AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011

Volker Mühlberger, Quality

AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011

4 Pediatric 36 Adult (11 in Vienna)

Rooms (n=49) http://iik.i-med.ac.at

http://iik.i-med.ac.at/

Monitor (Auditor) Report: 1990 – 2012

http://iik.i-med.ac.at

L.Kaltenbach, H. Ulmer, C.Kobel www.kardiologie.insel.ch/2164.html

B Meier - St Cook, "personal communication Micha T. Maeder, later [email protected]“

www.herzbericht.de E.Bruckenberger Georg Norman (SC) „Subregister“ = „true registry“


http://www.kardiologie.insel.ch/2164.html

mailto:[email protected]

http://www.herzbericht.de/


AUSTRIA 2010 / 2011

�Angiography 55.138 53.808�PTCA=PCI 20.294 20.295�-stent 92% 91%�- - DES 75% 78%� OP-CAD (Bruckenberger : 2008=4.248) Schistek 2.737

� OP- valve (Bruckenberger: 2008=2.280) Schistek 2.583


Coronary Angiography Frequency per Million Inhabitants 1992-2011

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

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


NUMBER OF CENTERS with<400 CA /year vs. <200 PCI/year vs. CA/y(*t)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

2

4

6

8

10

12

0

1

2

3

4

5

6

7

<400 CA/y+c

<200 PCI/y+c

CA/y x thousand


Case load per physicianPCI / CA (AU / CH)

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

50

100

150

200

250

PCI - AU

PCI - CH

CA - AU

CA - CH


% PCI/ CA 1992 - 2011 (AU/CH/D/CZ)

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

5

10

15

20

25

30

35

40

45

50

AU

CH

D

CZ


PCI during Diagnostic Angio (%) in Austria / Switzerland / EU

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

10

20

30

40

50

60

70

80

90

100

AUCHEU


% -multivessel PCI Austria / EU / CH

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

5

10

15

20

25

30

35

AUCHEU

Bifurcation PCI, left main stent Austria (% of… reporting centers only -2011)

2008 2009 2010 20110.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

left main stentbifurcation pci



PCI per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2011

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

0

500

1000

1500

2000

2500

3000

3500

4000

4500

USA

SL

AU

CH

D

CZ


PCI Frequency in Austria 2006-2011acute or non-acute Indications

2006 2007 2008 2009 2010 20110

5000

10000

15000

20000

25000

5009 6014 6686 6783 6466 6946

14254 13328 13041 13073 13828 13349

19263 19342 19727 19856 20294 20295

NICHT AKUTAKUT PCI


STEMI PCI / acute PCI/ STEMI % (n=) Austria 2007 – 2011

2007 2008 2009 2010 20110

1000

2000

3000

4000

5000

6000

7000

55 % 48%

STEMI

"acute"

STEMI % x10

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 20110

10

20

30

40

50

60

24 23

centers

tables

>36 STEMI-PCI/y+c


PCI Hospital-Mortality (%) in Austria, Switzerland,Germany, EU

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

0.5

1

1.5

2

2.5

AU

CH

D

EU

PCI Hospital-Mortality (%) in Austria – true vs. traditional

2008 2009 2009 2010 20110

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

allemeldende


PCI Hospital-Mortality (%) 2010 vs 2011 - Austria – all centers


0 0.5 1 1.5 2 2.5 30

0.5

1

1.5

2

2.5

3

PCI Mortalität

2010

20

11

PCI -Mortality (%) in Austria 2011

PCI gesamt PCI nicht-akut PCI akut PCI akut ohne Schock

PCI akut + Schock

0

2

4

6

8

10

12

14

16

18 2011


Intra – aortic balloon pump for PCI in Austria 2006 -2011

2005 2006 2007 2008 2009 2010 2011 20120

50

100

150

200

250

Ballonpumpe

Ballonpumpe



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

0.00

0.20

0.40

0.60

0.80

1.00

1.20

non-acute PCI

PCI for MI without Shock

PCI for MI with Shock

PCI –Mortality acute PCI with shock in Austria (ref.= reporting centers only)

20032004200520062007200820092010201120120

5

10

15

20

25

30

35

40

mort. PCI shock %

mort. PCI shock %


Akut PCI Mortalität 2011


0 5 10 15 20 25 30 350

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Akut PCI Mortalität


ACUTE PCI (% of total PCI) in

AU, CZ, EU, CH (=STEMI only)

