BCIS Audit Returns of Interventional Procedures 2000
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1 BCIS Audit Returns of Interventional Procedures 2 Southampton, October 21 Mark de Belder BCIS UK National Audit Officer on behalf of Council of the British Cardiovascular Intervention Society
2 UK Intervention Centres Year No. Centres
3 UK Interventional & Diagnostic Centres 2 NHS Interventional Private Interventional Diagnostic only No. No Data on Caths (%) 49 9 (18%) 17 4 (24%) 63 7 (11%) Caths (% of total) 85,3 (69%) 8,575 (7.%) 29,7 (24%) PCIs (% of total) 3,916 (92%) 2,736 (8.1%) TOTAL ,35 33,652 Making assumptions about no. of caths done in centres not reporting, estimated caths in UK approx 145, = 4.3 caths/pci 3.5 caths for every 1 PCI in Intervention centres (1.2-82) (3.51 NHS, 3.73 Private)
4 Centres providing NO DATA None!
5 Centres providing NO or MINIMAL data on Centre Description Form (A) Harefield Edinburgh Royal Infirmary Sheffield (Ayrshire & Arran) Cromwell Bristol BUPA
6 Centres providing NO or MINIMAL DATA on Minimum Data Form (B) No data Harefield BUPA Bristol Minimal Data Birmingham QEH Yorkshire Ht Centre Sheffield
7 Centres with MINIMAL or NO DATA on Outcome Form (C) Belfast City City, Birmingham Harefield Yorkshire Heart Centre UH Wales, Cardiff London Chest Manchester RI John Radcliffe, Oxford Royal Brompton Northern, Sheffield St Bartholomew s St Mary s Derriford, Plymouth Eastbourne Wellington Ross Hall London Independent St Anthony s The Priory, Birmingham Harley St Clinic BUPA Bristol BUPA Lea Cambridge
8 Centres with no HOSPITAL Outcome Data Cath Lab Data Only Blackpool Edinburgh Western Wythenshawe Morriston, Swansea BMI Alexander, Manchester BUPA Leicester HCI Glasgow Unspecified Data Belfast Royal Victoria Birmingham QE Bristol Royal Infirmary Hammersmith Hull Royal Infirmary Papworth Edinburgh Royal Infirmary Glasgow Western Glasgow Royal Infirmary Liverpool CTC Middlesex/UCH Freeman, Newcastle Glenfield, Leicester Hairmyres Unspecified Data BUPA Leeds London Bridge Cromwell Yorkshire Heart Clinic Park, Nottingham
9 Volume of procedures in NHS Centres Total number of procedures per annum < >1
10 Total UK PCI Procedures Year Centres Total Rate per Procedures million , % increase , , , , , , , , ,
11 PCI Rates per million population (UK) '85 '88 '9 '92 '94 '96 '98 '
12 PCI vs Isolated CABG Rates (UK) Data from BCIS and SCTS Registry BCIS SCTS 1 5 '91 '92 '93 '94 '95 '96 '97 '98 '99 '
13 PCI: UK vs Rest of Europe 1996/1998 PCIs/million Ita UK96 UK97 UK98 UK99 UK Spa Fin Gre Den Swe Nor Aust Neth Fra Swi Belg Ger
14 No. of Consultant Interventionists in NHS Centres, 2 data from 48 centres No of Centres No of Consultants/Centre Average 5.5 / Centre
15 No of PCIs per Consultant in NHS Centres, 2 data from 48 centres No of Centres >25 No PCIs/Consultant Average 125 / Consultant
16 All PCI Procedures Mortality 2 data from 48 centres Year Data From: Total Mortality % Range % ,71 (9,933) /52 1,483 (11,575) /53 11,859 (12,937) /54 12,598 (14,624) /54 11,365 (17,344) /53 14,476 (2,511) /58 17,577 (22,92) /61 16,946 (24,899) /63 2,975 (28,133) 2 48/66 24,323 (33,652)
17 All PCI procedures 2 data from 41 centres Year Total Vessels/ Success % MI % Em. Mortality case CABG % , , , , , , ,667 (22,92) ,56 (24,899) ,889 (28,133) 2 2,939 (33,652)
18 Stent procedures data from 61 centres % of all PCIs '92 '93 '94 '95 '96 '97 '98 '99 ' Year
19 Stenting in different centres data from 61 centres No. of Centres >9 % Stented
20 Impact of Stenting data from 4 centres Year % Stented % PCI for % needing Restenosis Em.CABG
21 Stenting and the need for emergency CABG (2 data from 4 centres) % % % Stent % Em.CABG '92 '93 '94 '95 '96 '97 '98 '99 ' Year
