Volker Mühlberger, QualityVolker Mühlberger, Quality

QUALITY 1990QUALITY 1990until today until today

Österreichische Kardiologische Gesellschaft

Arbeitsgruppe Interventionelle Kardiologie

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIA 2002 AUSTRIA 2002

Monitor ReportMonitor Report

W.KleinW.Klein P.ProbstP.Probst F.LeischF.Leisch V.MühlbergerV.Mühlberger

Volker Mühlberger, QualityVolker Mühlberger, Quality

EUROPEAN + AUSTRIAN EUROPEAN + AUSTRIAN ANGIOGRAPHY + PTCAANGIOGRAPHY + PTCA

QUALITY REPORTQUALITY REPORT

Europa

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIAN ANGIOGRAPHY AUSTRIAN ANGIOGRAPHY +/- PTCA- CENTERS 2001 +/- PTCA- CENTERS 2001

4 Pediatric 4 Pediatric 31 Adult 31 Adult ((7 7 in Vienna)in Vienna)

Rooms (n=39)Rooms (n=39) (37 PTCA, 2 CAG)(37 PTCA, 2 CAG)

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIA 2000/2001AUSTRIA 2000/2001

� AngiographyAngiography 35.558 38.71435.558 38.714

� PTCA=PCI 10.469 12.053PTCA=PCI 10.469 12.053

� stentstent 76% 81% 76% 81%

� CABG-OPCABG-OP 3.4413.441

� Vitium + Vitium +

� CABG-OP 621CABG-OP 621

Volker Mühlberger, QualityVolker Mühlberger, Quality

Coronary Angiography Frequency per Coronary Angiography Frequency per One Million Inhabitants in AU(8.06)/CH(7.18)One Million Inhabitants in AU(8.06)/CH(7.18)

7239

0

2000

4000

6000

800019

92

1994

1996

1998

2000

AU 8.06

CH 7.18

D 82.16

Volker Mühlberger, QualityVolker Mühlberger, Quality

PTCA Frequency per One Million PTCA Frequency per One Million Inhabitants in Austria / SwitzerlandInhabitants in Austria / Switzerland

2194

0

500

1000

1500

2000

2500

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

D

Volker Mühlberger, QualityVolker Mühlberger, Quality

RATIO PCI/CA (%) YEARS 2000/2001RATIO PCI/CA (%) YEARS 2000/2001 ALL AUSTRIAN CENTERSALL AUSTRIAN CENTERS

Prozentanteil von PCI bezogen auf Anzahl der diagnostischen Angiographien in den 31 Zentren in Österreich (Vergleich 2000/2001)

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 30 31

PCI-Zentrum Nr 1-26 (2000) und 1-29 (2001)

% P

CI/

CA JAHR 2000

JAHR 2001

Volker Mühlberger, QualityVolker Mühlberger, Quality

%-PTCA during Diagnostic %-PTCA during Diagnostic Angio in Austria/SwitzerlandAngio in Austria/Switzerland

0

10

20

30

40

50

60

70

80

90

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of (CABG-OP+PTCA) per Ratio of (CABG-OP+PTCA) per Angiography in Austria / SwitzerlandAngiography in Austria / Switzerland

4148 40

50

39

51

39

48

40

51

40 40

0

10

20

30

40

50

601992

1993

1994

1995

1996

1997

1998

1999

2000

2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

PTCA Hospital-Mortality (%) in PTCA Hospital-Mortality (%) in Austria and SwitzerlandAustria and Switzerland

00,10,20,30,40,50,60,70,80,9

1

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of STENTING per PTCA Ratio of STENTING per PTCA (%)in Austria and Switzerland(%)in Austria and Switzerland

0

10

20

30

40

50

60

70

80

90

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

Ratio of emergency CABG due Ratio of emergency CABG due to PTCA (%) in Austria/Switzerlandto PTCA (%) in Austria/Switzerland

0

0,2

0,4

0,6

0,8

1

1,2

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

EMERGENCY CABG AFTEREMERGENCY CABG AFTER PCI PCI (%)-MORTALITY in Austria(%)-MORTALITY in Austria

3,3

8,3

18,2

28,6

8,3

15,4 16

25

32

0

5

10

15

20

25

30

35

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Volker Mühlberger, QualityVolker Mühlberger, Quality

Acute Myocardial Infarction (%) after Acute Myocardial Infarction (%) after PTCA in Austria and SwitzerlandPTCA in Austria and Switzerland

00,20,40,60,8

11,21,41,61,8

2

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

PTCA for acute Myocardial Infarction PTCA for acute Myocardial Infarction (%) in Austria and Switzerland(%) in Austria and Switzerland

0

2

4

6

8

10

12

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

AU

CH

Volker Mühlberger, QualityVolker Mühlberger, Quality

PCI FOR =PCI FOR = DURING ACUTE MIDURING ACUTE MI(%)-MORTALITY in Austria(%)-MORTALITY in Austria

