Hellenic PCI Registry Organization - Structure - Directions - - PowerPoint PPT Presentation

Hellenic PCI Registry Organization - Structure - Directions - Initial Recordings http://registry.hellenicpci.gr/ Georgios I. Papaioannou, MD, MPH, FACC, FSCAI Athens Medical Center Cardiac Catheterization Laboratory 18/2/2010 1 WG 2010

Aim of the Hellenic PCI Registry (2008-2010) • 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 2 WG 2010

3 Registries & Clinical Practice WG 2010

Hellenic Heart Registry on PCI • Initial attempt in 1998 – paper based • Current decision of the WG of HSC for a f/u attempt • Analyses at a national level & submission of data to the ESC • Web-based database with secure data entry by individual users (user ID/password) • Central analyses of data by the WG of HSC • Each center may use the database for their own data analyses upon request 4 WG 2010

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) • 2/2010: 2 year completion – Decision about further continuation with existing participation - Data analysis 5 WG 2010

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) 6 WG 2010

7 ESC 15 Segment Model WG 2010

Centers/Operators/CABG on site: 2007 & 2008 PCI Centers-2007 n=40 208 Operators 24 with CABG on site Athens Metro Area Thessaloniki Metro Area Rest of Greece n=25 n=8 n=7 129 Operators 57 Operators 22 Operators 12 with CABG on site 7 with CABG on site 5 with CABG on site PCI Centers-2008 n=47 227 Operators 25 with CABG on site Athens Metro Area Thessaloniki Metro Area Rest of Greece n=29 n=8 n=10 138 Operators 65 Operators 24 Operators 12 with CABG on site 7 with CABG on site 6 with CABG on site 8 WG 2010

New PCI Centers: 2008 & 2009 New PCI Centers n=9 1 with CABG on site Athens Metro Area Thessaloniki Metro Area Rest of Greece n=6 n=0 n=3 0 with CABG on site 0 with CABG on site 1 with CABG on site 9 WG 2010

PCI Centers: 2009 Status 60 49 50 40 Hospitals 31 Government 30 Private 20 20 20 University 15 13 10 9 8 10 5 4 3 3 3 2 1 0 Total Athens Thess/niki Rest of Metro Metro Greece 10 WG 2010

COR/PCI Procedures: 2007 & 2008 2007 2008 56529 COR 60000 60000 53531 COR PCI 50000 50000 PCI 40000 40000 30216 28097 30000 30000 20111 18931 17496 16302 20000 20000 10788 9728 9132 8817 6779 6929 10000 10000 2424 2394 0 0 Total Athens Metro Thess/niki Rest of Total Athens Metro Thess/niki Rest of Metro Greece Metro Greece 11 WG 2010

COR Procedures: 2007 & 2008 16% 17% Athens Metro Thess/niki Metro 53% 53% 31% 30% Rest of Greece 2007 2008 12 WG 2010

PCI Procedures: 2007 & 2008 12% 13% Athens Metro Thess/niki Metro 51% 54% 34% 36% Rest of Greece 2007 2008 13 WG 2010

COR & PCI Procedures / 10 6 population: 2007 & 2008 (10,9 million) 9000 8300 8000 7000 6000 USA 5346 5186 4911 5000 Europe 4000 Greece 2007 Greece 2008 3000 2485 1845 1737 2000 1599 1000 0 COR PCI 14 WG 2010

PCI Volume per Center: 2007 & 2008 12 10 14 19 8 <200/year 10 201-400/year 6 8 401-600/year >600/year 2007 2008 15 WG 2010

PCI Centers & Primary PCI - 2008 PCI Centers n=47 Primary PCI* No Primary PCI* n=37 n=10 On call - 24/7 Working Hours CABG on site No CABG on site n=20 n=17 n=0 n=10 CABG on site No CABG on site CABG on site No CABG on site n=13 n=7 n=12 n=5 *Technical ability to perform primary PCI 16 WG 2010

Primary PCI numbers*: 2007 1600 1491 1400 1200 1087 1022 Greece 1000 850 Athens Metro 800 Thess/niki Metro 600 Rest of Greece 400 249 159 155 200 13 0 Actual (27 Centers) Projected (33 centers) * Data from 27 Centers (6 Centers with data missing ) 17 WG 2010

