ΕΚΕ 2012 1

Hellenic PCI Registry (2008-2011)

Περιεχόμενο και αναγκαιότητα διατήρησης Registry

Αγγειοπλαστικής

http://registry.hellenicpci.gr/

Georgios I. Papaioannou, MD, MPH, FACC, FSCAI

Athens Medical Center

Cardiac Catheterization Laboratory

18/2/2012

ΕΚΕ 2012 2

Aim of the Hellenic PCI Registry (2008-2011)

• 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

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Registries & Clinical Practice

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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)

• 2/2011: 3 year completion – Analyses of more than 4000 entries (National/Hospital/User level)

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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)

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PCI Centers: 2011

49

31

8 10

2116

3 2

19

12

4 39

3 15

0

10

20

30

40

50

60

Total AthensMetro

Thess/nikiMetro

Rest ofGreece

HospitalsGovernmentPrivateUniversity

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COR Procedures 2007-2010

56529

30216

17496

8817

52028

26493

16428

9107

52994

28330

14535

10129

23666

121069148

44920

0

10000

20000

30000

40000

50000

60000

Total Athens Metro Thess/niki Metro Rest of Greece

2007200820092010

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PCI Procedures 2007-2010

20111

10788

6929

2394

19566

10452

6429

2685

19974

10860

5776

3338

16508

8690

44883330

0

5000

10000

15000

20000

25000

Total Athens Metro Thess/nikiMetro

Rest of Greece

2007200820092010

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PCI Volume per Center: 2007-2009

10

106

1422

7

8

13

<200/year

201-400/year401-600/year

>600/year

2007 2009

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Primary PCI numbers: 2007-2011

2371

3733

10871267

15771721

3096

249 235 230 263 309155 221 249

387 328

2056

1723

1491

0

500

1000

1500

2000

2500

3000

3500

4000

2007 2008 2009 2010 2011*

GreeceAthens MetroThess/niki MetroRest of Greece

*2011: Estimated numbers

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Hellenic PCI Registry (2/2008-10/2010)n=3441 validated patients: Demographics

Males 2859 (83.1%)

Females 582 (16.9%)

Age 64.1 ± 11.1

Height 169.8 ± 10.8

Weight 81.9 ± 14.9

BMI 27.9 ± 3.9

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Demographics

Hx Stable Angina 877 (25.5%)

Hx Prior MI 797 (23.2%)

Hx CVA 56 (1.6%)

Hx PVD 171 (4,9%)

Hx of CRF 83 (2.4%)

Hx Prior PCI 726 (21.1%)

Hx Prior CABG 225 (9.1%)

Current Smokers 1337 (38.9%)

Former Smokers 1079 (31.4%)

Current Diabetes 1029 (29.9%)

Oral Agents - IDDM 601 - 172 (17.5% - 4.9%)

Hypertension 2392 (69.5%)

Dyslipidemia 2311 (67.1%)

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: PCI Indication

Elective PCI* 1622 (47.1%)

ACS (UA/NSTEMI)

441 (12.8%)

STEMI 284 (8.3%)

ACS stabilized 622 (18.1%)

STEMI stabilized

458 (13.3%)

Other 14 (0.4%)

*Stable angina/documented ischemia

47%

31%

22%0%

Elective*

UA/NSTEMI

STEMI

Other

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Hellenic PCI Registry (2/2008-10/2010)n=742 STEMI patients: Type of Therapy

Thrombolysis prior PCI 267 (35.9%)

Primary PCI 225 (30.3%)

Delayed PCI 517 (69.7%)

30%

70%

Primary PCI

Delayed PCI

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Hellenic PCI Registry (2/2008-10/2010)n=225 STEMI Primary PCI Patients: Times

Mean symptom to door (min) 249

Mean door to balloon (min) 140

Door to balloon < 120 min 147 (65.3%)

Door to balloon < 90 min 130 (57.7%)

58%

42%

DTB<90 min

DTB>90 min

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Angio Data

EF >50% 2460 (71.5%)

30%EF50% 647 (18.7%)

EF<30% 84 (2.5%)

EF Unknown 250 (7.3%)

LM>50% 93 (2.7%)

1VD 1754 (51%)

2VD 1087 (31.6%)

3VD 598 (17.4%)

Cardiogenic Shock 18 (0.5%)

Treated LM 67 (1.2%)

Treated LAD* 2189 (39.6%)

Treated CX* 1440 (26.1%)

Treated RCA* 1825 (33.1%)

Treated by-pass graft 116 (2.1%)*Lesions

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: PCI Data

Femoral Access 3299 (95.9%)

Radial Access 109 (3.2%)

IVUS 74 (2.2%)

Pressure wire 67 (1.9%)

IABP 7 (0.2%)

Distal Protection 17 (0.5%)

Thrombectomy 150 (4.3%)

Vascular closure device 1135 (32.9%)

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients – 5521 Lesions: PCI Data

Type A lesion 637 (11.5%)

