Hellenic PCI Registry Organization - Structure - Directions - - - PowerPoint PPT Presentation

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Hellenic PCI Registry Organization - Structure - Directions - - - PowerPoint PPT Presentation

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Hellenic PCI Registry Organization - Structure - Directions - Initial Recordings http://registry.hellenicpci.gr/ Georgios I. Papaioannou, MD, MPH, FACC, FSCAI Athens Medical Center Cardiac Catheterization Laboratory 18/2/2010 1 WG 2010

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WG 2010

1

Hellenic PCI Registry

Organization - Structure - Directions - Initial Recordings http://registry.hellenicpci.gr/

Georgios I. Papaioannou, MD, MPH, FACC, FSCAI Athens Medical Center Cardiac Catheterization Laboratory 18/2/2010

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Aim of the Hellenic PCI Registry (2008-2010)

  • 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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WG 2010

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Registries & Clinical Practice

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WG 2010

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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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WG 2010

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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 (>2500 patients entered so far)

  • 2/2010:

2 year completion – Decision about further continuation with existing participation - Data analysis

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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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ESC 15 Segment Model

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Centers/Operators/CABG on site: 2007 & 2008

Athens Metro Area n=25 129 Operators 12 with CABG on site Thessaloniki Metro Area n=8 57 Operators 7 with CABG on site Rest of Greece n=7 22 Operators 5 with CABG on site PCI Centers-2007 n=40 208 Operators 24 with CABG on site

Athens Metro Area n=29 138 Operators 12 with CABG on site Thessaloniki Metro Area n=8 65 Operators 7 with CABG on site Rest of Greece n=10 24 Operators 6 with CABG on site PCI Centers-2008 n=47 227 Operators 25 with CABG on site

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New PCI Centers: 2008 & 2009

Athens Metro Area n=6 0 with CABG on site Thessaloniki Metro Area n=0 0 with CABG on site Rest of Greece n=3 1 with CABG on site New PCI Centers n=9 1 with CABG on site

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PCI Centers: 2009 Status

49 31 8 10 20 15 3 2 20 13 4 3 9 3 1 5 10 20 30 40 50 60 Total Athens Metro Thess/niki Metro Rest of Greece Hospitals Government Private University

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COR/PCI Procedures: 2007 & 2008

56529 30216 17496 8817 20111 10788 6929 2394

10000 20000 30000 40000 50000 60000 Total Athens Metro Thess/niki Metro Rest of Greece COR PCI

53531 28097 16302 9132 18931 9728 6779 2424

10000 20000 30000 40000 50000 60000 Total Athens Metro Thess/niki Metro Rest of Greece COR PCI

2007 2008

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COR Procedures: 2007 & 2008

53% 31% 16%

Athens Metro Thess/niki Metro Rest of Greece

53% 30% 17%

2007 2008

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PCI Procedures: 2007 & 2008

51% 36% 13%

Athens Metro Thess/niki Metro Rest of Greece

54% 34% 12%

2007 2008

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COR & PCI Procedures / 106 population: 2007 & 2008 (10,9 million)

8300 2485 5346 1599 5186 1845 4911 1737

1000 2000 3000 4000 5000 6000 7000 8000 9000 COR PCI USA Europe Greece 2007 Greece 2008

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PCI Volume per Center: 2007 & 2008

10 10 6 14

19 8 8 12

<200/year 201-400/year 401-600/year >600/year

2007 2008

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PCI Centers & Primary PCI - 2008

CABG on site n=13 No CABG on site n=7 On call - 24/7 n=20 CABG on site n=12 No CABG on site n=5 Working Hours n=17 Primary PCI* n=37 CABG on site n=0 No CABG on site n=10 No Primary PCI* n=10 PCI Centers n=47

*Technical ability to perform primary PCI

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Primary PCI numbers*: 2007

850 1087 159 249 13 155 1491 1022

200 400 600 800 1000 1200 1400 1600 Actual (27 Centers) Projected (33 centers) Greece Athens Metro Thess/niki Metro Rest of Greece * Data from 27 Centers (6 Centers with data missing )

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Primary PCI numbers: 2008

1363 236 219 1818

200 400 600 800 1000 1200 1400 1600 1800 2000 Projected (47 centers) Greece Athens Metro Thess/niki Metro Rest of Greece

9,6% 7,2% 1,25% 1,15%

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Volume of Primary PCI per Center

7 12 3 11

<10/year 11-36/year 37-50/year >50/year

16 16 3 12

2007 2008

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Demographics

Males 2221 (83.6%) Females 433 (16.4%) Age 64.1 ± 10.8 Height 169.9 ± 10.8 Weight 81.6 ± 14.6 BMI 28.6 ± 1.2

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Demographics

Hx Stable Angina 734 (27.6%) Hx Prior MI 660 (24.9%) Hx CVA 51 (1.9%) Hx PVD 132 (5%) Hx of CRF 66 (2.5%) Hx Prior PCI 543 (20.5%) Hx Prior CABG 225 (8.5%) Current Smokers 1007 (37.9%) Former Smokers 828 (31.2%) Current Diabetes 781 (29.4%) Hypertension 1792 (67.5%) Dyslipidemia 1767 (66.5%)

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Indication

Elective PCI* 1261 (47.5%) ACS (UA/NSTEMI) 313 (11.8%) STEMI 248 (9.3%) ACS stabilized 426 (16.1%) STEMI stabilized 334 (12.6%) Other 72 (2.7%)

