Österr.kardiol.gesellschaft 1990–2009 arbeitsgruppe intervent. kardiologie monitor (auditor)...

Österr.Kardiol.Gesellschaft 1990–2009 Österr.Kardiol.Gesellschaft 1990–2009 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie

Monitor (Auditor) Report: 2008/2009

Contact and References:Contact and References:

http://iik.i-med.ac.at (L.Kaltenbach, KP http://iik.i-med.ac.at (L.Kaltenbach, KP Pfeiffer)Pfeiffer)

www.kardiologie.insel.ch/2164.html (B www.kardiologie.insel.ch/2164.html (B Meier - St Cook – MT Maeder)Meier - St Cook – MT Maeder)

CARDS; EU Heart J. 2005;26: 308-313 CARDS; EU Heart J. 2005;26: 308-313 (ESC-WG 10; F.Weidinger)(ESC-WG 10; F.Weidinger)

www.herzbericht.de (E.Bruckenberger)www.herzbericht.de (E.Bruckenberger)

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PCI- CENTERS 2009 +/- PCI- CENTERS 2009

4 Pediatric 4 Pediatric 37 Adult 37 Adult ((11 11 in Vienna)in Vienna)

Rooms (n=49)Rooms (n=49) http://iik.i-med.ac.at 2008: Waidhofen,Braunau, SMZ-Süd2008: Waidhofen,Braunau, SMZ-Süd

Volker Mühlberger, QualityVolker Mühlberger, Quality

Wunschliste 2010Wunschliste 2010

AKHAKH Lainz/HietzingLainz/Hietzing HanuschHanusch JosefstadtJosefstadt InnsbruckInnsbruck Wr. NeustadtWr. Neustadt Wiener PrivatklinikWiener Privatklinik

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIA 2007/2008AUSTRIA 2007/2008

� Angiography 52.260 51.292Angiography 52.260 51.292

� PTCA=PCI 19.342 19.727PTCA=PCI 19.342 19.727

� -stent-stent 90% 90% 88% 88%

� - - DES- - DES 64% 64% 67% 67%

� OP-CAD(Unger) 3.316 OP-CAD(Unger) 3.316 � OP-CAD (Bruckenberger)OP-CAD (Bruckenberger) 4.281 4.281

� OP- valve 2.691 OP- valve 2.691 � OP- valve (Bruckenberger)OP- valve (Bruckenberger) 2.1062.106

Volker Mühlberger, QualityVolker Mühlberger, Quality

Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants 1992-2008 per One Million Inhabitants 1992-2008

0

2000

4000

6000

8000

10000

12000

1992 1995 1998 2001 2004 2007

AU 8.12/8.3CH 7.4D 82.2/81.9CZ 10.0NO 4.8Mio EW

Volker Mühlberger, QualityVolker Mühlberger, Quality

NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR LOW CASE LOAD FOR CACA DURING 2000/08 DURING 2000/08

0

2

4

6

8

10

12

14

16

<400 CA peryear and

center

400-1000 1000-2000 >2000 CA

AU 2000AU 2001AU 2002AU 2003AU 2004CH 2004AU 2005AU 2006CH 2006AU 2007AU 2008

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI Frequency per One Million Inhabitants PCI Frequency per One Million Inhabitants ((AUAU//CHCH//D/D/CZCZ//NONO//USAUSA) 1992-2008) 1992-2008

0

500

1000

1500

2000

2500

3000

3500

4000

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

D

CZ

NO

USA

Volker Mühlberger, QualityVolker Mühlberger, Quality

NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR LOW CASE LOAD FOR PCIPCI DURING 2000/08 DURING 2000/08

0

5

10

15

20

25

<200 PCI per yearand center

200-400 >400 PCI

AU 2000AU 2001AU 2002AU 2003AU 2004CH 2004AU 2005AU 2006CH 2006AU 2007AU 2008

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI Frequency in Austria 2006-2008 PCI Frequency in Austria 2006-2008 according according to acute or non-acute Indicationsto acute or non-acute Indications

