Österr.kardiol.gesellschaft 1990 arbeitsgruppe intervent. kardiologie monitor (auditor) report:...
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Österr.Kardiol.Gesellschaft 1990 Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie
Monitor (Auditor) Report: 2005/2006
European Society of CardiologyEuropean Society of Cardiology WG 10 – EAPCI (2006)WG 10 – EAPCI (2006)
AUSTRIA 1990 -2005AUSTRIA 1990 -2005
BERNBERNESCESC
Contact and References:Contact and References:
http://iik.msig.at (V.Barbieri, http://iik.msig.at (V.Barbieri, L.Kaltenbach, KP Pfeiffer)L.Kaltenbach, KP Pfeiffer)
www.kardiologie.insel.ch/2164.html www.kardiologie.insel.ch/2164.html (T.Carrel, B Meier)(T.Carrel, B Meier)
CARDS; EU Heart J. 2005;26: 308-313 CARDS; EU Heart J. 2005;26: 308-313 (ESC-WG 10; F.Weidinger)(ESC-WG 10; F.Weidinger)
www.herzbericht.de (E.Bruckenberger)www.herzbericht.de (E.Bruckenberger)
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PCI- CENTERS 2005/6 +/- PCI- CENTERS 2005/6
4 Pediatric 4 Pediatric 32 Adult 32 Adult ((8 8 in Vienna)in Vienna)
Rooms (n=44)Rooms (n=44) http://iik.msig.athttp://iik.msig.at Schwarzach + Wiener Privatklinik – 2005 Mödling ab 2006Schwarzach + Wiener Privatklinik – 2005 Mödling ab 2006
103 parameters were reported 103 parameters were reported by all by all 31/30/32 cathlabs 2003/2004/200531/30/32 cathlabs 2003/2004/2005
0
20
40
60
80
100
120
99,0
396
,12
93,2
90,2
987
,38
84,4
781
,55
78,6
475
,73
72,8
269
,966
,99
64,0
861
,17
58,2
555
,34
52,4
349
,51
46,6
43,6
940
,78
37,8
634
,95
32,0
429
,13
26,2
123
,320
,39
17,4
814
,56
11,6
58,
745,
832,
91
% Rückmeldung
% H
erz
kath
ete
rze
ntr
en
2003
2004
2005
Volker Mühlberger, QualityVolker Mühlberger, Quality
AUSTRIA 2004/2005AUSTRIA 2004/2005
� Angiography 44.742 48.791Angiography 44.742 48.791� PTCA=PCI 16.738 18.591PTCA=PCI 16.738 18.591� stentstent 87% 91% 87% 91%� -DES-DES 44% 44% 66% 66%� OP-CAD OP-CAD 3.762 3.762 3.443 3.443� OP- valve 2.217 OP- valve 2.217 2.376 2.376
Volker Mühlberger, QualityVolker Mühlberger, Quality
Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants per One Million Inhabitants
0
2000
4000
6000
8000
10000
1992 1995 1998 2001 2004
AU 8.12
CH 7.4
D 82.53
PCI Frequency per One Million PCI Frequency per One Million Inhabitants (Inhabitants (AUAU//CHCH//DD))
0
500
1000
1500
2000
2500
3000
3500
1992 1994 1996 1998 2000 2002 2004
AU
CH
D
n= 32 centers - Austria 2005; according to incremental PCI/CA % quota (n=)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
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
Zentrumsnummern geordnet nach Größenverhältnis PCI/CA aufsteigend
Ab
so
lute
An
za
hl
Anzahl KAG
GESAMT PCI
n= 32 centers - according to incremental PCI/CA % quota in Austria 2005; (%=)
0
10
20
30
40
50
60
70
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
Zentrumsnummern geordnet nach Größenverhältnis PCI/CA aufsteigend
PC
I/C
A in
Pro
zen
t (%
)
PCI/CA 2001
PCI/CA 2002
PCI/CA 2003
PCI/CA 2004
PCI/CA 2005
Volker Mühlberger, QualityVolker Mühlberger, Quality
%-PCI during Diagnostic %-PCI during Diagnostic Angio in Angio in
