Österr.kardiol.gesellschaft 1990–2009 arbeitsgruppe intervent. kardiologie
DESCRIPTION
Österr.Kardiol.Gesellschaft 1990–2009 Arbeitsgruppe Intervent. Kardiologie. Monitor (Auditor) Report: 2008/2009. Contact and References:. http://iik.i-med.ac.at (L.Kaltenbach, KP Pfeiffer) www.kardiologie.insel.ch/2164.html (B Meier - St Cook – MT Maeder) - PowerPoint PPT PresentationTRANSCRIPT
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