PCI in Asia Pacific Region Angioplasty Summit TCT Asia Pacific 2006 27 th April 2006
PCI inasia Pacific Region Pakistan Bangladesh Brunei Philipines
AUSTRALIA Started 1981 Population: 20.5 million Growth of PCI 40000 30000 30,040 20000 10000 0 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 No. of PCI
AUSTRALIA Population in mid 2004 : 20.5 million Australia & New Zealand Number of Cases in 2004: PCI ~ 35,000 Number of stents: 53000 Number of stents per pt 1.4 to 1.7 per pt Number of stents in 2004: BMS 23000 DES 30000 = 56.6% PCI institutions 85
NEW ZEALAND Started 1981 Population: 4.1 million 5000 4000 3000 2000 1000 Growth of PCI 5,000 0 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 No. of PCI
NEW ZEALAND Population in mid 2004 : 4.1 million Number of Cases in 2004: 4948 Number of stents in 2003: BMS 6000 DES 922 = 13.3 % Number of centres in 2004: 11 Number of Interventionalists: 30 Who performs peripheral intervention: Mostly Radiologists Some renal, carotid & stenting by Cardiologists
BANGLADESH Started 1995 3000 Growth of PCI 2,726 2500 2000 1500 1000 500 0 2005 2005 Dr. Sufia Rahman
BANGLADESH Number of Cases: 2726 [2004] Number of stents: 3913 Number of DES: 926 Number of centres: 11 Number of Interventionalists: 25 Number of peripheral intervention: 510
BRUNEI Started in 2003 Population: 383,744 250 229 240 200 150 145 100 50 0 2002 2003 2004 2005 No. of PCI Dr. Patrick Ang drpatrick_ang@gleneaglesjpmc.com.bn
BRUNEI Population 2004 : 383,744 Number of centres: 1 Number of Interventionalists: 1 Stents/ patient : 397/240 = 1.65 Drug-Eluting Stents Cypher (Sirolimus-Eluting Stent) Aug 2004 Taxus (Paclitaxel-Eluting Stent) May 2003 % DES 95% in 2004 96.5% in 2005 DES for all cases except Large vessels > 3.5mm Who performs peripheral intervention: Renal: Interventional Cardiologist Iliac: Interventional Cardiologist
CHINA Started 1984 Population: 1,300.1 million 50,000 Growth of PCI 50,000 40,000 30,000 20,000 10,000 Dr. Gao Runlin grl@public.bta.net.cn 0 2004 2004
CHINA Population in mid 2004 : 1,300.1 million Number of Cases a year: ~ 50,000 [2004] Number of BMS: ~ 54,000 Number of DES: ~ 36,000 ~ 40% Number of centres: ~ 250 Number of Interventionalists: ~ 500 Who performs peripheral intervention: Cardiologists Radiologists Neurologists
HONG KONG Started 1984 Population: 6.8 million Growth of PCI in 2004 ~ 5700 6,000 5,000 4,000 3,000 2,000 1,000 0 800 4,900 Private Public Dr. Michael Lee kylee1991@hotmail,com Public Private
HONG KONG Population 6.8million Number of centres: 10 cath labs in public hospitals 5 cath labs in private sector (8 centres annual case volume <150) Number of Interventionalists: 100 [not many are high volume operators] Who performs peripheral intervention: interventional cardiologists interventional radiologists Audit: Complication rate: Overall mortality 0.6% All-cause Complications 1.8% Dr. Michael Lee kylee1991@hotmail,com
HONG KONG Drug-Eluting Stents % DES almost 100% in private practice ~ 60% in public sector Dr. Michael Lee kylee1991@hotmail,com
INDIA Started 1985 Population: 1,086.6 million 40000 35000 30000 29715 23228 31382 25933 36363 32665 25000 20000 15000 10000 5000 0 2002 2003 2004 Industry Data Rec Interventional Council of India
