Österr.kardiol.gesellschaft 1990–2010 arbeitsgruppe intervent. kardiologie

Österr.Kardiol.Gesellschaft 1990–2010 Österr.Kardiol.Gesellschaft 1990–2010 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie

Monitor (Auditor) Report: 2009/2010

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, H. Ulmer, C.Kobel)Pfeiffer, H. Ulmer, C.Kobel)

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 38 Adult 38 Adult ((11 11 in Vienna)in Vienna)

Rooms (n=51)Rooms (n=51) http://iik.i-med.ac.at 2009: Ried i.I.2009: Ried i.I.


Wunschliste AUDIT 2011Wunschliste AUDIT 2011

AKHAKH Graz UniklinikGraz Uniklinik HanuschHanusch InnsbruckInnsbruck Privatklinik JosefstadtPrivatklinik Josefstadt Wiener PrivatklinikWiener Privatklinik Ried i.I.Ried i.I.


AUSTRIA AUSTRIA 2008 / 20092008 / 2009

� Angiography 51.292 52.149Angiography 51.292 52.149

� PTCA=PCI 19.727 19.856PTCA=PCI 19.727 19.856

� -stent-stent 88% 88% 89%89%

� - - DES- - DES 67% 67% 69% 69%� OP-CAD (Bruckenberger)OP-CAD (Bruckenberger) 4.2484.248

� OP- valve (Bruckenberger)OP- valve (Bruckenberger) 2.2802.280


Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants 1992-2009 per One Million Inhabitants 1992-2009

0

2000

4000

6000

8000

10000

12000

AU 8.12-8.38

CH 7.4

D 82.2-81.8

CZ 10.0

NO 4.8

Mio EW

More Centres, more Tables, but not More Centres, more Tables, but not more Angios in Austria 2005-2009?more Angios in Austria 2005-2009?



NUMBER OF CENTERS WITH NUMBER OF CENTERS WITH <400 CA /year <400 CA /year vs. vs. <200 PCI/year <200 PCI/year vs.vs. Number of CA/y(*t) 2000-092000-09

0

2

4

6

8

10

12

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

1

2

3

4

5

6

7<400CA/y+c

<200PCI/y+c

CA/y xthousand

Volker Mühlberger, Quality Silber 2005 / DiMario 2006; ESCVolker Mühlberger, Quality Silber 2005 / DiMario 2006; ESC

NUMBER OF NUMBER OF CENTERSCENTERS WITH > 36 STEMI- PCI / year vs.vs. Number of Tables Number of Tables 2003-20092003-2009

0

10

20

30

40

50

60

2003 2004 2005 2006 2007 2008 2009

centers

tables

>36STEMI-PCI/y+c


PCI Frequency per One Million Inhabitants PCI Frequency per One Million Inhabitants ((AUAU//CHCH//D/D/CZCZ//NONO//USAUSA) 1992-2009) 1992-2009

0

500

1000

1500

2000

2500

3000

3500

4000

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AUCHDCZNOUSA


PCI Frequency in Austria 2006-2009 PCI Frequency in Austria 2006-2009 according according to acute or non-acute Indicationsto acute or non-acute Indications

14254

5009

19263

13328

6014

19342

13041

6686

19727

13073

6783

19856

02000

400060008000

10000120001400016000

1800020000

2006 2007 2008 2009

NICHT AKUT

AKUT PCI

PCI GESAMT


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

2009PC I

1998C A

1999C A

2000C A

2001C A

2002C A

2003C A

2004C A

2005C A

2006C A

2007C A

2008C A

2009C A

AU

CH


% PCI/ CA 1992-2009 % PCI/ CA 1992-2009 ((AUAU//CHCH//D/D/CZCZ))

0

5

10

15

20

25

30

35

40

45

50

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

A

CH

D

CZ


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

D


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

EU


%-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 2009

AUSTRIAEUCH


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

0

0,5

1

1,5

2

2,5

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

D

EU


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Overall

Elective


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Non-acute

Rest%

Overall


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 %


STEMI PCISTEMI PCI / / acute PCIacute PCI/ / STEMI %STEMI % (n=) Austria 2007 / 2008 / 2009(n=) Austria 2007 / 2008 / 2009

