Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. Kardiologie n H. Mlczoch n W.Klein(+) n P.Probst n F.Leisch n V.Mühlberger Monitor (Auditor)
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Österr.Kardiol.Gesellschaft 1990 Österr.Kardiol.Gesellschaft 1990 Arbeitsgruppe Intervent. KardiologieArbeitsgruppe Intervent. Kardiologie
H. MlczochH. Mlczoch W.Klein(+)W.Klein(+) P.ProbstP.Probst F.LeischF.Leisch V.MühlbergerV.Mühlberger
Monitor (Auditor) Report: 2005
European Society of CardiologyEuropean Society of Cardiology WG 10WG 10
AUSTRIA 1990 -2005AUSTRIA 1990 -2005
BERNBERNESCESC
Contact and References:Contact and References:
http://iik.msig.at (V.Barbieri, http://iik.msig.at (V.Barbieri, L.Kaltenbach, KP Pfeiffer)L.Kaltenbach, KP Pfeiffer)
www.kardiologie.insel.ch/2164.html www.kardiologie.insel.ch/2164.html (T.Carrel, B Meier)(T.Carrel, B Meier)
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 2005 +/- PCI- CENTERS 2005
4 Pediatric 4 Pediatric 31 Adult 31 Adult ((7 7 in Vienna)in Vienna)
Rooms (n=42)Rooms (n=42) (41 PTCA, 1 CAG)(41 PTCA, 1 CAG) http://iik.msig.athttp://iik.msig.at Schwarzach + Neue Wiener Privatklinik are new 2005Schwarzach + Neue Wiener Privatklinik are new 2005
103 parameters were reported 103 parameters were reported by all 31/30 cathlabs 2003/2004by all 31/30 cathlabs 2003/2004
0
20
40
60
80
100
120 10
0,0
0 97
,09
94,1
7 91
,26
88,3
5 85
,44
82,5
2 79
,61
76,7
0 73
,79
70,8
7 67
,96
65,0
5 62
,14
59,2
2 56
,31
53,4
0 50
,49
47,5
7 44
,66
41,7
5 38
,83
35,9
2 33
,01
30,1
0 27
,18
24,2
7 21
,36
18,4
5 15
,53
12,6
2 9,
71
6,8
0
3,8
8
0,9
7
% rückgemeldete Parameter
% d
er H
erzk
ath
ete
rlab
ors
2003 2004
AUSTRIA 2003/2004AUSTRIA 2003/2004
� Angiography 43.644 44.742Angiography 43.644 44.742� PTCA=PCI 15.056 16.738PTCA=PCI 15.056 16.738� stentstent 87% 87% 87%87%� -DES-DES 22%22% 44% 44%� OP-CAD OP-CAD 4.020 4.020 3.762 3.762� OP- valve 1.988 OP- valve 1.988 2.217 2.217
Volker Mühlberger, QualityVolker Mühlberger, Quality
Coronary Angiography Frequency Coronary Angiography Frequency per One Million Inhabitants per One Million Inhabitants
0
2000
4000
6000
8000
10000
1992
1994
1996
1998
2000
2002
2004
AU 8.12
CH 7.4
D 82.53
PCI Frequency per One Million PCI Frequency per One Million Inhabitants (Inhabitants (AUAU//CHCH//DD))
0
500
1000
1500
2000
2500
3000
3500
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
D
n= 29 centres - Austria 2004; according to incremental PCI/CA % quota (n=)
0
500
1000
1500
2000
2500
3000
3500
4000
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
Zentrums- Nummern 1-29 geordnet nach Größenverhältnis PCI/CA aufsteigend
Ab
solu
te A
nza
hl
CA 2004GESAMT PCI 2004
n= 29 centres - according to incremental PCI/CA % quota in Austria 2005; (%=)
0
10
20
30
40
50
60
70
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
Zentrums-Nummern geordnet nach Größenverhältnis PCI/CA aufsteigend
Pro
zen
twer
t P
CI/
CA
(%
)
PCI/CA 2001PCI/CA 2002
PCI/CA 2003PCI/CA 2004
Volker Mühlberger, QualityVolker Mühlberger, Quality
%-PCI during Diagnostic %-PCI during Diagnostic Angio in Angio in
AustriaAustria//SwitzerlandSwitzerland//EUEU
0
10
20
30
40
50
60
70
80
9019
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
EU
%-multivessel PCI %-multivessel PCI AustriaAustria//EUEU
0
2
4
6
8
10
12
14
16
18
20
2002 2003 2004
AUSTRIAEU
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of (CABG-OP+PCI) per Ratio of (CABG-OP+PCI) per Angiography in Angiography in AUAU CHCH DD
41
48
40
50
39
51
39
48
40
51
4047
42,844,9
43,744,9
47,4
44,2
0
10
20
30
40
50
6019
92
1994
1996
1998
2000
2002
2004
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI Hospital-Mortality (%) in PCI Hospital-Mortality (%) in AustriaAustria, , SwitzerlandSwitzerland,,GermanyGermany, , EUEU
0,27
0,6
0,030
0,2
0,4
0,6
0,8
119
92
1994
1996
1998
2000
2002
2004
AU
CH
D
EU
Volker Mühlberger, QualityVolker Mühlberger, Quality
Elective and Overall - Elective and Overall - PCI Hospital-PCI Hospital-Mortality (%) in AustriaMortality (%) in Austria
00,10,20,30,40,50,60,70,80,9
119
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Overall
Elective
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of STENTING per PCI Ratio of STENTING per PCI (%) in (%) in AUAU//CHCH//DD
76 79 81 81,6
0
10
20
30
40
50
60
70
80
90
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
D
Volker Mühlberger, QualityVolker Mühlberger, Quality
Ratio of emergency CABG due to Ratio of emergency CABG due to PCI (%) in PCI (%) in AustriaAustria//SwitzerlandSwitzerland,,EUEU
0
0,2
0,4
0,6
0,8
1
1,219
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
EU
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
0
5
10
15
20
25
30
35
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Volker Mühlberger, QualityVolker Mühlberger, Quality
Infarction as Complication (%) after Infarction as Complication (%) after PCI in PCI in AustriaAustria, , CHCH, , DD, , EUEU
