AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2013

Volker Mühlberger, Quality

AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2013

n = 34 locations

n = 50 rooms

Monitor (Auditor) Report: 1989 – 2014

www.iik.i-med.ac.at

Lalit Kaltenbach, Hanno Ulmer www.ptca.ch

Gregor Fahrni, Christoph Kaiser – Basel

Bernhard Meier, Micha T. Maeder www.herzstiftung.de Martin Vestweber

www.herzbericht.de E.Bruckenberger bis 2011

„Österreichische Spezialregister“Volker Mühlberger, Quality

http://www.herzbericht.de/

ANCALAR („Versorgungsforschung “)

to describe practice patterns and trends, to identify outliers and to detect safety signals

Lauer MS, D´Agostino RB NEJM 2013; 369:1579-81



AUSTRIA 2012 / 2013

� Angiography 53.064 54.566� PCI 20.543 21.698� - stent 90% 92%� - - DES 85% 85%� OP-CAD (Bruckenberger : 2008=4.248) Schistek 2.737

� OP- valve (Bruckenberger: 2008=2.280) Schistek 2.583


Coronary Angiography Frequency per Million Inhabitants 1992-2013

19911993

19951997

19992001

20032005

20072009

20112013

0

2000

4000

6000

8000

10000

12000

AU 8.12-8.43CH 7.4 - 7.95D 82.2-81.8CZ 10.0-10.5SL 5.5 -5.4


% PCI/ CA 1992 - 2013 (AU/CH/D/CZ)

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

5

10

15

20

25

30

35

40

45

50

AU

CH

D

CZ


PCI per One Million Inhabitants (AU/CH/D/CZ/SL/USA) 1992-2013

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

500

1000

1500

2000

2500

3000

3500

4000

4500

USA

SL

AU

CH

D

CZ

Volker Mühlberger, Quality Silber 2005 / DiMario 2006;

ESC

Number of tables, CENTERS and centers with > 36 STEMI - PCI / year

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

10

20

30

40

50

60

19 18 2024

20 22 23 23 2327

23centers

tables

>36 STEMI-PCI/y+c


PCI Frequency in Austria 2006-2013acute or non-acute Indications

2006 2007 2008 2009 2010 2011 2012 20130

5000

10000

15000

20000

25000

5009 6014 6686 6783 6466 6946 7026 7148

14254 13328 13041 13073 13828 13349 13517 14550

19263 19342 19727 19856 20294 20295 2054321698

NICHT AKUT

AKUT PCI


Acute PCI/ STEMI PCI / % (n=) Austria 2007 – 2013

2007 2008 2009 2010 2011 2012 20130

1000

2000

3000

4000

5000

6000

7000

8000

55 %50%

STEMI

"acute"

STEMI % x10


ACUTE minus STEMI PCI (% of total PCI) in AU, CH, CZ, EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

5

10

15

20

25

30

35

40

45

AU acuteCH STEMIEUCZCH acuteAU STEMI

Non- femoral (radial) approach (% of procedure) AUT 2011/2012 /2013

ANGIO 2

011

2012

2013

PCI 201

120

1220

13

PCI ele

ktiv

201

120

1220

13

PCI aku

t 201

120

1220

130

5

10

15

20

25

30

35

40

2011

2012

2013



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

2012

2013

2014

0

10

20

30

40

50

60

70

AUCHfrench CHgerman CHCZ

Severe bleeding (% of …reporting only) AUT 2010 / 2011 / 2012 / 2013


% of CA bleeding % of PCI nonacute % of PCI acute0

5

10

15

20

25

30

35

40

Bifurcation PCI, left main stent Austria (% of PCI… reporting centers only )

2008 2009 2010 2011 2012 20130.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0



% GP IIb/IIIa for PCI (AU/CH) % dir.ThrombinInhibitor (TI-AU)

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

5

10

15

20

25

30

AUCHAU-TI


Ratio of emergency CABG due to PCI (%): Austria/Switzerland/EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