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

0

5

10

15

20

25

30

35

40

AU acute

CH STEMI

EU

CZ


% 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

0

5

10

15

20

25

30

AUCHAU-TI


EMERGENCY CABG AFTER PCI (%): MORTALITY in Austria

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

5

10

15

20

25

30

35

40

45

50

03.3

8.3

18.2

28.6

8.3

15.4 16

25

32

12 10.5

18.2

13.6

23.1

36.4

46.7

36.4

26.1

6.25


Ratio of emergency CABG due to PCI (%): Austria/Switzerland/EU

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

0.2

0.4

0.6

0.8

1

1.2

1.4

AUCHEU


Ratio of STENTING per PCI (%) in AU/CH/D/CZ

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

10

20

30

40

50

60

70

80

90

100

AU

CH

D

CZ


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

0

10

20

30

40

50

60

70

80

90

EU EU

CZAU

CH

D

EU


DRUG ELUTING stents (DES/PCI) versus Re-Stenosis/PCI in Austria (%)

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

1020304050607080

6.6 5

DES % REDO % (reporting Centers only)


STENT REDO : Thrombus (n/%), chronic Restenosis (n)

2007 2008 2009 2010 20110

100200300400500600700800900

1000

8,5%15,2%

11,9%

Thrombus Restenose Thrombus x10% reporting centres


Puncture site closing devices (% of PCI in AU/CH)

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

0

10

20

30

40

50

60

70

80

AUCH

Puncture site closing devices (% of…..)

% of PCI % of CA % of PCI nonacute

% of PCI acute0

10

20

30

40

50

60

70

802011



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

0

10

20

30

40

50

60

70

AUCHfrench CHgerman CHCZ

Non- femoral Approach 2010/2011 (% of procedure) in Austria

Series1

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

15,7

KAG 2011

PCI 2010

PCI 2011

PCI akut 2011

PCI elektiv 2011


OLD and NEW DEVICES I Austria 2002-2011


2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

50

100

150

200

250

300

350

PTSMAREnalDenervNOGA mappingThrombin lokalMitraClip


OLD and NEW DEVICES II Austria 2002-2011

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

500

1000

1500

2000

2500

3000

3500

4000

PTSMAREnalDenervNOGA mappingThrombin lokalOCTDefektverschl.DE Balloonclot catcher


OLD and NEW DEVICES III Austria 1992 -2011

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

0

5000

10000

15000

20000

25000

30000

35000

40000

STENTDESIIb/IIIai.c.PRESSUREIVUSROTABLDCALASER


OLD and NEW DEVICES („loser“)

Austria 2002-2011

Brachytherapie 163/101/28/3/0/0/0/0/0/0 Ultraschalltherapie 1/0/0/0/0/0/0/0/0/0 Transmyokardialer Laser 16/0/13/0/0/0/0/0/0/0 Spinal Cord Stimulation 4/0/0/0/0/0/0/0/0/0 Herzohrverschluss links 7/4/13/0/0/0/0/?/? Stammzellth. -Katheter 1/16/23/12/40/3/0/0/0

stereotaktische Drahtnavigation -/-/-/-/-/33 /13/4/0

Austria e.g. LAA closure 2002– 2011 („loser“) v.s. CH 2011

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

20

40

60

80

100

120

AUCH0


Myocardial Biopsies in Austria 2006 -2011

2006 2007 2008 2009 2010 20110

50

100

150

200

250

300

350

400

450myocardial biopsies



Ablation (n) / Electrophysiology (n; %) in CathLab Implantations / Austria

2003 2004 2005 2006 2007 2008 2009 2010 20110

500

1000

1500

2000

2500

3000

72%97%

Ablation Diagnostics A/D % x10 Implantation


Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2011

2005 2006 2007 2008 2009 2010 20110

100

200

300

400

500

600

0 0

397

501Balloon onlyTransapical ValveTransarterialAU- TAVIEdwards SapienCorValveCH- TAVI

Intention to audit a center


2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

CA

PCI


Wunschliste AUDIT 2013

AKH Wiener Privatklinik Innsbruck Graz Uniklinik

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AUSTRIAS ANGIOGRAPHY and PCI- CENTERS 2011