INDIA Population 1086.6million Number of centres: 86 Audit: Complication rate: Overall mortality 0.6% Complications 1.8% Interventional Council of India
INDIA 20000 DRUG ELUTING STENTS 16941 15000 10000 5000 1715 8472 0 2002 2003 2004 DES Interventional Council of India
INDONESIA Started 1987 Population: 219 million Growth of PCI 5000 4000 3000 4227 2000 1000 0 1999 2000 2001 2002 2003 No. of PCI
INDONESIA Population 219 million Indonesian Association of Interventional Cardiology Number of centres: 12 (8 centres annual case volume <150) Number of Interventionalists: 25 30 Who performs peripheral intervention: Carotid: Interventional Cardiologist (1 centre) Renal: Interventional Cardiologist Interventional Radiologist Aorto-Iliac: Interventional Cardiologist Interventional Radiologist Iliac: Interventional Cardiologist Interventional Radiologist Aortic Aneurysm: interventional Cardiologist (1 centre)
INDONESIA Drug-Eluting Stents Cypher (Sirolimus-Eluting Stent) July 2002 Taxus (Paclitaxel-Eluting Stent) June 2003 Excel (Sirolimus-Eluting Stent) January 2004 Infinium (Paclitaxel) April 2004 % DES 60% to 70% in private practice 30% to 40% in public sector 1. if cost not an issue, in most except in SVGs Large vessels > 3.5mm 2. Highly restenotic lesions: Small vessels Long lesions Diabetics
JAPAN Started 1981 Population: 127.6 million 180,000 160,000 140,000 120,000 100,000 80,000 60,000 40,000 20,000 0 Growth of PCI 2004 167,000 Dr. Hideo Tamai tamai@cct.gr.jp 2004
JAPAN Population in mid 2004 : 127.6 million Number of Cases a year: 167,000 [2004] 70% of cases receive stents 70% of stents are Cypher Number of centres: 1,300 Number of Interventionalists: 2,500-3,000 Who performs peripheral intervention: Cardiologists Neurosurgeons Radiologists
Korea Started 1983 Population: 48.2 million 30000 Growth of PCI 25000 20000 15000 10000 5000 0 2000 2001 2002 2003 2004 2000 2001 2002 2003 2004
Korea Population in mid 2004 : 48.2 million Number of Cases a year: 27,000 [2004] Number of centres: 89 Number of Interventionalists: 258 68% of PCI was DES in 2003 97% of PCI was DES in 2004 Who performs peripheral intervention: Carotid: Interventional Cardiologist Renal: Interventional Cardiologist / Interventional Radiologist Iliac: Interventional Cardiologist / Interventional Radiologist Femoral : Interventional Cardiologist / Interventional Radiologist Subclavian : Interventional Cardiologist
MALAYSIA Started 1984 Population: 26.5 million 8000 6000 4000 2000 Growth of PCI 7192 7000 0 1999 2000 2001 2002 2003 2004 2005 No. of PCI
Cardiac Services with Invasive Cardiology and Cardiac Surgery 2005 33 6 2 1 1 3 1 12 2 3 2
Total No of Cardiologist in Malaysia - 2005 144 24 2 4 3 7 1 78 6 10 9
MALAYSIA Started 1984 Growth of Cath Labs 30 25 20 15 10 5 0 30 1999 2000 2001 2002 2003 2004 No. of Cath Labs
MALAYSIA Started 1984 DES Penetration 80% 60% 63% 40% 20% 0% 2002 2003 2004 up to 6 '05 DES penetration
MALAYSIA Interventional Cardiovascular Society of Malaysia (ICSM) Number of Centres: 33 Number of Interventionalists: 144 Population in mid 2004: 26.5 million Who performs peripheral intervention: Carotid: Interventional Cardiologist/Radiologist Renal: Interventional Cardiologist/Radiologist Aorto-Iliac: Interventional Cardiologist/Radiologist/ Vasc Surgeon Iliac: Interventional Cardiologist/Radiologist/ Vasc Surgeon Aortic Aneurysm: Interventional Cardiologist/Radiologist/ Vasc Surgeon