14254

5009

19263

13328

6014

19342

13041

6686

19727

02000

40006000

800010000

1200014000

1600018000

20000

2006 2007 2008

NICHT AKUT

AKUT PCI

PCI GESAMT

Volker Mühlberger, QualityVolker Mühlberger, Quality

Case load per physicianCase load per physicianPCIPCI CACA

0

50

100

150

200

250

1998PC I

1999PC I

2000PC I

2001PC I

2002PC I

2003PC I

2004PC I

2005PC I

2006PC I

2007PC I

2008PC I

0 1998C A

1999C A

2000C A

2001C A

2002C A

2003C A

2004C A

2005C A

2006C A

2007C A

2008C A

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

% PCI/ CA 1992-2008 % PCI/ CA 1992-2008 ((AUAU//CHCH//DD))

0

510

1520

2530

3540

4550

1992 1994 1996 1998 2000 2002 2004 2006 2008

A

CH

D

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI during Diagnostic Angio PCI during Diagnostic Angio (%)(%) in in AustriaAustria//SwitzerlandSwitzerland//EUEU

0

10

20

30

40

50

60

70

80

90

100

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

EU

Volker Mühlberger, QualityVolker Mühlberger, Quality

%-multivessel PCI %-multivessel PCI AustriaAustria//EU/EU/CHCH

0

2

4

6

8

10

12

14

16

18

20

2002 2003 2004 2005 2006 2007 2008

AUSTRIAEUCH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of (CABG-OP+PCI) Ratio of (CABG-OP+PCI) per Angiography in per Angiography in AUAU CHCH DD

0

10

20

30

40

50

60

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

D

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI Hospital-Mortality (%) in PCI Hospital-Mortality (%) in AustriaAustria, , SwitzerlandSwitzerland,,GermanyGermany, , EUEU

0

0,5

1

1,5

2

2,5

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

D

EU

Volker Mühlberger, QualityVolker Mühlberger, Quality

Elective (non-acute)Elective (non-acute) and and OverallOverall – – PCI-Hospital-Mortality (%) in AustriaPCI-Hospital-Mortality (%) in Austria

0

0,2

0,4

0,6

0,8

1

1,2

1992 1994 1996 1998 2000 2002 2004 2006 2008

Overall

Elective

Volker Mühlberger, QualityVolker Mühlberger, Quality

Non-acuteNon-acute and and Overall Overall - - PCI PCI Hospital-Mortality (%) in AustriaHospital-Mortality (%) in Austria

0

0,2

0,4

0,6

0,8

1

1,2

1992 1994 1996 1998 2000 2002 2004 2006 2008

Non-acute

Rest%

Overall

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of STENTING per PCI Ratio of STENTING per PCI (%) in (%) in AUAU//CHCH//D/D/CZCZ

0

10

20

30

40

50

60

70

80

90

100

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

D

CZ

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of emergency CABG due to Ratio of emergency CABG due to PCI (%): PCI (%): AustriaAustria//SwitzerlandSwitzerland//EUEU

0

0,2

0,4

0,6

0,8

1

1,2

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

EU

Volker Mühlberger, QualityVolker Mühlberger, Quality

EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI (%): MORTALITY in AustriaPCI (%): MORTALITY in Austria

3,38,3

18,2

28,6

8,3

15,4 16

25

32

12 10,5

18,2

13,6

23,1

36,4

46,7

0

5

10

15

20

25

30

35

40

45

50

1992 1994 1996 1998 2000 2002 2004 2006 2008

Volker Mühlberger, QualityVolker Mühlberger, Quality

Infarction as Complication (%) after Infarction as Complication (%) after PCI in PCI in AustriaAustria, , CHCH, , DD, , EUEU

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

2

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

D

EU

Volker Mühlberger, QualityVolker Mühlberger, Quality

STEMI PCI / acute PCI % STEMI PCI / acute PCI % Austria 2007 - all Centers Austria 2007 - all Centers

