hellenic pci registry (2008-201 1 )
DESCRIPTION
Hellenic PCI Registry (2008-201 1 ) Περιεχόμενο και αναγκαιότητα διατήρησης Registry Αγγειοπλαστικής http://registry.hellenicpci.gr/. Georgios I. Papaioannou, MD , MPH , FACC, FSCAI Athens Medical Center Cardiac Catheterization Laboratory 1 8 /2/201 2. - PowerPoint PPT PresentationTRANSCRIPT
ΕΚΕ 2012 1
Hellenic PCI Registry (2008-2011)
Περιεχόμενο και αναγκαιότητα διατήρησης Registry
Αγγειοπλαστικής
http://registry.hellenicpci.gr/
Georgios I. Papaioannou, MD, MPH, FACC, FSCAI
Athens Medical Center
Cardiac Catheterization Laboratory
18/2/2012
ΕΚΕ 2012 2
Aim of the Hellenic PCI Registry (2008-2011)
• 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
ΕΚΕ 2012 4
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)
• 2/2011: 3 year completion – Analyses of more than 4000 entries (National/Hospital/User level)
ΕΚΕ 2012 5
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)
ΕΚΕ 2012 6
PCI Centers: 2011
49
31
8 10
2116
3 2
19
12
4 39
3 15
0
10
20
30
40
50
60
Total AthensMetro
Thess/nikiMetro
Rest ofGreece
HospitalsGovernmentPrivateUniversity
ΕΚΕ 2012 7
COR Procedures 2007-2010
56529
30216
17496
8817
52028
26493
16428
9107
52994
28330
14535
10129
23666
121069148
44920
0
10000
20000
30000
40000
50000
60000
Total Athens Metro Thess/niki Metro Rest of Greece
2007200820092010
ΕΚΕ 2012 8
PCI Procedures 2007-2010
20111
10788
6929
2394
19566
10452
6429
2685
19974
10860
5776
3338
16508
8690
44883330
0
5000
10000
15000
20000
25000
Total Athens Metro Thess/nikiMetro
Rest of Greece
2007200820092010
ΕΚΕ 2012 9
PCI Volume per Center: 2007-2009
10
106
1422
7
8
13
<200/year
201-400/year401-600/year
>600/year
2007 2009
ΕΚΕ 2012 10
Primary PCI numbers: 2007-2011
2371
3733
10871267
15771721
3096
249 235 230 263 309155 221 249
387 328
2056
1723
1491
0
500
1000
1500
2000
2500
3000
3500
4000
2007 2008 2009 2010 2011*
GreeceAthens MetroThess/niki MetroRest of Greece
*2011: Estimated numbers
ΕΚΕ 2012 11
Hellenic PCI Registry (2/2008-10/2010)n=3441 validated patients: Demographics
Males 2859 (83.1%)
Females 582 (16.9%)
Age 64.1 ± 11.1
Height 169.8 ± 10.8
Weight 81.9 ± 14.9
BMI 27.9 ± 3.9
ΕΚΕ 2012 12
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Demographics
Hx Stable Angina 877 (25.5%)
Hx Prior MI 797 (23.2%)
Hx CVA 56 (1.6%)
Hx PVD 171 (4,9%)
Hx of CRF 83 (2.4%)
Hx Prior PCI 726 (21.1%)
Hx Prior CABG 225 (9.1%)
Current Smokers 1337 (38.9%)
Former Smokers 1079 (31.4%)
Current Diabetes 1029 (29.9%)
Oral Agents - IDDM 601 - 172 (17.5% - 4.9%)
Hypertension 2392 (69.5%)
Dyslipidemia 2311 (67.1%)
ΕΚΕ 2012 13
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: PCI Indication
Elective PCI* 1622 (47.1%)
ACS (UA/NSTEMI)
441 (12.8%)
STEMI 284 (8.3%)
ACS stabilized 622 (18.1%)
STEMI stabilized
458 (13.3%)
Other 14 (0.4%)
*Stable angina/documented ischemia
47%
31%
22%0%
Elective*
UA/NSTEMI
STEMI
Other
ΕΚΕ 2012 14
Hellenic PCI Registry (2/2008-10/2010)n=742 STEMI patients: Type of Therapy
Thrombolysis prior PCI 267 (35.9%)
Primary PCI 225 (30.3%)
Delayed PCI 517 (69.7%)
30%
70%
Primary PCI
Delayed PCI
ΕΚΕ 2012 15
Hellenic PCI Registry (2/2008-10/2010)n=225 STEMI Primary PCI Patients: Times
Mean symptom to door (min) 249
Mean door to balloon (min) 140
Door to balloon < 120 min 147 (65.3%)
Door to balloon < 90 min 130 (57.7%)
58%
42%
DTB<90 min
DTB>90 min
ΕΚΕ 2012 16
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Angio Data
EF >50% 2460 (71.5%)
30%EF50% 647 (18.7%)
EF<30% 84 (2.5%)
EF Unknown 250 (7.3%)
LM>50% 93 (2.7%)
1VD 1754 (51%)
2VD 1087 (31.6%)
3VD 598 (17.4%)
Cardiogenic Shock 18 (0.5%)
Treated LM 67 (1.2%)
Treated LAD* 2189 (39.6%)
Treated CX* 1440 (26.1%)
Treated RCA* 1825 (33.1%)
Treated by-pass graft 116 (2.1%)*Lesions
ΕΚΕ 2012 17
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: PCI Data
Femoral Access 3299 (95.9%)
Radial Access 109 (3.2%)
IVUS 74 (2.2%)
Pressure wire 67 (1.9%)
IABP 7 (0.2%)
Distal Protection 17 (0.5%)
Thrombectomy 150 (4.3%)
Vascular closure device 1135 (32.9%)
ΕΚΕ 2012 18
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients – 5521 Lesions: PCI Data
