14
AUT
CH
Volker Mühlberger, Quality
AUT 2013 CH
Volker Mühlberger, QualityPTSM
A %
bioab
STENT %
CTO %
FFR %
IVUS %
OCT %
shock
PCI %
0
2
4
6
8
10
12
14
AUT
CH
AUT 2012 CH
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
100
200
300
400
500
600
700
800
900
AUT
CH
Volker Mühlberger, Quality
AUT 2013 CH
Volker Mühlberger, Quality
Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0
100
200
300
400
500
600
700
800
900
AUT
CH
Austria vs. CH 2002– 2013 LAA closure
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
50
100
150
200
250
300
AUCH0
Volker Mühlberger, Quality
Volker Mühlberger, Quality
OLD and NEW DEVICES (35.000/a)
Austria 1992 -201319
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
Volker Mühlberger, Quality
OLD and NEW DEVICES (<3000/a)
Austria 2002-201320
02
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
500
1000
1500
2000
2500
3000
3500
(„Catheter Thrombectomy“ or
DE Balloon
Defektverschl.
OLD and NEW DEVICES (<400/a)
Austria 2002-2013
Volker Mühlberger, Quality
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
0
50
100
150
200
250
300
350
400
MitraClipThrombin lokalNOGA mappingREnalDenervPTSMA
Myocardial biopsies in Austria 2006 -2013
2006 2007 2008 2009 2010 2011 2012 20130
50
100
150
200
250
300
350
400
450myocardial biopsies
Volker Mühlberger, Quality
Volker Mühlberger, Quality
Ablation (n) / Electrophysiology (n; %) & CathLab Implantations / Austria
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130
500
1000
1500
2000
2500
3000
3500
72%
95%Ablation Diagnostics A/D % x10 Implantation
Volker Mühlberger, Quality
Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2013
2005 2006 2007 2008 2009 2010 2011 2012 20130
100
200
300
400
500
600
700
800
0 0
480
781AU- TAVI
CH- TAVI
Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2013
Volker Mühlberger, Quality
2005 2006 2007 2008 2009 2010 2011 2012 20130
100
200
300
400
500
600
700
800
0 0
397 432 480501
650781
AU tapAU taoAU- TAVICH tapCH taoCH- TAVI