*Stable angina/documented ischemia

47% 28% 22% 3%

Elective UA/NSTEMI STEMI Other

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Hellenic PCI Registry (2/2008-10/2009) n=582 STEMI patients: Type of Therapy

Thrombolytic Rx 186 (31.9%) Primary PCI 248 (43%) Post STEMI PCI 334 (57%)

43% 57%

Primary PCI Delayed PCI

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Angio Data

EF >50% 1866 (70.4%) 30%EF50% 457 (17.2%) EF<30% 110 (4.1%) EF Unknown 221 (8.3%) LM>50% 73 (2.7%) 1VD 1354 (51%) 2VD 838 (31.6%) 3VD 462 (17.4%) Treated LM 9 (0.3%) Treated LAD 1357 (51.1%) Treated CX 847 (31.9%) Treated RCA 1055 (39.8%) Treated by-pass graft 58 (2.2%)

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Data

Femoral Access 2436 (91.8%) Radial Access 110 (4.2%) IVUS 59 (2.2%) Pressure wire 38 (1.4%) IABP 7 (0.2%) Distal Protection 12 (0.4%) Thrombectomy 112 (4.2%)

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Data

Type A lesion 14% Type B lesion 63% Type C lesion 27% Mean No stents per lesion 1.2 Mean stent size (mm) 2.8 Mean stent length (mm) 17.4 BMS stenting 40.7% DES stenting 59.3% Clopidogrel 300 mg 1994 (75%) Clopidogrel 600 mg 597 (22.5%) GP IIbIIIa inhibitors 355 (13.4%)

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Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Complications & Outcomes

Periprocedural complications 85 (3.2%) Acute segment closure 19 (0.7%) Side branch occlusion 25 (0.9%) Distal embolization 13 (0.5%) No flow/slow flow 26 (1%) In hospital death 6 (0.2%)* Periprocedural MI 18 (0.7%)* Periprocedural CVA 7 (0.3%) Stent thrombosis 9 (0.3%) Repeat PCI 16 (0.6%) Emergency CABG 7 (0.3%) Major bleed 15 (0.6%) Renal failure 7 (0.3%)

* 1.2% ESC PCI Registry

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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

  • Minimal increase in participation in year 2008
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2010 Proposal to WG

  • Continue keeping the existing structure of

the Database (web site – server)

  • Complete a 2 year recording (2/2010)
  • Perform analyses of the data and f/u
  • Discussion in the WG regarding ways to

expand participation for further continuation

  • f the Database
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EAPCI Data

  • ESC effort to collect “minimal”

basic interventional data – effort to record practices and patterns across Europe (obligatory)

  • Started in 2006 –

Data submitted for 2007 & 2008

  • 2009 data should be collected in a more precise

pattern retrospectively

  • Monthly forms created for 2010 (prospective

collection)

  • We should all participate!
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Coronary

Please insert 0, if a procedure is not performed in your country, please c

Number Not available Coronary angiography: cases

53531

PCI: cases

18931

  • multivessel PCI (in 1 session!)

6125

  • PCI of unprotected LM

NA

  • PCI for ongoing infarction

1533

  • PCI during diagnostic study (ad hoc)

17998

  • radial/brachial approach

379

  • puncture site closing device

NA

PCI: complications

NA

  • infarction after PCI (by any definition)

NA

  • emergency CABG after PCI

NA

  • in-hospital death after PCI

NA

Stent: cases

18135

  • multiple stents

NA

  • drug-eluting stents

12948

Directional atherectomy

NA

Rotablator

NA

Laser catheter/wire

NA

Brachytherapy

NA

Clot catcher/ clot remover

NA

Intracoronary pressure registration

284

Intracoronary doppler

NA

Intracoronary ultrasound

965

Intracoronary OCT

NA

Intra-aortic balloon pump during PCI

267

Percutaneous left ventricular assist pump Other devices GP IIb/IIIa antagonist

3325

Ionic low-osmolar contrast medium

NA

Nonionic contrast medium

NA

Iliac or leg artery intervention

NA

Renal artery intervention

NA

Carotid artery intervention

NA

Other

Alcohol ablation for septal hypertrophy

NA

Mitral valvuloplasty (interventional)

NA

Aortic valvuloplasty (interventional)

NA

Pulmonary valvuloplasty (interventional)

NA

Percutaneous Mitral Valve Repair

NA

Transcatheter Aortic Valve Replacement

NA

Transcatheter Pulmonary Valve Replacement

NA

PDA closure by catheter

NA

PFO closure by catheter

80

ASD closure by catheter

165

VSD closure by catheter

NA

Coarctation angioplasty

NA

Left atrial appendage closure

NA

2008 Country Summary

Not available Country

Greece

Population (in Mio)

10.9

Representative/Delegate: name

Georgios I. Papaioannou, MD, MPH

Representative/Delegate: institution

Athens Medical Center

Representative/Delegate: phone

2106106715

Representative/Delegate: fax

2106862270

Representative/Delegate: e-mail

gpapaio@otenet.gr

Catheterization centers (number)

47

  • diagnostic only:
  • diagnostic and interventional:

47

  • cath rooms:

71

  • cath operators:

238

PCI operators:

205

PCI centers with cardiac surgery:

25

PCI centers with cardiac database:

5

Regional/National database:

Y

EAPCI Form

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WG 2010

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Hellenic Heart Registry on Percutaneous Coronary Interventions

  • Link:

http://registry.hellenicpci.gr/

  • Επικοινωνία:
  • admin@hellenicpci.gr
  • gpapaio@otenet.gr
  • athanasios_kotsanis@hotmail.com
  • ananou@cc.uoi.gr

Thank you for your participation!