Primary PCI numbers: 2008 9,6% 2000 1818 1800 7,2% 1600 1363 1400 Greece 1200 Athens Metro 1000 Thess/niki Metro 800 Rest of Greece 600 1,25% 1,15% 400 236 219 200 0 Projected (47 centers) 18 WG 2010

Volume of Primary PCI per Center 2007 2008 7 12 11 <10/year 16 11-36/year 37-50/year 3 >50/year 3 12 16 19 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Demographics 2221 (83.6%) Males 433 (16.4%) Females 64.1 ± 10.8 Age 169.9 ± 10.8 Height 81.6 ± 14.6 Weight 28.6 ± 1.2 BMI 20 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Demographics 734 (27.6%) Hx Stable Angina 660 (24.9%) Hx Prior MI 51 (1.9%) Hx CVA 132 (5%) Hx PVD 66 (2.5%) Hx of CRF 543 (20.5%) Hx Prior PCI 225 (8.5%) Hx Prior CABG 1007 (37.9%) Current Smokers 828 (31.2%) Former Smokers 781 (29.4%) Current Diabetes 1792 (67.5%) Hypertension 1767 (66.5%) Dyslipidemia 21 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Indication 1261 (47.5%) Elective PCI* 3% ACS 313 (11.8%) 22% (UA/NSTEMI) Elective 248 (9.3%) STEMI UA/NSTEMI 47% STEMI 426 (16.1%) ACS stabilized Other STEMI 334 (12.6%) 28% stabilized 72 (2.7%) Other *Stable angina/documented ischemia 22 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=582 STEMI patients: Type of Therapy Primary PCI 43% 57% Delayed PCI 186 (31.9%) Thrombolytic Rx 248 (43%) Primary PCI 334 (57%) Post STEMI PCI 23 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Angio Data 1866 (70.4%) EF >50% 30%  EF  50% 457 (17.2%) 110 (4.1%) EF<30% 221 (8.3%) EF Unknown 73 (2.7%) LM>50% 1354 (51%) 1VD 838 (31.6%) 2VD 462 (17.4%) 3VD 9 (0.3%) Treated LM 1357 (51.1%) Treated LAD 847 (31.9%) Treated CX 1055 (39.8%) Treated RCA 58 (2.2%) Treated by-pass graft 24 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Data Femoral Access 2436 (91.8%) Radial Access 110 (4.2%) IVUS 59 (2.2%) Pressure wire 38 (1.4%) IABP 7 (0.2%) Distal Protection 12 (0.4%) Thrombectomy 112 (4.2%) 25 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: PCI Data 14% Type A lesion 63% Type B lesion 27% Type C lesion 1.2 Mean No stents per lesion 2.8 Mean stent size (mm) 17.4 Mean stent length (mm) 40.7% BMS stenting 59.3% DES stenting 1994 (75%) Clopidogrel 300 mg 597 (22.5%) Clopidogrel 600 mg 355 (13.4%) GP IIbIIIa inhibitors 26 WG 2010

Hellenic PCI Registry (2/2008-10/2009) n=2654 patients: Complications & Outcomes 85 (3.2%) Periprocedural complications 19 (0.7%) Acute segment closure 25 (0.9%) Side branch occlusion 13 (0.5%) Distal embolization 26 (1%) No flow/slow flow 6 (0.2%)* In hospital death 18 (0.7%)* Periprocedural MI 7 (0.3%) Periprocedural CVA 9 (0.3%) Stent thrombosis 16 (0.6%) Repeat PCI 7 (0.3%) Emergency CABG 15 (0.6%) Major bleed 7 (0.3%) Renal failure * 1.2% ESC PCI Registry 27 WG 2010

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 • Minimal increase in participation in year 2008 28 WG 2010

2010 Proposal to WG • Continue keeping the existing structure of the Database (web site – server) • Complete a 2 year recording (2/2010) • Perform analyses of the data and f/u • Discussion in the WG regarding ways to expand participation for further continuation of the Database 29 WG 2010

EAPCI Data • ESC effort to collect “minimal” basic interventional data – effort to record practices and patterns across Europe (obligatory) • Started in 2006 – Data submitted for 2007 & 2008 • 2009 data should be collected in a more precise pattern retrospectively • Monthly forms created for 2010 (prospective collection) • We should all participate! 30 WG 2010