0,0

20,0

40,0

60,0

80,0

100,0

120,0

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

28 meldende Zentren (NR 12=Mittelwert)

PC

I STE

MI/P

CI a

kut %

Volker Mühlberger, QualityVolker Mühlberger, Quality

STEMI PCISTEMI PCI / / acute PCIacute PCI/ / STEMI %STEMI % Austria 2007 / 2008 (n=) Austria 2007 / 2008 (n=)

0

1000

2000

3000

4000

5000

6000

7000

2007 2008

STEMI"acute"STEMI % x10

Volker Mühlberger, QualityVolker Mühlberger, Quality

acuteacute PCI (% of total PCI) in PCI (% of total PCI) in Austria,Austria, Switzerland,Switzerland, EUEU

0

5

10

15

20

25

30

35

1992 1994 1996 1998 2000 2002 2004 2006 2008

AU

CH

EU

CZ

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI (n) for acute & subacute PCI (n) for acute & subacute Myocardial Infarction in AustriaMyocardial Infarction in Austria

0

1000

2000

3000

4000

5000

6000

7000

1998 2000 2002 2004 2006 2008

PCI MIwithshock

PCI MIwithoutshock

Volker Mühlberger, QualityVolker Mühlberger, Quality

MORTALITY (%) after PCI for acute & MORTALITY (%) after PCI for acute & subacute Myocardial Infarction in Austriasubacute Myocardial Infarction in Austria

27

2,5

31

2,8

35

2,6

30

2,1

17

2

17,2

2,2

21,8

1,6

22,8

1,5

25,3

1,2

32,4

1,2

29,17

1,01

0

5

10

15

20

25

30

35

1998 2000 2002 2004 2006 2008

PCI forMI+Shock

PCI for MIwithoutShock

Volker Mühlberger, QualityVolker Mühlberger, Quality

% GP IIb/IIIa for PCI (% GP IIb/IIIa for PCI (AUAU//CHCH) ) % ThrombinInhibitor (TI in AU)% ThrombinInhibitor (TI in AU)

0

5

10

15

20

25

1996 1998 2000 2002 2004 2006 2008

AU

CH

AU-TI

Volker Mühlberger, QualityVolker Mühlberger, Quality

DRUG ELUTING STENTSDRUG ELUTING STENTS (DES) in (DES) in AU,AU,CH,CH,D,D,EUEU (% of stents) (% of stents)

0

10

20

30

40

50

60

70

80

90

2001 2002 2003 2004 2005 2006 2007 2008

Austria

CH

D

EU

Volker Mühlberger, QualityVolker Mühlberger, Quality

DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n)in Austria (n)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2002 2003 2004 2005 2006 2007 2008

Paclitaxel

Sirolimus

Zotarolimus

others/n.a.

Tacrolimus

Everolimus

Volker Mühlberger, QualityVolker Mühlberger, Quality

DRUG ELUTING STENTS DRUG ELUTING STENTS (DES)(DES) versus versus REDOREDO in Austria (%) in Austria (%)

0

10

20

30

40

50

60

70

2002 2003 2004 2005 2006 2007 2008

DES % REDO % (reporting Centers only)

Volker Mühlberger, QualityVolker Mühlberger, Quality

STENT REDO STENT REDO (Thrombus) (Thrombus) versus versus (chronic (chronic Restenosis) Restenosis) in Austria (n=) 2007/2008 in Austria (n=) 2007/2008

0

100

200

300400

500

600700

800

9001000

2007 2008

Thrombus

Restenose

Thrombus % x10

Volker Mühlberger, QualityVolker Mühlberger, Quality

Puncture site closing devices Puncture site closing devices (% of PCI in (% of PCI in AUAU//CHCH))

0

10

20

30

40

50

60

70

80

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Brachial and Radial Approach Brachial and Radial Approach (% of PCI in (% of PCI in AUAU//CHCH))

0

1

2

3

4

5

6

7

8

9

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

AUCH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Brachial/Radial Approach (n=) Brachial/Radial Approach (n=) 37 Centers Austria 2008 37 Centers Austria 2008