0.2

0.4

0.6

0.8

1

1.2

1.4

AUCHEU


PCI Hospital-Mortality (%) in Austria, Switzerland,Germany, EU

1991

1993

1995

1997

1999

2001

2003

2005

2007

2009

2011

2013

0

0.5

1

1.5

2

2.5

AU

CH

D

EU

PCI -Mortality (% of procedure)

in Austria 2011 / 2012 / 2013

0

5

10

15

20

25

30

0.85 0.12.4

1

25.9



PCI -Mortality (ref.=overall-% mortality in Austria)(non-acute / without /with shock)

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

0.00

0.20

0.40

0.60

0.80

1.00

1.20

non-acute PCI bezogen auf Gesamt PCI

PCI for MI without Shock bezogen auf Gesamt PCI

PCI for MI with Shock bezogen auf Gesamt PCI

Intra – aortic balloon pump for PCI in Austria 2005 -2013 (CH 2012/13)

2005 2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

350

400

450

500

AUTCH



DRUG ELUTING stents (DES) in AU,CH,D,EU-CZ (% of stents)

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

0

10

20

30

40

50

60

70

80

90

100

EU EU

CZAUCHDEUCZ


DES/stent and re-stenosis REDOreporting Centres (% of stent)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

102030405060708090

6.6 6.3 55.1

DES % REDO % (reporting Centers only)


REDO for all chronic restenoses vs. thrombus reporting centres (n/%)

2007 2008 2009 2010 2011 2012 20130

100200300400500600700800900

1000

8,5%15,2%

11,9%15,1 % 16,8 %

Thrombus Restenose Thrombus x10% reporting centres

AUT 2012 CH

PTSMA %

bioab

STENT %

CTO %

FFR %

IVUS %

OCT %

shock

PCI %

0

2

4

6

8

10

12

14

AUT

CH


AUT 2013 CH

Volker Mühlberger, QualityPTSM

A %

bioab

STENT %

CTO %

FFR %

IVUS %

OCT %

shock

PCI %

0

2

4

6

8

10

12

14

AUT

CH

AUT 2012 CH

Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0

100

200

300

400

500

600

700

800

900

AUT

CH


AUT 2013 CH


Mitraclip PFOASDPDAVSD IABP PeRenaleDe rotablator0

100

200

300

400

500

600

700

800

900

AUT

CH

Austria vs. CH 2002– 2013 LAA closure

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

AUCH0



OLD and NEW DEVICES (35.000/a)

Austria 1992 -201319

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

0920

1020

1120

12

0

5000

10000

15000

20000

25000

30000

35000

40000

STENTDESSeries4IVUSROTABLi.c.PRESSURE


OLD and NEW DEVICES (<3000/a)

Austria 2002-201320

02

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

0

500

1000

1500

2000

2500

3000

3500

(„Catheter Thrombectomy“ or

DE Balloon

Defektverschl.

OLD and NEW DEVICES (<400/a)

Austria 2002-2013


2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

0

50

100

150

200

250

300

350

400

MitraClipThrombin lokalNOGA mappingREnalDenervPTSMA

Myocardial biopsies in Austria 2006 -2013

2006 2007 2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

350

400

450myocardial biopsies



Ablation (n) / Electrophysiology (n; %) & CathLab Implantations / Austria

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

500

1000

1500

2000

2500

3000

3500

72%

95%Ablation Diagnostics A/D % x10 Implantation


Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2013

2005 2006 2007 2008 2009 2010 2011 2012 20130

100

200

300

400

500

600

700

800

0 0

480

781AU- TAVI

CH- TAVI

Transcatheter aortic valve implantation (TAVI; n = ) in AU, CH -2013


2005 2006 2007 2008 2009 2010 2011 2012 20130

100

200

300

400

500

600

700

800

0 0

397 432 480501

650781

AU tapAU taoAU- TAVICH tapCH taoCH- TAVI

AUSTRIA´s ANGIOGRAPHY and PCI - CENTRES 2013

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