0

1000

2000

3000

4000

5000

6000

7000

2007 2008 2009

STEMI"acute"STEMI % x10


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

0

5

10

15

20

25

30

35

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

EU

CZ


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 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

PCI MIwithshockPCI MIwithoutshockCH withshock


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

23,32

1,18

0

5

10

15

20

25

30

35

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

PCI forMI+Shock

PCI for MIwithoutShock


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

EU


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

3,3

8,3

18,2

28,6

8,3

15,4 16

25

32

12 10,5

18,2

13,6

23,1

36,4

46,7

36,4

0

5

10

15

20

25

30

35

40

45

50

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

D

CZ


% 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 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

AU-TI


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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

AU

CH

D

EU


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 2009

Austria

CH

D

EU


DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n) 2002 - 2008in Austria (n) 2002 - 2008

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


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 2009

DES % REDO % (reporting Centers only)


STENT REDO STENT REDO (Thrombus) (Thrombus) versus versus (chronic (chronic Restenosis) Restenosis) in Austria (n/%) 2007-2009 in Austria (n/%) 2007-2009

0

200

400

600

800

1000

2007 2008 2009

Thrombus Restenose Thrombus x10% reporting centres


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 2009

AU

CH


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

0

5

10

15

20

25

30

35

1999 2001 2003 2005 2007 2009

AUCHfrench CHgerman CH


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


OLD and NEW DEVICES, AustriaOLD and NEW DEVICES, Austria

LASERDCAROTABL

IVUSi.c.PRESSUREIIb/IIIaDESSTENT

0

5000

10000

15000

20000

LASER

DCA

ROTABL

IVUS

i.c.PRESSURE

IIb/IIIa

DES

STENT


Transcatheter aortic valve implantationTranscatheter aortic valve implantation (TAVI; n=) in (TAVI; n=) in AustriaAustria 2007-2009 ( 2007-2009 (CH 2009CH 2009))

0

50

100

150

200

250

300

2005 2006 2007 2008 2009

Balloon onlyTransapical ValveTransarterialTAVIEdwards SapienCorValveCH- TAVI


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 2009

Ablation Diagnostics

A/D % x10 Implantation


NEW DEVICES NEW DEVICES Austria 2002 – 2009 Austria 2002 – 2009 („winner“)(„winner“)

GerinnselentfernerGerinnselentferner 148/173/213/380/580/148/173/213/380/580/950/1065/1405(7,08%)950/1065/1405(7,08%) Intracoronary Pressure wire Intracoronary Pressure wire (CH= 4.2% 2009)(CH= 4.2% 2009)

242(1,6%)/312/709/879/1184/1548/242(1,6%)/312/709/879/1184/1548/1649(8,3%)1649(8,3%) Alkoholablation = PTSMA Alkoholablation = PTSMA 4/4/6/15/11/4/4/6/15/11/16/13/16/13/3030 Defektverschlüsse Defektverschlüsse

162/243/269/162/243/269/332332/214/202/296//214/202/296/316316 Optical coherence tomogr.(OTC) Optical coherence tomogr.(OTC) -/-/-/-/ -/-/-/-/ 60/113/13760/113/137 perkutaner Aortenklappenersatz perkutaner Aortenklappenersatz –/-/-/-/–/-/-/-/30/144/18830/144/188


NEW DEVICES NEW DEVICES Austria 2002 – 2009 („loser“)Austria 2002 – 2009 („loser“)

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

21/16/23/12/21/16/23/12/40/40/3/03/0


„„NEW DEVICES“ III NEW DEVICES“ III Austria 2003 – 2009Austria 2003 – 2009

NOGA MappingNOGA Mapping 16/26/26/21/16/26/26/21/6565/68//68/5050 Thrombininjektion bei lokaler Thrombininjektion bei lokaler

Gefäßkomplikation Gefäßkomplikation -/ 88/-/ 88/143143//115115/77/96//77/96/120120 stereotaktische Drahtnavigationstereotaktische Drahtnavigation -/-/-/-/-/-/-/-/-/-/3333 /13 /13 Drug eluting Balloon Drug eluting Balloon 253253 (2009)(2009)

Österr.kardiol.gesellschaft 1990–2010 arbeitsgruppe intervent. kardiologie

Documents