0

100

200

300

400

500

600

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

Volker Mühlberger, QualityVolker Mühlberger, Quality

OLD and NEW DEVICES, AustriaOLD and NEW DEVICES, Austria

LASER

IVUS

STENT

0

5000

10000

15000

20000 LASER

DCA

ROTABL

IVUS

IIb/IIIa

DES

STENT

Volker Mühlberger, QualityVolker Mühlberger, Quality

Transcatheter aortic valve implantationTranscatheter aortic valve implantation (TAVI; n=) in Austria 2007-2008(TAVI; n=) in Austria 2007-2008

0

20

40

60

80

100

120

140

160

2005 2006 2007 2008

Balloon only

Transapical Valve

Transfemoral Valve

TAVI

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ablation / Electrophysiology and Device Ablation / Electrophysiology and Device Implantation in CathLabs (Austria)Implantation in CathLabs (Austria)

0

500

1000

1500

2000

2500

3000

2003 2004 2005 2006 2007 2008

Ablation Diagnostics

A/D % x10 Implantation

Volker Mühlberger, QualityVolker Mühlberger, Quality

NEW DEVICES NEW DEVICES Austria 2002 – 2008 („winner“)Austria 2002 – 2008 („winner“)

Gerinnselentferner 148/173/213/380/580/Gerinnselentferner 148/173/213/380/580/950/1065950/1065 NOGA MappingNOGA Mapping 16/26/26/21/ 16/26/26/21/65/6865/68 Alkoholablation = PTSMA 4/4/6/15/11/Alkoholablation = PTSMA 4/4/6/15/11/16/1316/13 Defektverschlüsse 162/243/269/Defektverschlüsse 162/243/269/332332/214/202/296/214/202/296 Thrombininjektion bei lokaler Gefäßkomplikation -/ Thrombininjektion bei lokaler Gefäßkomplikation -/

88/143/88/143/115115/77/96/77/96 Optical coherence tomography (OTC) -/-/-/-/ -/-/-/-/ 60/11360/113 perkutaner Aortenklappenersatz –/-/-/-/perkutaner Aortenklappenersatz –/-/-/-/30/14430/144

Volker Mühlberger, QualityVolker Mühlberger, Quality

NEW DEVICES NEW DEVICES Austria 2002 – 2008 („loser“)Austria 2002 – 2008 („loser“)

Brachytherapie 163/101/28/3/0/0/0Brachytherapie 163/101/28/3/0/0/0 Ultraschalltherapie 1/0/0/0/0/0/0Ultraschalltherapie 1/0/0/0/0/0/0 Transmyokardialer Laser 16/0/13/0/0/0/0Transmyokardialer Laser 16/0/13/0/0/0/0 Spinal Cord Stimulation 4/0/0/0/0/0/0Spinal Cord Stimulation 4/0/0/0/0/0/0 Herzohrverschluss linksHerzohrverschluss links 7/4/13/0/0/0 7/4/13/0/0/0 Stammzelltherapie -Katheter 21/16/23/12/Stammzelltherapie -Katheter 21/16/23/12/40/340/3

Volker Mühlberger, QualityVolker Mühlberger, Quality

„„NEW DEVICES“ III NEW DEVICES“ III Austria 2003 – 2008Austria 2003 – 2008

PCI wg. instent-Restenose PCI wg. instent-Restenose 737/921/905/1359/1003/1324737/921/905/1359/1003/1324

- wegen akuter Stentthrombose -/-/-/-/ 85/130- wegen akuter Stentthrombose -/-/-/-/ 85/130 - wegen STEMI -/-/-/-/ 3342/3677 - wegen STEMI -/-/-/-/ 3342/3677 DES 620/2938/6430/11209/DES 620/2938/6430/11209/1203712037/ /

11217/1157911217/11579 stereotaktische Drahtnavigationstereotaktische Drahtnavigation -/-/-/-/-/33 AKH-/-/-/-/-/33 AKH