22 Stenting and procedures for restenosis (2 data from 4 centres) 9 14 % % % Stent % Restenosis '92 '93 '94 '95 '96 '97 '98 '99 ' Year
23 PCI for Restenosis (2 data from 4 centres) 25 2 No. of Centres >15 % for Restenosis
24 Stent Procedures data from 29 centres Elective ,595 2,373 3,17 (45%) (7.5-1) Sub-optimal 2,166 2,759 (39%) (-98) 3,376 (56%) (-1) 2,238 (37%) (-1) 7,244 (64%) (19-1) 3,99 (31%) (-83) 9,365 (75%) (19-1) 2,773 (22%) (-79) Bail-out ,86 1, (14%) (-52) 41 (6.8%) (-27) 538 (4.8%) (-35) 299 (2.4%) (-35) % Bail-out % 2.4% Total Stent Procedures ,937 4,574 9,165 7,96 of 11,95 6,24 of 12,57 11,691 of 19,769 12,437 of 27,57
25 Stent use (2 data from 29 centres) % of all stented cases ES SOS BOS Stent use
26 ReoPro in different centres data from 61 centres No. of Centres _1 11_2 21_3 31_4 41_5 51_6 61_7 71_8 81_9 % ReoPro ReoPro used in 22% of cases in 2 5 cases using eptifibatide or tirofiban reported
27 ReoPro use data from 61 centres 25% 2% % use 15% 1% 5% % Year
28 Other procedures 2-1 PTCRA DCA TEC Laser CB Thromb Centres No * Mean Range , =, - : increase, no change or decrease compared to 1999 * mainly Xsizer NB Only 2 reported to voluntary registry
29 Other procedures 2-2 BrachyRx P(D)MR IVUS Angioscopy Groin closure* Centres Number Mean Range , =, - : increase, no change, or decrease compared to 1999 * Mainly Angioseal
30 Other Procedures 2-3 MVplasty AVplasty PVplasty TVPlasty Coart/ Re-coarct Centres = 5 No = 1 Mean = Range , =, - : increase, no change, or decrease compared to 1999
31 Other Procedures 2-4 PDA ASD* PFO* VSD Centres 7 No. 12 Mean 1.7 = = = - Range , =, - : increase, no change or decrease compared to 1999 * Some centres give combined data for ASD/PFO closure
32 Other Procedures 2-5 Renal Subclavian Pulm. artery Aorta SVC Carotid Centres 1 = 1 = No. 4 = 1 = = 1 Mean Range , =, - : increase, no change, or decrease compared to 1999
33 Other procedures 2-6 FB removal Emboln. Pericard. Pressure Wire Flow Wire Septal Abln. Embolis n Protection Device Centres = 2 = 1 = 1 = 4 Number Mean Range , =, - : increase, no change, or decrease compared to 1999
34 Centres providing complete or near complete data on Hospital Outcome 2 (18) Aberdeen Birmingham Heartlands Guy s & St Thomas s King s College Hospital Walsgrave, Coventry Royal Free Hospital Stoke City General Southampton St George s James Cook UH, Middlesbrough Nottingham City Hospital Royal Devon & Exeter KE VIIth, Midhurst Sandwell Hospital Royal Sussex County, Brighton Ayrshire & Arran RCH Truro Heart Hospital
35 Hospital Outcome 2 All patients Data from 18 centres No. (centres) 896 (18) Success 92% (86-1) Partial Success 1.6% (-2.1) Failed 3.9% (-7.9) Repeat PCI.5% (-.9) CABG MI Death (Range).5% (-9.1).8% (-3.1) 1.1% (-2.7)
36 Hospital Outcome Death (with 95% CI) Data from 18 centres
37 Hospital Outcome Freedom from MACE rates (with 95% CI) Data from 18 centres
38 Hospital Outcome Em. CABG (with 95% CI) Data from 17 centres
39 Hospital Outcome Failed Procedures (with 95% CI) Data from 18 centres
40 Examples of different case-mix Centre Elective No CTO CTO cases UA Shock Non-shock MI cases Post MI 1 (n=343) 2 (n=963) 3 (n=749) 4 (n=131) 5 (n=1) 29% 3.8% 31% 2.3% 11% 22% 44% 7.5% 27%.3% 6.3% 16% 35% 2.9% 18% 2% 18% 24% 77% 12% 11% % % % % % 5% % 2% 3%
41 Hospital Outcome 2 Elective patients Stable Single Ves (no CTO) No. (centres) 3448 (15) Success 96% (88-97) Partial Success.2% (-1.2) Repeat PCI.3% (-1.2) CABG MI Death (Range).3% (-1.1).5% (-1.6).12% (-.5) Stable Multivessel (no CTO) Single Ves CTO * Multivessel Inc. CTO * 912 (14) 47 (14) 241 (13) 92% (85-1) 64% (45-91) 8% (4-1) 3.9% (-6.7) 1.% (-5.3) 14% (-37).2% (-.8).2% (-1.4).3% (-1.4).2% (-1.).8% (-1.5).5% (-2.) % %.4% (-2.2).5% (-3.9) %.4 % (-2.9) * does not account for clinical syndrome
