c hinese d atabase for c ardiovascular s urgery questions and thoughts shengshou hu m.d. president,...
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Chinese Database for Cardiovascular Surgery
Questions and Thoughts
Shengshou Hu M.D.President, Cardiovascular Institute & Fuwai Hospital
Director, National Center for Cardiovascular Disease Prevention and Treatment
STS Adult CV national databaseThe biggest cardiovascular surgical databaseSince 1994681 sites*Cumulative number: >2,100,000*
*Data from STS Fall 2006 Report
Background
Adult Cardiac Surgical Database of EACTS– 220,000 patients records*– 12 countries*– 99 hospitals*
*Data from EACTS first adult cardiac surgical database report 2003
Background
Case Number
54321
Valu
e m
ort
ality
.07
.06
.05
.04
.03
.02
.01
Parsonnet EuroSCORE Cleveland OPR Actual Mortality
1.87%1.65%
3.30%
2.82%
5.78%
Prediction value for operative mortality of four different coronary artery bypass graft risk stratification models in Chinese patients
Zhonghua Xin Xue Guan Bing Za Zhi;2006;34:504-7
Western’s Risk model can’t expect actual mortality of Chinese patients
Background
Fu Wai STS EuroSCORE
LVEF + + +
Cr + + +
Priority + + +
Cardiac Shock + + +
Age - + +
Female - + +
Previous CVP Procedure - + +
LM + + -
Arrythmia + + -
MI + + -
PI + - -
Aortic Aneurysm Procedure + - +
Tri-vessel Disease - + -
Different Risk factors for CABG
Risk factors for CABG—Chinese experience (Submitted)
Chinese patients with cardiovascular surgery
Compare with database of STS or EACTS Different characteristic of race
Different practice guideline Indication and selection
Peri-operative therapy
Different outcome
0%
1%
2%
3%
4%
5%
1996 1997 1998 1999 2000 2001 2002 2003
Year
Mortality
Mortality of Isolated CABG in Fu Wai HospitalCompare with STS Database
STS*
Fuwai Hospital
*Executive summary of STS national database www.sts.org
Background
Purpose of CV database Define Risk factors and outcome
Application of practice guideline
Quality control improvement for surgeons and centers
Clinical trial based on the register
Research in targeted areas of cardiac surgery
Questions for Database in China
Arouse enthusiasm of contributing centers Cooperative network
No database in the most centers Software developing
Dataset link to the world fit to clinical practice
Collecting, monitoring and validating data The most important step
Questions for Database in China
Cooperative network
To arouse the enthusiasm of each potential contributing
center and surgeon
– Responsibility
– Resource share
• Risk factors evaluation
• Quality improvement
• Clinical analysis and Research
Questions for Database in China
Dataset Link with STS and Europe database Fit to Chinese cardiovascular surgical practice Union the definition of data
• Patient Data• Demographics• Cardiac history• Co-morbidities• Preoperative investigations• Preoperative support
• Operative Data• Operative priority• Procedure data
• Outcome Data• Complications• Survival
Questions for Database in China
Center
Inspection
Double input
Center Center
DatabaseData center
Basic analysis Clinical researchRisk model
Collecting, monitoring and validating data
Dataset
Database software developing
Local database
Submit data to data center regularly
Data share online
Questions for Database in China
Our practice: Step by Step
First stageRetrospectively CABG register
• CABG during 2004~2005
• Thirty-three hospital
Adult cardiac surgical register database
Second stage
National cardiac database
Retrospectively CABG register
(Oct 2006 ~ March 2007) 33 centers in Mainland
CABG in 2004~2005
More than 10000 cases
Set up CABG database
Describe risk factors and
outcome of CABG
Adult cardiac surgery register– Supported by Ministry of Science and Technology
– Call for national cooperation
Define Risk factors and outcome
Application of practice guideline
Quality control improvement
Clinical trial and research
National cardiac database
Supported by society or government
Nation wide participate
Special team for data collect and analysis