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Hellenic PCI RegistryOrganization - Structure - Directions - Initial Recordingshttp://registry.hellenicpci.gr/
Georgios I. Papaioannou, MD, MPH, FACC, FSCAI
Athens Medical Center
Cardiac Catheterization Laboratory
5/12/2008
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Aim of the Hellenic PCI Registry
• Common link with ESC (ESC PCI Registry) and EAPCI• Recording of Centers/Operators/ Interventional Coronary
Procedures with regional and national analyses• Recording of basic indications, demographic, procedural
and outcomes data of patients undergoing PCI• National database for educational and professional
requirements (in accordance to ESC/ACC)• Quality and Outcomes Research
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Greek Participation in the ESC PCI Registry
• Advantages– Existing structure
– Simple process
– Direct participation in ESC PCI
– Instant comparison with ESC data
– No expenses on time, structure and analyses
• Disadvantages– Certain format of
database
– No independent access and analyses of center data
– No independent access and analyses of regional & national data
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Hellenic Heart Registry on PCI
• Initial attempt in 1998 – paper based• Current decision of the WG of HSC for a f/u
attempt• Analyses at a national level & submission of data
to the ESC• Web-based database with secure data entry by
individual users (user ID/password)• Central analyses of data by the WG of HSC• Each center may use the database for their own
data analyses upon request
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Timetable of the PCI Registry
• 5/2006: WG decision• 7/2006: Funding for the initial phase • 9/2006: Collaboration with Philip Lees (Webmaster)• 12/2006: Early design of database• 3/2007: Testing version in a separate domain (Phase
I)• 7/2007: Phase II – Pilot cases entry (>300 patients, 9
centers)• 2/2008: Phase III – Official start of Registry
retrospectively from 1/1/2008 with a 3-5 year plan (>1000 patients entered so far in 2008)
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Database Organization
• Users (case entry)
• Local Administrators (case entry – contact person in each center)
• National Administrators (new center entry – new user entry – validation process)
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Users
• New User entry from National Administrators after User’s request
• Users: Registry enter with unique personal User ID/Password (automatic generation via software)
• Unique (not shared) e-mail address
• Users may change their own information subsequently
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Tables (8)
• Patient (Automatic entry ID-Demographics-Patient initials)
• Workup (History-Risk factors-Indication-Times-Admission Medications)
• PCI Angiogram (Angiographic findings based on the 15-segment model of ESC)
• PCI Procedure (Periprocedural medications-Additional diagnostic or theurapeutic devices-Complications)
• PCI Lesions (Lesion characteristics-PCI device-Result)
• Outcome (In-hospital outcome)
• Follow up (1 year/3 years/5 years)
• Submit (Automatic initial validation)
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User Obligations
• List of cases entered that corresponds to the unique system ID (case is entered with initials only for patient confidentiality)
• Communication Information
• Watch for color coding
• F/U submission
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Case submitted…
• National Administrator confirms valid submission or rejects the entry and explains the reason via e-mail
• Case is permanent
• No edit of entered data can be performed
• The only open table is the F/U form
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Local Administrators
• Enter cases as regular Users
• Complete the form with Center Data for the previous year
• Contact Person for Center issues
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National Administrators
• New Users entry• New Centers entry• Validation process• National Administrators do not have any
authority to change or edit any data individual Users enter
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Recording Tips and Caution
• Patient history (Prior CAD, CHF, CRI) – under reporting• Medications on admission (Aspirin, antiplatelets) – over
reporting• Timelines
– STD: (0-3-6 hrs in STEMI) and (0-24-48 in NSTEMI)
– DTB: Please record as much as possible accurate STEMI times due to small numbers / The majority of EU and USA centers have a DTB time >90 min
• In hospital events – Be accurate• Explanation question boxes: Take a look!