27

2,5

31

2,8

35

2,6

30

2,10

5

10

15

20

25

30

35

1998 1999 2000 2001

PCI forMI+Shock

PCI for MIwithoutShock

Volker Mühlberger, QualityVolker Mühlberger, Quality

% GP IIb/IIIa for PTCA% GP IIb/IIIa for PTCA

0

5

10

15

20

25

1996 1997 1998 1999 2000 2001

AustriaSwitzerland

Volker Mühlberger, QualityVolker Mühlberger, Quality

Puncture site closing devices Puncture site closing devices (% of PCI)(% of PCI)

19

23

0

5

10

15

20

25

30

35

1998 1999 2000 2001

AUSTRIASWISS

Volker Mühlberger, QualityVolker Mühlberger, Quality

Brachial and Radial Approach %Brachial and Radial Approach %

0

0,5

1

1,5

2

2,5

3

3,5

1999 2000 2001

AUCH

Volker Mühlberger, Quality 96/97Volker Mühlberger, Quality 96/97

NEW DEVICES, AustriaNEW DEVICES, Austria

1992

1994

1996

1998

2000

LASER

ROTABL

IIb/IIIa

0

2000

4000

6000

8000

10000

LASER

DCA

ROTABL

IVUS

IIb/IIIa

STENT

Volker Mühlberger, QualityVolker Mühlberger, Quality

OTHER NEW DEVICESOTHER NEW DEVICES Austria 2001Austria 2001

Brachytherapie 101Brachytherapie 101 Ultraschalltherapie 11Ultraschalltherapie 11 Gerinnselentferner 45Gerinnselentferner 45 Transmyokardialer Laser 16Transmyokardialer Laser 16 Spinal Cord Stimulation 3Spinal Cord Stimulation 3 Alkoholablation 3Alkoholablation 3 Defektverschlüsse 100Defektverschlüsse 100

Volker Mühlberger, QualityVolker Mühlberger, Quality

Case load per physicianCase load per physician

0

50

100

150

200

250

1998PCI

1999PCI

2000PCI

2001PCI

1998KAG

1999KAG

2000KAG

2001KAG

AUSTRIA

SWISS

Säule (3D) 3

Volker Mühlberger, QualityVolker Mühlberger, Quality

NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR PCI DURING 2000LOW CASE LOAD FOR PCI DURING 2000

0

2

4

6

8

10

12

<200 PCI per yearand center

200-400 >400 PCI

AUCH

Volker Mühlberger, QualityVolker Mühlberger, Quality

NUMBER OF CENTERS WITH HIGH OR NUMBER OF CENTERS WITH HIGH OR LOW CASE LOAD FOR CA DURING 2000LOW CASE LOAD FOR CA DURING 2000

0

2

4

6

8

10

12

14

<400 CA peryear and

center

400-1000 1000-2000 >2000 CA

AUCH

Volker Mühlberger, QualityVolker Mühlberger, Quality

AUSTRIA (8.06 million inhabitants) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Coronary angiography (CA) per million inhabitants (n) 2351 2721 2637 2996 3296 3726 3927 4082 4417 4803

PTCA per million inhabitants (n) 472 533 617 737 838 951 1070 1152 1300 1495

Ratio of (CABG+PTCA) per CA (%) 36 36 40 41 40 39 39 40 40 40

PTCA during diagnostic CA (%) 39 50 48 50 55 61 70 72 77 78

Ratio of PTCA for ongoing myocardial infarction (%) 1,7 1,8 2,3 2,8 5,1 3,9 5,5 9,1 11,0 9,2

Ratio of hospital mortality after PTCA (%) 0,5 0,5 0,5 0,5 0,6 0,6 0,5 0,6 0,66 0,61

Ratio of myocardial infarction due to PTCA (%) 1,9 1,2 1,4 1,3 1,1 0,9 0,9 0,8 1,5 1,6

Ratio of emergency CABG due to PTCA (%) 0,9 0,7 1,2 0,8 0,4 0,3 0,2 0,3 0,15 0,16

Ratio of stenting in PTCA (%) 2,4 4,3 8,9 27 47 58 68 74 76 81

Volker Mühlberger, QualityVolker Mühlberger, Quality

WITZERLAND7.18 million inhabitants)

1992 1993 1994 1995 1996 1997 1998 1999

ronary angiography (CA) per million inhabitants (n) 2110 2602 3031 3307 3508 3632 4000 3900

CA per million inhabitants (n) 462 665 822 959 1102 1241 1366 1355

tio of (CABG+PTCA) per CA (%) 48 50 50 48 50 51 48 51

CA during diagnostic CA (%) 43 39 51 59 60 74 77 83

tio of PTCA for ongoing myocardial infarction (%) 3,1 3,3 4,4 6,0 6,1 6,8 8,0 10

tio of hospital mortality after PTCA (%) 1,0 0,6 0,6 0,6 0,7 0,6 0,6 0,9

tio of myocardial infarction due to PTCA (%) 1,8 1,2 1,2 1,1 1,1 1,2 1,2 1,5

tio of emergency CABG due to PTCA (%) 1,2 0,8 0,9 0,7 0,4 0,3 0,2 0,3

tio of stenting in PTCA (%) 3,6 6,0 15 28 50 57 67 73

STAND 02/01