AustriaAustria//SwitzerlandSwitzerland//EUEU
0
10
20
30
40
50
60
70
80
90
1992 1994 1996 1998 2000 2002 2004
AU
CH
EU
%-multivessel PCI %-multivessel PCI AustriaAustria//EUEU
0
2
4
6
8
10
12
14
16
18
20
2002 2003 2004 2005
AUSTRIAEU
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of (CABG-OP+PCI) per Ratio of (CABG-OP+PCI) per Angiography in Angiography in AUAU CHCH DD
0
10
20
30
40
50
60
1992 1994 1996 1998 2000 2002 2004
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI Hospital-Mortality (%) in PCI Hospital-Mortality (%) in AustriaAustria, , SwitzerlandSwitzerland,,GermanyGermany, , EUEU
0,27
0,6
0,03
0,5
0
0,2
0,4
0,6
0,8
1
1,2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
D
EU
Volker Mühlberger, QualityVolker Mühlberger, Quality
Elective (non-acute) and Overall - Elective (non-acute) and Overall - PCI PCI Hospital-Mortality (%) in AustriaHospital-Mortality (%) in Austria
0
0,2
0,4
0,6
0,8
1
1,2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Overall
Elective
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of STENTING per PCI Ratio of STENTING per PCI (%) in (%) in AUAU//CHCH//DD
2,4 4,38,9
27
47
58
6874 76
81 84 87 8791
0
10
20
30
40
50
60
70
80
90
100
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of emergency CABG due to Ratio of emergency CABG due to PCI (%) in PCI (%) in AustriaAustria//SwitzerlandSwitzerland,,EUEU
0
0,2
0,4
0,6
0,8
1
1,2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
EU
Volker Mühlberger, QualityVolker Mühlberger, Quality
EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI (%)-MORTALITY in AustriaPCI (%)-MORTALITY in Austria
3,3
8,3
18,2
28,6
8,3
15,4 16
25
32
1210,5
18,2
13,6
0
5
10
15
20
25
30
35
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Volker Mühlberger, QualityVolker Mühlberger, Quality
Infarction as Complication (%) after Infarction as Complication (%) after PCI in PCI in AustriaAustria, , CHCH, , DD, , EUEU
0,85
0,8
0,3
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
2
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
D
EU
PPCI/PCI % Austria 2004 all Centers
0
50
100
1. Qrtl. 2. Qrtl. 3. Qrtl. 4. Qrtl.
Ost
West
Nord
0
5
10
15
20
25
30
35
40
MIT 24h Dienst (n=15) OHNE 24h Dienst (n=14)
% P
PC
I vo
n P
CI
acuteacute PCI (% of total PCI) in PCI (% of total PCI) in AustriaAustria and and SwitzerlandSwitzerland,,EUEU
17
20
0
5
10
15
20
25
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
EU
PCI for acute & subacute PCI for acute & subacute myocardial infarction (n) in Austriamyocardial infarction (n) in Austria
0
500
1000
1500
2000
2500
3000
3500
4000
1998 1999 2000 2001 2002 2003 2004 2005
PCI MIwith shock
PCI MIwithoutshock
Volker Mühlberger, QualityVolker Mühlberger, Quality
MORTALITY after PCI for acute & MORTALITY after PCI for acute & subacute myocardial infarction in Austria(%)subacute myocardial infarction in Austria(%)
27
2,5
31
2,8
35
2,6
30
2,1
17
2
17,2
2,2
21,8
1,6
22,8
1,5
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004 2005
PCI forMI+Shock
PCI for MIwithoutShock
Volker Mühlberger, QualityVolker Mühlberger, Quality
