Österr.kardiol.gesellschaft 1990–2011 arbeitsgruppe intervent. kardiologie
Post on 15-Mar-2016
25 Views
Preview:
DESCRIPTION
TRANSCRIPT
Österr.Kardiol.Gesellschaft 1990–2011 Arbeitsgruppe Intervent. Kardiologie
Monitor (Auditor) Report: 2011
Contact and References:
http://iik.i-med.ac.at L.Kaltenbach, H. Ulmer, C.Kobel
www.kardiologie.insel.ch/2164.html MT Maeder -B Meier - St Cook
ESC-WG 10; F.Weidinger- Subregister Roland Schistek; Georg Normann www.herzbericht.de E.Bruckenberger
Volker Mühlberger, Quality
AUSTRIAN ANGIOGRAPHY +/- PCI- CENTERS 2011
4 Pediatric 37 Adult (11 in Vienna)
Rooms (n=50) http://iik.i-med.ac.at 2010: Großgmain (-) ; Ried (?)
Volker Mühlberger, Quality
Wunschliste AUDIT 2012
AKH Graz Uniklinik Innsbruck Privatklinik Josefstadt Wiener Privatklinik Ried i.I.
Volker Mühlberger, Quality
AUSTRIA 2009 / 2010
�Angiography 52.149 55.138�PTCA=PCI 19.856 20.294�-stent 89% 92%�- - DES 69% 75%� OP-CAD (Bruckenberger : 2008=4.248) Schistek 2.737
� OP- valve (Bruckenberger: 2008=2.280) Schistek 2.583
Volker Mühlberger, Quality
Coronary Angiography Frequency per Million Inhabitants 1992-2010
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
0
2000
4000
6000
8000
10000
12000
AU 8.12-8.38CH 7.4D 82.2-81.8CZ 10.0-10.5SL 5.5
More Centres, more Tables, but not more Angios in Austria 2005-2009?
2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
Angiocenterstables
Volker Mühlberger, Quantity 2009 to 2010?
Volker Mühlberger, Quality
NUMBER OF CENTERS WITH <400 CA /year vs. <200 PCI/year vs. Number of CA/y(*t) 2000-10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
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
Volker Mühlberger, Quality Silber 2005 / DiMario 2006;
ESC
NUMBER OF CENTERS WITH > 36 STEMI- PCI / year vs. Number of tables 2003-2010
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
centers
tables
>36 STEMI-PCI/y+c
Volker Mühlberger, Quality
PCI Frequency per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2010
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
500
1000
1500
2000
2500
3000
3500
4000
4500
USA
SL
AUCHDCZ
Volker Mühlberger, Quality
PCI Frequency in Austria 2006-2010 according to acute or non-acute Indications
2006 2007 2008 2009 20100
5000
10000
15000
20000
25000
5009 6014 6686 6783 6466
14254 13328 13041 13073 13828
19263 19342 19727 19856 20294
NICHT AKUTAKUT PCI
Volker Mühlberger, Quality
Case load per physicianPCI / CA (AU / CH)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
50
100
150
200
250
PCI - AU
PCI - CH
CA - AU
CA - CH
Volker Mühlberger, Quality
% PCI/ CA 1992-2010 (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
0
5
10
15
20
25
30
35
40
45
50
AUCHDCZ
Volker Mühlberger, Quality
Ratio of: CABG-OP+PCI / per Angiography in AU CH D
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
10
20
30
40
50
60
AUCHD
Volker Mühlberger, Quality
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
0
10
20
30
40
50
60
70
80
90
100
AUCHEU
Volker Mühlberger, Quality
%-multivessel PCI Austria / EU / CH
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
5
10
15
20
25
AUCHEU
Volker Mühlberger, Quality
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
0
0.5
1
1.5
2
2.5
AUCHDEU
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (non-acute PCI) *ref.= only
1997
*19
98*
1999
*20
00*
2001
*20
0220
0320
0420
0520
0620
0720
0820
0920
10
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
non-acute PCI
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (acute / non-acute PCI) ref.=overall-mortality
1997
*19
98*
1999
*20
00*
2001
*20
0220
0320
0420
0520
0620
0720
0820
0920
10
0.00
0.20
0.40
0.60
0.80
1.00
1.20
acute PCInon-acute PCI
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (acute =without /with shock PCI) ref.=overall-mortality
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
1
2
3
4
5
6
7
8
9
PCI for MI with ShockPCI for MI without Shock
Volker Mühlberger, Quality
PCI -Mortality (%) in Austria (non-acute / without /with shock PCI) ref.=overall-mortality
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
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
Volker Mühlberger, Quality
Number of PCI (n) for Myocardial Infarction in AU, CH
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
1000
2000
3000
4000
5000
6000
7000
PCI MI with shock
PCI MI without shock
CH with shock
Volker Mühlberger, Quality
STEMI PCI / acute PCI/ STEMI % (n=) Austria 2007 / 2008 / 2009 / 2010
2007 2008 2009 20100
1000
2000
3000
4000
5000
6000
7000
3440 3354
51% 52%
STEMI"acute"STEMI % x10
Volker Mühlberger, Quality