PAKISTAN Started 1985 Population: 159.2 million 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 Growth of PCI 8,127 5,923 2004 2005 No. of PCI
PAKISTAN Population in mid 2004 : 159. 2 million Number of cases Stents/Patient % DES No. Interventional Cardiologists No. Cardiac Centres No. Cath Labs 2004 8127 ~ 40-45 16 2005 5923 12,631/5923 = 2.1 5010/12,631 = 39.7% ~ 50 60 26 47 Mujeed-ul- Haq
PHILIPPINES Started 1989 Population: 84,174,092 Growth of PCI 1200 1,200 1,000 800 600 400 200 0 2004 No. of PCI
PHILIPPINES Population in mid 2004 : 84,174,092 Number of Cases a year (2004) : 1200 Number of centres: 13 Number of Interventionalists: 62 Stents: BMS 190 DES 1800 DES penetration 90%
SINGAPORE Started 1984 Population: 3,547,809 5000 4000 3000 2000 1000 Growth of PCI ~ 4500-5000 0 1999 2000 2001 2002 2003 2004 1999 2000 2001 2002 2003 2004
SINGAPORE Population in mid 2004 : 3,547,092 Number of Cases a year: 4500-5000 Stents used : BMS 190 DES 1836 (~ 1.7 DES/ procedure) DES penetration: 99% private practice 30% public sector Number of centres: 5 Number of Interventionalists: ~ 24 Who performs peripheral intervention : Mostly Cardiologists
THAILAND Started 1989 Population: 63.8 million Growth of PCI 5000-6000 6000 5000 4000 3000 2000 1000 0 1999 2000 2001 2002 2003 2004 1999 2000 2001 2002 2003 2004 Dr. Damras Tresukosol sidts@mahidol.ac.th
THAILAND Population in mid 2004 : 63.8 millions Coronary Intervention Club Number of centres: 24 (2003) 35 (2004) Number of Interventionalists: 48 (2003) 50 (2004) Who performs peripheral intervention: Cardiologists [rarely] Radiologists
THAILAND Drug-Eluting Stents Cypher (Sirolimus-Eluting Stent) August 2002 Taxus (Paclitaxel-Eluting Stent) April 2003 % DES 30% (2004) Specific group where DES preferred: Diabetics Small vessels Long lesions Left main Ostial
VIETNAM Population: 82,851,971 1500 Growth of PCI 1,382 1000 500 0 1999 2000 2001 2002 2003 No. of PCI
VIETNAM Number of centres: 8 Number of interventionalists: 15 Who performs peripheral intervention: Carotid: Interventional Cardiologist Vascular Surgeon Renal: Interventional Cardiologist Interventional Radiologist Vascular Surgeon Aorto-Iliac: Interventional Cardiologist Interventional Radiologist Vascular Surgeon Aortic Aneurysm: Vascular surgeon
VIETNAM Drug-Eluting Stents Cypher (Sirolimus-Eluting Stent) July 2002 % DES 35% (2004) Specific group where DES preferred: Diabetics Small vessels Long lesions Prox LAD CTO ISR
PTCA TREND IN ASIA PACIFIC Presented @ World Congress in 2002: Prof Y L Lim 160000 140000 120000 100000 80000 60000 40000 20000 0 1997 1998 1999 2000 2001 Phillipines Thailand Pakistan New Zealand Malaysia Japan S.Korea India China Bangledash Aust ralia Australia Bangledash China India S.Korea Japan Malaysia New Zealand Pakistan Thailand Phillipines
PTCA TREND IN ASIA PACIFIC 180000 160000 140000 120000 100000 80000 60000 40000 20000 0 1997 1998 1999 2000 2001 2004 Singapore Phillipines Thailand Pakistan New Zealand Malaysia Japan S.Korea India China Bangledash Australia Australia Bangledash China India S.Korea Japan Malaysia New Zealand Pakistan Thailand Phillipines Singapore
PCI in Asia Pacific Region PCI is growing Use of DES: rapid growth esp in private practice Need of Registry