St Asaph - November 2015 Dr Richard Anderson Consultant Cardiologist Senior Lecturer University Hospital of Wales, Cardiff, UK Wales Audit Data Stable Angina PCI and CTO

Definitions Stable PCI – all elective PCI excluding acute STEMI/NSTEMI – Can include OP staged post STEMI patients Four PCI centres – UHW - Cardiff – MH - Swansea – NWCC - Glan Clwyd – RGH - Newport Period 1 st Apr 2014 to 31 st Mar 2015 UHW + GWE 2014 calender year Comparison with BCIS UK 2014 PCI data

Thank you for the data Shantu Bundhoo Paul Das Steve Dorman

PCI Numbers by Centre

UHW – 26% MOR % YGC – 29.5% GWE – 45.5%

Radial Access Site by Centre All indications

Optical Coherence Tomography Ruptured thin cap atheromatous plaque Coronary Intramural haematoma

Procedural techniques by centre All PCI Indications

Death or need for Emergency CABG (%) Stable PCI Only 11

Chronic Total Occlusions (CTO’s) A chronic total occlusion (CTO) is defined - complete occlusion of the coronary vessel with TIMI 0 flow, present for an (estimated) duration of ≥3 months. A = Occluded Vessel F = Restablishing antegrade blood flow B = Collateral fiiling of distal coronary bed

Reduction in ischemic burden Enable completeness of revascularization Improvement of symptoms Improvement in LV function Reduced predisposition to arrhythmic events and ischemic events Avoidance of procedures and reduced medications Survival benefit Chronic Total Occlusions (CTO’s) Why do them?

What are the downsides? Technical and procedural challenges (radiation, contrast etc...) Misperceptions regarding viability, collateral flow Uncertainty regarding which patients may benefit Concern for complications in patients who may not derive much/any clinical benefit Centre – long cases and take up valuable cath lab session (1-2 hours+)

CTO Numbers by Centre

YGC – 12.4% MOR – 19% UHW – 18% GWE – 16.5%

No reported mortalities in the Welsh centres for the financial year 2014/5

UHW

GWE

Glan Clwyd YGC

MOR

Operator Specific data

Summary Stable PCI numbers PMP in Wales below the national UK average Outcomes are V good Contemporaneous adjunctive techniques CTO numbers are in line with the UK volume – Subspecialization is advised per centre to maximize expertise and improve patient outcomes.

Many thanks