0,850,8
0,3
00,2
0,40,60,8
11,21,4
1,61,8
219
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
D
EU
PPCI/PCI % Austria 2004 all Centres
0
50
100
1. Qrtl. 2. Qrtl. 3. Qrtl. 4. Qrtl.
Ost
West
Nord
0
5
10
15
20
25
30
35
40
MIT 24h Dienst (n=15) OHNE 24h Dienst (n=14)
% P
PC
I vo
n P
CI
PCI for acute Myocardial Infarction PCI for acute Myocardial Infarction (% of (% of total PCI) in total PCI) in AustriaAustria and and SwitzerlandSwitzerland,,EUEU
17
0
2
4
6
8
10
12
14
16
1819
92
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
AU
CH
EU
PCI for acute myocardial PCI for acute myocardial infarction (n) in Austriainfarction (n) in Austria
0
500
1000
1500
2000
2500
1998 1999 2000 2001 2002 2003 2004
PCI MIwith shock
PCI MIwithoutshock
Volker Mühlberger, QualityVolker Mühlberger, Quality
MORTALITY in Austria FOR MORTALITY in Austria FOR PCI DURING ACUTE MIPCI DURING ACUTE MI (%)-(%)-
27
2,5
31
2,8
35
2,6
30
2,1
17
2
17,2
2,2
21,8
1,6
0
5
10
15
20
25
30
35
1998 1999 2000 2001 2002 2003 2004
PCI forMI+Shock
PCI for MIwithoutShock
Volker Mühlberger, QualityVolker Mühlberger, Quality
% GP IIb/IIIa for PCI% GP IIb/IIIa for PCI
0
5
10
15
20
25
1996 1997 1998 1999 2000 2001 2002 2003 2004
AU
CH
DRUG ELUTING STENTSDRUG ELUTING STENTS (DES) in (DES) in AUAU,,CHCH,,DD (% of stents) (% of stents)
0
10
20
30
40
50
60
2001 2002 2003 2004
CH
Austria
D
DRUG ELUTING STENTS (DES) DRUG ELUTING STENTS (DES) in Austria (n)in Austria (n)
0
500
1000
1500
2000
2500
3000
2002 2003 2004
Tacrolimus
Paclitaxel
Sirolimus
other
Volker Mühlberger, QualityVolker Mühlberger, Quality
Puncture site closing devices Puncture site closing devices (% of PCI)(% of PCI)
1923
39,3
0
10
20
30
40
50
60
1998 1999 2000 2001 2002 2003 2004
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
Brachial Brachial and Radial Approach %and Radial Approach %
0
0,5
1
1,5
2
2,5
3
3,5
1999 2000 2001 2002 2003 2004
AUCH
Volker Mühlberger, QualityVolker Mühlberger, Quality
NEW DEVICES, AustriaNEW DEVICES, Austria
1992
1994
1996
1998
2000
2002
2004
LASER
IVUS
STENT
0
5000
10000
15000 LASER
DCA
ROTABL
IVUS
IIb/IIIa
DES
STENT
Volker Mühlberger, QualityVolker Mühlberger, Quality
NEW DEVICES NEW DEVICES Austria 2002/2003/2004Austria 2002/2003/2004 Brachytherapie 163/101/28Brachytherapie 163/101/28 Ultraschalltherapie 1/0/0Ultraschalltherapie 1/0/0 Gerinnselentferner 148/173/213Gerinnselentferner 148/173/213 Transmyokardialer Laser 16/0/13Transmyokardialer Laser 16/0/13 Spinal Cord Stimulation 4/0/0Spinal Cord Stimulation 4/0/0 Alkoholablation 4/4/6Alkoholablation 4/4/6 Defektverschlüsse 162/243/269Defektverschlüsse 162/243/269 Drug - Eluting - Stents 620/2938/6430Drug - Eluting - Stents 620/2938/6430
NEW DEVICES II NEW DEVICES II Austria 2003/2004Austria 2003/2004
Stammzelltherapie mit Katheter 21/16Stammzelltherapie mit Katheter 21/16 NOGA MappingNOGA Mapping 16/26 16/26 Herzohrverschluss linksHerzohrverschluss links 7/4 7/4 PCI wegen instent-Restenose 737/921PCI wegen instent-Restenose 737/921 Thrombininjektion bei lokaler Thrombininjektion bei lokaler
Gefäßkomplikation 88Gefäßkomplikation 88
Volker Mühlberger, QualityVolker Mühlberger, Quality
Case load per physicianCase load per physician
0
50
100
150
200
250
1998
PC
I
2000
PC
I
2002
PC
I
2004
PC
I
1999
CA
2001
CA
2003
CA
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR PCI DURING 2000/04LOW CASE LOAD FOR PCI DURING 2000/04
0
2
4
6
8
10
12
14
16
18
<200 PCI per yearand center
200-400 >400 PCI
AU 2000
CH 2000
AU 2001
AU 2002
AU 2003
AU 2004
Volker Mühlberger, QualityVolker Mühlberger, Quality
NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR CA DURING 2000/04LOW CASE LOAD FOR CA DURING 2000/04
0
2
4
6
8
10
12
14
<400 CA peryear and
center
400-1000 1000-2000 >2000 CA
AU 2000
CH 2000
AU 2001
AU 2002
AU 2003
AU 2004
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