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

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

Model of data collection in EACTS

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