Type B lesion 3454 (62.6%)

Type C lesion 1430 (25.9%)

Restenosis - Bifuraction 197 - 799 (3.6% - 14.5%)

Direct stenting 876 (15.9%)

PCI with stent 5161 (93.5%)

Mean number stent(s) per patient 1.74

Mean number stent(s) per lesion 1.14

Mean stent size (mm) 3.08

Mean stent length (mm) 22.08

Multi-segment PCI 3517 (63.7%)

Successful PCI 5378 (97.4%)

BMS stenting* 1060 (19.2%)

DES stenting* 4097 (74.2%)

* Stent not specified: 362 (6.6%)

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Concurrent PCI Management

Clopidogrel prior PCI 2051 (59.6%)

--- 300 mg 1765 (51.3%)

--- 600 mg 286 (8.3%)

--- <6 hrs 626 (30.5%)

--- >6 hrs 1425 (59.5%)

Clopidogrel during PCI 1364 (39.6%)

--- 300 mg 857 (62.8%)

--- 600 mg 507 (37.2%)

GIIbIIIa inhibitors (upstream) 99 (2.9%)

GIIbIIIa inhibitors (procedural) 383 (11.1%)

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Hellenic PCI Registry (2/2008-10/2010)n=3441 patients: Complications & OutcomesPeriprocedural complications 105 (3.1%)

Acute segment closure 21 (0.6%)

Side branch occlusion 28 (0.8%)

Distal embolization 12 (0.3%)

Coronary perforation 13 (0.4%)

No flow/slow flow 31 (0.9%)

In hospital death 18 (0.5%)*

Periprocedural MI 35 (1.0%)*

Periprocedural CVA 15 (0.4%)

MACE (Death/MI/CVA) 65 (1.9%)

Stent thrombosis 15 (0.4%)

Repeat PCI 16 (0.5%)

Emergency CABG 4 (0.1%)

Major bleed 21 (0.6%)

Renal failure 11(0.3%)

* 1.2% ESC PCI Registry for Death and MI

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Hellenic PCI Registry (2009-2010)n=2191 validated patients: Outcomes*

Death 15 (0.7%)

Myocardial Infarction 22 (1.0%)

CVA 9 (0.4%)

MACE 44 (2.0%)

*Improved reporting of outcomes (mainly death) as Registry evolves – Pending non-validated entries in 2010 with outcomes

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Registry General Issues

• National vs Regional

• “Selective” National

• “Selective” Regional

• Individual Hospital– Type of information / patients (?ACS only)– Amount of information– Obligation of filling

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Financial Issues

M a in te na n ce o f s iteH o s tin g /D o m a in

W e b M a s te rP h ilip L e es

N a tio n a l A d m in istra to r(s)S e n io r &

V a lid a tio n & Q u a lity C o n tro l

S e c re ta ria l C o ve ra geC o m m u n ica tio n w ith H osp ita ls

P ro fe ss io n a ls(F u ll t im e )

P C I R E G IS T R YC o s ts

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Registry Benefits

• Data on all patients having PCI

• Data on ACS – Stent-for-life initiative

• Type of care – Areas of improvement in ACS patients

• Number of operators – Hospitals with Cath Lab facilities – Regional differences

• Type of interventional procedures (expanding to non-coronary cases too)

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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

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2012 Proposal to WG• Continue keeping the existing structure of

the Database (web site – server) with full-time professional(s)

• Complete a 3 year recording (2/2011) (done already)

• Establish software for National/Center/User analysis of entries (in plan)

• Decision regarding a “Selective” National Registry with aim to cover representative patients/data across the whole country

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Participating Hospitals (>20 entries)IKA Pedelis, Athens (1)*Univ Ioannina (2)*Univ Alexandroulopis (3)*Interbalcan ThessalonikiUniv PatrasGennimatas, AthensAthens Medical CenterEuromedica, ThessalonikiThriassio, AthensMetropolitan, AthensOnassio, AthensKyanoys Stavros, AthensNikaias, AthensIatriko Psyhiko, Athens

*Top 3 Hospitals

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Participating Physicians (Alphabetic order >10 entries)

Achtypis, DionysisAlexopoulos, DemetriosArampatzis, Akis (3)Avramides, DimitriosDavlouros, PeriklisHahalis, GeorgiosKantzis, IoannisKapetanopoulos, AthanasiosKaranikolas, NikolaosKostopoulos, KonstantinosKotsanis, AthanasiosKoutsogiannis, NikolaosMaginas, AthanasiosMichalis, Lambros (1)

Olympios, ChristoforosPapaioannou, GeorgiosRaisakis, Kostis

Routoulas, Theodoros

Sassalos, CostantinosSionis, DimitriosSkalidis, ManolisSourgounis, AngelosStefanidis, IoannisStratigis, NikolaosTriantis, GeorgiosTsigas, GregoriosTsikaderis, DemetriosTziakas, Dimitris (2)

*Top 3 Physicians