Österr.Kardiol.Gesellschaft Österr.Kardiol.Gesellschaft 1990–2010 1990–2010 Arbeitsgruppe Arbeitsgruppe Intervent. Kardiologie Intervent. Kardiologie Monitor (Auditor) Report: 2009/2010
Jan 11, 2016
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.
Volker Mühlberger, QualityVolker Mühlberger, Quality
Wunschliste AUDIT 2011Wunschliste AUDIT 2011
AKHAKH Graz UniklinikGraz Uniklinik HanuschHanusch InnsbruckInnsbruck Privatklinik JosefstadtPrivatklinik Josefstadt Wiener PrivatklinikWiener Privatklinik Ried i.I.Ried i.I.
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
Volker Mühlberger, QualityVolker Mühlberger, Quality
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?
Volker Mühlberger, QualityVolker Mühlberger, Quality
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
Volker Mühlberger, QualityVolker Mühlberger, Quality
PCI Frequency per One Million Inhabitants PCI Frequency per One Million Inhabitants ((AUAU//CHCH//D/D/CZCZ//NONO//USAUSA) 1992-2009) 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
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
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
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
Volker Mühlberger, QualityVolker Mühlberger, Quality
% 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
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
AU
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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 2009
AUSTRIAEUCH
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Non-acute
Rest%
Overall
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 % (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
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
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 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
PCI MIwithshockPCI MIwithoutshockCH withshock
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
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
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
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
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
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
AU
CH
D
CZ
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 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
AU
CH
AU-TI
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 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
AU
CH
D
EU
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 2009
Austria
CH
D
EU
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
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 2009
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/%) 2007-2009 in Austria (n/%) 2007-2009
0
200
400
600
800
1000
2007 2008 2009
Thrombus Restenose Thrombus x10% reporting centres
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 2009
AU
CH
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
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
LASERDCAROTABL
IVUSi.c.PRESSUREIIb/IIIaDESSTENT
0
5000
10000
15000
20000
LASER
DCA
ROTABL
IVUS
i.c.PRESSURE
IIb/IIIa
DES
STENT
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
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 2009
Ablation Diagnostics
A/D % x10 Implantation
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
Volker Mühlberger, QualityVolker Mühlberger, Quality
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
Volker Mühlberger, QualityVolker Mühlberger, Quality
„„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)