42 Hospital Outcome 2 Patients with previous CABG and those treated for restenosis No. (centres) CABG pts * 97 (14) Restenosis * 45 (15) Success 9% (8-97) 93% (79-1) Partial Success 2.1% (-8.9) 1.% (-1.9) Repeat PCI.3% (-2.2).7% (-2.9) CABG MI Death (Range).2% (-2.9) 1.5% (-1) 1.3% (-6.7).5% (-2) 1.% (-4.4).7% (-3.1) * does not account for clinical syndrome
43 Hospital Outcome 2 Unstable angina No. (Centres) Success Partial Success Repeat PCI CABG Q MI Death (Range) Single Ves UA 1945 (17) 93% (67-1).6% (-2.7).8% (-4.2).6% (-33).6% (-3.3).9% (-1.6) Multivessel UA 488 (14) 9% (83-1) 6.8% (-15).8% (-2.6).2% (-5).4% (-1.5).6% (-4.2)
44 Hospital Outcome 2 Acute closure No. (Centres) Success Partial Success Repeat PCI CABG Q MI Death (Range) Acute closure 68 (12) 81% (4-1) 1.5% (-2) 4.4% (-1) 1.5% (-2) 8.8% (-1) 1% (-1)
45 Hospital Outcome 2 Acute MI patients No. (Centres) Success Partial Success Repeat PCI CABG re-mi Death (Range) Primary PTCA 163 (13) 86% (6-1).6 % (-7.7) 1.2% (-2).6 % (-5) 4. % (-17) 4.9% (-4) Salvage PTCA 242 (15) 88% (59-1) 1.7% (-7.4) 1.2% (-5.9) 1.7% (-1) 1.2% (-1) 6.2% (-26) Re-MI PTCA 166 (1) 87% (-1) 3% (-6) 2.4% (-1) 2.4% (-6.3) 1.2% (-1) 6% (-13) Shock 92 (13) 55% (-1) 1.% (-2) 4.% (-1) 2.% (-4) 1% (-6.3) 39% (19-1)
46 Hospital Outcome 2 Post MI patients No. (Centres) Success Partial Success Repeat PCI CABG Re- MI Death (Range) Post MI UA 986 (14) 94% (86-1) 1.2% (-5.6).6% (-2.8).9% (-2.5).9% (-5.3) 1.% (-2.8) Post MI Stable/ETT 319 (8) 95% (88-1).9% (-5.9) %.6% (-1.9).9% (-1.7).3% (-1) ALL MI Patients 1498 (15) 89% (67-95) 1.% (-5) 1.1% (-4.3) 1.2% (-5.5) 1.2% (-6.5) 5.% (-2)
47 Hospital Outcome Elective Single Vessel PCI (no CTO) Success (Freedom from MACE) rates (with 95% CI) Data from 15 centres
48 Hospital Outcome Elective Single Vessel PCI (no CTO) Mortality rates (with 95% CI) Data from 15 centres
49 Hospital Outcome Cardiogenic Shock PCI (Primary or Rescue) Mortality rates (with 95% CI) Data from 15 centres of
50 Comparison of data reported from a single centre with other contributing centres Syndrome No Success or Partial Succ. CBG MI or re-mi Death Elective (96%) 1V No CTO (96%) 1 (.3%) 18 (.6%) 4 (.1%) All Unstable (96%) Angina (94%) 13 (.6%) 14 (.6%) 2 (.9%) Rescue 5 47 (92%) 2 (4%) PCI (89%) 4 (2.1%) 3 (1.6%) 13 (6.8%) All Shock PCI (Primary & Rescue) 15 1 (67%) 5 (33%) (54%) 2 (3%) 1 (1.4%) 31 (4%)
51 BCIS/CCAD Update CCAD Questionnaire DoH Meeting, November 21 NHSIA Meeting to revisit datasets Phased participation over 22? Pressure on Trusts/Commissioners
52 BCIS/CCAD Update Data Set Parallel Projects A = Centre B = Bean Count C = Outcome data by Syndrome
53 BCIS New Technologies Group - Registries Brachytherapy Endicor X-sizer
54 BCIS/CCAD Update Conclusions Continued growth in PTCA (84% stented, 22-23% with GP IIb/IIIa) but still lagging behind European/American centres Still a lot of low volume operators Expansion of PCI activity appears to have been achieved in 2 ways higher numbers of PCIs performed in a small number of hands increased numbers of operators (presumably attending consultants from other hospitals)
55 BCIS/CCAD Update Conclusions Data submission still incomplete - questionnaire to establish what is needed. Encouraging noises from DoH re CCAD BCIS will continue current data collection system even for those units who start to use CCAD Current system provides some means of benchmarking New Technologies Registries may not be effective on a voluntary basis (CCAD could overcome this)
56 Clinical Governance Individual outcomes to be public within a year Hospital Doctor 18th October 21 DoH considering a proposal from Dr Foster
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