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Centers/Operators/CABG on site - 2007
Athens Metro Arean=25
1 2 9 O pe ra to rs1 2 w ith C A B G on s ite
Thessaloniki Metro Arean=8
5 7 O p e ra to rs7 w ith C A B G on s ite
Rest of Greecen=7
2 2 O p e ra to rs5 w ith C A B G on s ite
PCI Centersn=40
2 0 8 O pe ra to rs2 4 w ith C A B G on s ite
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PCI Centers - 2007
40
25
8 7
1814
3 1
138
41
9
3 15
05
1015202530354045
Total AthensMetro
Thess/nikiMetro
Rest ofGreece
HospitalsGovernmentPrivateUniversity
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COR/PCI Procedures - 2007
56529
30216
17496
8817
19311
99886929
2394
0
10000
20000
30000
40000
50000
60000
Total Athens Metro Thess/nikiMetro
Rest ofGreece
CORPCI
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COR/PCI Procedures - 2007
53%
31%
16%
Athens Metro
Thess/niki Metro
Rest of Greece
52%
36%
12%
Coronary Angiograms Percutaneous Coronary Interventions
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COR & PCI Procedures / 106 population - 2007
8300
2485
5346
1599
5383
1839
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
COR PCI
USAEuropeGreece
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PCI Centers & Primary PCI - 2007
C A B G o n s iten =9
N o C A B G on s iten =2
O n ca ll - 2 4 /7n = 11
C A B G o n s iten = 14
N o C A B G on s iten =8
W o rk ing H o u rsn = 22
P rim a ry P C I*n = 33
C A B G o n s iten =1
N o C A B G on s iten =6
N o P rim a ry P C I*n =7
P C I C e n te rsn = 40
*Technical ability to perform primary PCI
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Primary PCI numbers* - 2007
850
1087
159249
13
155
1491
1022
0
200
400
600
800
1000
1200
1400
1600
Actual (27 Centers) Projected (33 centers)
GreeceAthens MetroThess/niki MetroRest of Greece
* Data from 27 Centers (6 Centers with data missing )
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Volume of Primary PCI in Centers with and without CABG on site - 2007
19311
14212
5099
02000400060008000
100001200014000160001800020000
All Hospitals(n=33)
CABG on site(n=23)
Without CΑBGon site (n=10)
Total PCIPrimary PCI
7,7% 69% 31%
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Volume of Primary PCI per Center - 2007
5
13
12
3
<10/year10-30/year31-100/year>100/year
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ESC PCI Registry (>28,000 pts) – Greece vs Europe (Δεδομένα έως 26/11/2008)
Greece (%) Europe (%) OR
Males 85.00 73.69 0.49*
Smokers 43.14 26.06 0.46*
Prior MI 20.92 35.90 2.12*
Prior CHF 1.05 14.37 >5*
STEMI 22.72 22.78 NS
Primary PCI 3.83 15.93 >5*
Resc/Fac PCI 2.64 1.50 0.4*
CS 0.54 1.60 NA
STEMI STD (hrs) 2.00 2.92 NE
STEMI DTB (hrs) 1.58 0.92 NE
*p<0.05 for OR
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ESC PCI Registry (>28,000 pts) – Greece vs Europe (Δεδομένα έως 26/11/2008)
Greece (%) Europe (%) OR
NSTEMI STD 2.75 7.50 NE
NSTEMI DTB 76.00 30.15 NE
Femoral Vascular access 99.34 78.17 0.02*
DES Implantation 32.10 37.95 NS
Stent length (11-20 mm) 64.21 56.02 0.71*
Stent length>20 mm 26.58 35.21 1.50*
Stent thrombosis 1.05 0.59 NS
*p<0.05 for OR
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Benefits of HHR PCI Registry• Physicians may record their own patients
electronically
• Hospitals may establish their own database
• National status on PCI based on HSC
• Policy making for professional and educational reasons
• Direct participation and strengthening of Greek participation into the ESC/EAPCI
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Difficulties & Problems
• Motivation of physicians (multifactorial)• Politics• Clear understanding of the role and the benefits of
the registry with broad participation in analyses• Establish a structure especially in high-volume
centers for secretarial help• Loss of enthusiasm of existing users if a wide
participation can not be achieved
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Hellenic Heart Registry on Percutaneous Coronary
Interventions
• Link: http://registry.hellenicpci.gr/
• Επικοινωνία:• [email protected]
Thank you for your participation!