ACUTE PCI (% of total PCI) in AU, CZ, EU, CH (=STEMI only)
1991
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
AUCHEUCZ
Volker Mühlberger, Quality
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
0
0.2
0.4
0.6
0.8
1
1.2
1.4
AUCHEU
Volker Mühlberger, Quality
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
05
101520253035404550
03.3
8.3
18.2
28.6
8.3
15.4 16
25
32
12 10.5
18.213.6
23.1
36.4
46.7
36.4
26.1
Volker Mühlberger, Quality
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
0
10
20
30
40
50
60
70
80
90
100
AUCHDCZ
Volker Mühlberger, Quality
% GP IIb/IIIa for PCI (AU/CH) % ThrombinInhibitor (TI in AU)
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
5
10
15
20
25
30
AUCHAU-TI
Volker Mühlberger, Quality
Infarction as Complication (%) after PCI in Austria, CH, D, EU
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
AUCHDEU
Volker Mühlberger, Quality
DRUG ELUTING STENTS (DES) in AU,CH,D,EU-CZ (% of stents)
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
10
20
30
40
50
60
70
80
90
EU EU
CZAUCHDEU
Volker Mühlberger, Quality
DRUG ELUTING STENTS (DES) in Austria (n) 2002 – 2010
2002 2003 2004 2005 2006 2007 2008 2009 20100
500100015002000250030003500400045005000 Paclitaxel
SirolimusZotarolimusothers/n.a.TacrolimusEverolimus
Volker Mühlberger, Quality
DRUG ELUTING STENTS (DES/PCI) versus REDO/PCI in Austria (%)
2002 2003 2004 2005 2006 2007 2008 2009 20100
1020304050607080
7.2 6.7 4,6
DES % REDO % (reporting Centers only)
Volker Mühlberger, Quality
STENT REDO: Thrombus (n/%) versus chronic Restenosis (n) in Austria
2007 2008 2009 20100
100200300400500600700800900
1000
8,5%15,2%
Thrombus Restenose Thrombus x10% reporting centres
Volker Mühlberger, Quality
Puncture site closing devices (% of PCI in AU/CH)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
10
20
30
40
50
60
70
80
AUCH
Volker Mühlberger, Quality
Brachial/Radial Approach (n=) 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, Quality
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
0
5
10
15
20
25
30
35
AU
CH
french CH
german CH
Volker Mühlberger, Quality
Ablation (n) / Electrophysiology (n; %) and Implantations in Austrian CathLabs
2003 2004 2005 2006 2007 2008 2009 20100
500
1000
1500
2000
2500
3000
88%76%
90%
Ablation DiagnosticsA/D % x10 Implantation
Volker Mühlberger, Quality
NEW DEVICES I, Austria 2002-201020
02
2003
2004
2005
2006
2007
2008
2009
2010
0
500
1000
1500
2000
2500
3000
PTSMAREnalDenervNOGA mappingThrombin lokalOCTDefektverschl.DE Balloonclot catcher
NEW DEVICES II, Austria 2002-2010
Volker Mühlberger, Quality
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
50
100
150
200
250
300
PTSMAREnalDenervNOGA mappingThrombin lokalMitraClipSeries3Series2Series1
Volker Mühlberger, Quality
NEWER and OLDER DEVICESAustria 1992 -2010
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
0
5000
10000
15000
20000
25000
30000
35000
40000
STENTDESIIb/IIIai.c.PRESSUREIVUSROTABLDCALASER
Volker Mühlberger, Quality
NEW DEVICES Austria 2002 – 2010 („loser“)
Brachytherapie 163/101/28/3/0/0/0/0/0 Ultraschalltherapie 1/0/0/0/0/0/0/0/0 Transmyokardialer Laser 16/0/13/0/0/0/0/0/0 Spinal Cord Stimulation 4/0/0/0/0/0/0/0/0 Herzohrverschluss links 7/4/13/0/0/0/0/? Stammzellth. -Katheter 21/16/23/12/40/3/0/0stereotaktische Drahtnavigation -/-/-/-/-/33 /13/4
Volker Mühlberger, Quality
Transcatheter aortic valve implantation (TAVI; n=) in AU, CH -2010
2005 2006 2007 2008 2009 20100
50
100
150
200
250
300
350
400 Balloon onlyTransapical ValveTransarterialAU- TAVIEdwards SapienCorValveCH- TAVI
benchmarking: over the years
Volker Mühlberger, Quality
2000 2002 2004 2006 2008 2010 20120.000
0.500
1.000
1.500
2.000
2.500
Gesamt PCI Mortalität % AT Gesamt PCI Mortalität %
benchmarking: over the centres 2010
Volker Mühlberger, Quality
0 5 10 15 20 25 30 35 400
0.5
1
1.5
2
2.5
3
PCI Mortalität
benchmarking: over the centres 2010
Volker Mühlberger, Quality
0 5 10 15 20 25 30 350
20
40
60
80
100
120
akut PCI mit Schock Mortalität
.
DANKE SEHR
Volker Mühlberger, Quality
Volker Mühlberger, Quality
Gerinnselentferner 148/173/213/380/580/950/1065/1405/1596 (7.9%)Bis hier Intracoronary Pressure wire (CH= 4.2% 2009)
242(1,6%)/312/709/879/1184/1548/1649(8,3%) Alkoholablation = PTSMA 4/4/6/15/11/16/13/30 Defektverschlüsse
162/243/269/332/214/202/296/316 Optical coherence tomogr.(OTC) -/-/-/-/ 60/113/137 perkutaner Aortenklappenersatz –/-/-/-/30/144/188
Volker Mühlberger, Quality
NOGA Mapping 16/26/26/21/65/68/50 Thrombininjektion bei lokaler Gefäßkomplikation -/
88/143/115/77/96/120 Drug eluting Balloon 253 (2009)
top related