% GP IIb/IIIa for PCI (% GP IIb/IIIa for PCI (AUAU//CHCH))
0
5
10
15
20
25
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
DRUG ELUTING STENTSDRUG ELUTING STENTS (DES) in (DES) in AUAU,,CHCH,,DD (% of stents) (% of stents)
0
10
20
30
40
50
60
70
80
2001 2002 2003 2004 2005
CH
Austria
D
EU
DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n)in Austria (n)
0
500
1000
1500
2000
2500
3000
3500
4000
4500
2002 2003 2004 2005
Tacrolimus
Paclitaxel
Sirolimus
notavailable
DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) versus REDO in Austria (%)versus REDO in Austria (%)
0
10
20
30
40
50
60
70
2002 2003 2004 2005
DESREDO
Volker Mühlberger, QualityVolker Mühlberger, Quality
Puncture site closing devices Puncture site closing devices (% of PCI in (% of PCI in AUAU//CHCH))
0
10
20
30
40
50
60
70
1998 1999 2000 2001 2002 2003 2004 2005
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Brachial and Radial Brachial and Radial Approach (% of PCI in Approach (% of PCI in AUAU//CHCH))
0
0,5
1
1,5
2
2,5
3
3,5
4
1999 2000 2001 2002 2003 2004 2005
AUCH
Volker Mühlberger, QualityVolker Mühlberger, Quality
OLD and NEW DEVICES, AustriaOLD and NEW DEVICES, Austria
LASER
IVUS
STENT
0
5000
10000
15000
20000 LASER
DCA
ROTABL
IVUS
IIb/IIIa
DES
STENT
Volker Mühlberger, QualityVolker Mühlberger, Quality
NEW DEVICES NEW DEVICES Austria 2002/2003/2004/2005Austria 2002/2003/2004/2005
Brachytherapie 163/101/28/3Brachytherapie 163/101/28/3 Ultraschalltherapie 1/0/0/0Ultraschalltherapie 1/0/0/0 Gerinnselentferner 148/173/213/380Gerinnselentferner 148/173/213/380 Transmyokardialer Laser 16/0/13/0Transmyokardialer Laser 16/0/13/0 Spinal Cord Stimulation 4/0/0/0Spinal Cord Stimulation 4/0/0/0 Alkoholablation 4/4/6/15Alkoholablation 4/4/6/15 Defektverschlüsse 162/243/269/319Defektverschlüsse 162/243/269/319 Drug - Eluting – Stents 620/2938/6430/11209Drug - Eluting – Stents 620/2938/6430/11209
NEW DEVICES II NEW DEVICES II Austria 2003/2004/2005Austria 2003/2004/2005
Stammzelltherapie mit Katheter 21/16/23Stammzelltherapie mit Katheter 21/16/23 NOGA MappingNOGA Mapping
16/26/2616/26/26 Herzohrverschluss linksHerzohrverschluss links 7/4/13 7/4/13 PCI wegen instent-Restenose 737/921/905PCI wegen instent-Restenose 737/921/905 Thrombininjektion bei lokaler Thrombininjektion bei lokaler
Gefäßkomplikation -/ 88/143Gefäßkomplikation -/ 88/143
Volker Mühlberger, QualityVolker Mühlberger, Quality
Case load per physicianCase load per physician
0
50
100
150
200
250
1998PC I
1999PC I
2000PC I
2001PC I
2002PC I
2003PC I
2004PC I
2005PC I
1998C A
1999C A
2000C A
2001C A
2002C A
2003C A
2004C A
2005C A
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR PCI DURING 2000/05LOW CASE LOAD FOR PCI DURING 2000/05
0
5
10
15
20
25
<200 PCI per yearand center
200-400 >400 PCI
AU 2000
AU 2001
AU 2002
AU 2003
AU 2004
AU 2005
CH 2004
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR CA DURING 2000/05LOW CASE LOAD FOR CA DURING 2000/05
0
2
4
6
8
10
12
14
16
<400 CA peryear and
center
400-1000 1000-2000 >2000 CA
AU 2000
AU 2001
AU 2002
AU 2003
AU 2004
AU 2005
CH 2004
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