Type A lesion 637 (11.5%)
Type B lesion 3454 (62.6%)
Type C lesion 1430 (25.9%)
Restenosis - Bifuraction 197 - 799 (3.6% - 14.5%)
Direct stenting 876 (15.9%)
PCI with stent 5161 (93.5%)
Mean number stent(s) per patient 1.74
Mean number stent(s) per lesion 1.14
Mean stent size (mm) 3.08
Mean stent length (mm) 22.08
Multi-segment PCI 3517 (63.7%)
Successful PCI 5378 (97.4%)
BMS stenting* 1060 (19.2%)
DES stenting* 4097 (74.2%)
* Stent not specified: 362 (6.6%)
ΕΚΕ 2012 19
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Concurrent PCI Management
Clopidogrel prior PCI 2051 (59.6%)
--- 300 mg 1765 (51.3%)
--- 600 mg 286 (8.3%)
--- <6 hrs 626 (30.5%)
--- >6 hrs 1425 (59.5%)
Clopidogrel during PCI 1364 (39.6%)
--- 300 mg 857 (62.8%)
--- 600 mg 507 (37.2%)
GIIbIIIa inhibitors (upstream) 99 (2.9%)
GIIbIIIa inhibitors (procedural) 383 (11.1%)
ΕΚΕ 2012 20
Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Complications & OutcomesPeriprocedural complications 105 (3.1%)
Acute segment closure 21 (0.6%)
Side branch occlusion 28 (0.8%)
Distal embolization 12 (0.3%)
Coronary perforation 13 (0.4%)
No flow/slow flow 31 (0.9%)
In hospital death 18 (0.5%)*
Periprocedural MI 35 (1.0%)*
Periprocedural CVA 15 (0.4%)
MACE (Death/MI/CVA) 65 (1.9%)
Stent thrombosis 15 (0.4%)
Repeat PCI 16 (0.5%)
Emergency CABG 4 (0.1%)
Major bleed 21 (0.6%)
Renal failure 11(0.3%)
* 1.2% ESC PCI Registry for Death and MI
ΕΚΕ 2012 21
Hellenic PCI Registry (2009-2010)n=2191 validated patients: Outcomes*
Death 15 (0.7%)
Myocardial Infarction 22 (1.0%)
CVA 9 (0.4%)
MACE 44 (2.0%)
*Improved reporting of outcomes (mainly death) as Registry evolves – Pending non-validated entries in 2010 with outcomes
ΕΚΕ 2012 22
Registry General Issues
• National vs Regional
• “Selective” National
• “Selective” Regional
• Individual Hospital– Type of information / patients (?ACS only)– Amount of information– Obligation of filling
ΕΚΕ 2012 23
Financial Issues
M a in te na n ce o f s iteH o s tin g /D o m a in
W e b M a s te rP h ilip L e es
N a tio n a l A d m in istra to r(s)S e n io r &
V a lid a tio n & Q u a lity C o n tro l
S e c re ta ria l C o ve ra geC o m m u n ica tio n w ith H osp ita ls
P ro fe ss io n a ls(F u ll t im e )
P C I R E G IS T R YC o s ts
ΕΚΕ 2012 24
Registry Benefits
• Data on all patients having PCI
• Data on ACS – Stent-for-life initiative
• Type of care – Areas of improvement in ACS patients
• Number of operators – Hospitals with Cath Lab facilities – Regional differences
• Type of interventional procedures (expanding to non-coronary cases too)
ΕΚΕ 2012 25
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
ΕΚΕ 2012 26
2012 Proposal to WG• Continue keeping the existing structure of
the Database (web site – server) with full-time professional(s)
• Complete a 3 year recording (2/2011) (done already)
• Establish software for National/Center/User analysis of entries (in plan)
• Decision regarding a “Selective” National Registry with aim to cover representative patients/data across the whole country
ΕΚΕ 2012 27
Participating Hospitals (>20 entries)IKA Pedelis, Athens (1)*Univ Ioannina (2)*Univ Alexandroulopis (3)*Interbalcan ThessalonikiUniv PatrasGennimatas, AthensAthens Medical CenterEuromedica, ThessalonikiThriassio, AthensMetropolitan, AthensOnassio, AthensKyanoys Stavros, AthensNikaias, AthensIatriko Psyhiko, Athens
*Top 3 Hospitals
ΕΚΕ 2012 28
Participating Physicians (Alphabetic order >10 entries)
Achtypis, DionysisAlexopoulos, DemetriosArampatzis, Akis (3)Avramides, DimitriosDavlouros, PeriklisHahalis, GeorgiosKantzis, IoannisKapetanopoulos, AthanasiosKaranikolas, NikolaosKostopoulos, KonstantinosKotsanis, AthanasiosKoutsogiannis, NikolaosMaginas, AthanasiosMichalis, Lambros (1)
Olympios, ChristoforosPapaioannou, GeorgiosRaisakis, Kostis
Routoulas, Theodoros
Sassalos, CostantinosSionis, DimitriosSkalidis, ManolisSourgounis, AngelosStefanidis, IoannisStratigis, NikolaosTriantis, GeorgiosTsigas, GregoriosTsikaderis, DemetriosTziakas, Dimitris (2)
*Top 3 Physicians