National Cardiovascular Disease Database Percutaneous Coronary Intervention (PCI) Registry Malaysia NCVD-PCI Registry – Are We Any Different? Presented.

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Presentation transcript:

National Cardiovascular Disease Database Percutaneous Coronary Intervention (PCI) Registry Malaysia NCVD-PCI Registry – Are We Any Different? Presented by: ROSLI Mohd Ali Chairman of NCVD-PCI Registry Hilton Kuala Lumpur 30th July 2009 (Malaysia LIVE 2009) National Cardiovascular Disease Database (NCVD)

PCI Registry Participating Sites HUSM PH QEH SDMC DSH KPJSSH SUNMED SH IJN UMMC HUKM SGH HSAJB * Active sites National Cardiovascular Disease Database (NCVD)

NCVD-PCI Registry Participating sites: PH Penang Hospital SDMC Sime Darby Medical Centre UMMC University Malaya Medical Centre DSH KPJ Damansara Specialist Hospital KPJSSH KPJ Selangor Specialist Hospital SUNMED Sunway Medical Centre SH Serdang Hospital HUSM Universiti Sains Malaysia Hospital HSAJB Sultanah Aminah Hospital SGH Sarawak General Hospital QEH Queen Elizabeth Hospital IJN Institut Jantung Negara HUKM Universiti Kebangsaan Malaysia Hospital National Cardiovascular Disease Database (NCVD)

(based on unclean data) NCVD-PCI Registry Results as of 9th April 2009 (based on unclean data) National Cardiovascular Disease Database (NCVD)

As of 9th April 2009: Total PCI Procedures done 8,236 Total Lesions treated 11,508 Total Stents Used for procedures 13,150 Follow Up Total 30 Days Follow Up done 3,470 Total 6 Months Follow Up done 1,700 National Cardiovascular Disease Database (NCVD)

Patient Demographics Age Min, Max Mean ± sd 22, 95 years Age <40 years 0.33 % Age >40 years 0.55% Gender Male 81.99 % Female 18.01 % National Cardiovascular Disease Database (NCVD)

Clinical Presentation Previous Interventions Previous PCI 22.21 % Previous CABG 4.02 % Acute Coronary Syndrome (n=2,039) 24.76 % STEMI 44.92 % NSTEMI 32.81 % Unstable Angina 19.86 % National Cardiovascular Disease Database (NCVD)

Clinical Background & CV Risk Factors Baseline (n=8,236) Dyslipidaemia 73.42 % Hypertension 73.03 % Diabetes 45.41 % OHA 77.94 % Insulin 13.60 % Chronic Renal Failure 6.23 % Family history of premature CVD 16.57 % MI History 38.19 % Documented CAD 55.28 % National Cardiovascular Disease Database (NCVD)

Clinical Background & CV Risk Factors Baseline (n=8,236) New Onset Angina (< 2 weeks) 23.08 % Congestive Heart Failure (> 2 weeks prior) 3.68 % Chronic Lung Disease 1.29 % Cerebrovascular Disease 1.51 % Peripheral vascular disease 1.03 % National Cardiovascular Disease Database (NCVD)

Clinical Background & CV Risk Factors Baseline (n=8,236) Smoking status Never 36.78 % Former (quit >30 days) 27.84 % Current (any tobacco use within last 30 days) 18.43 % Not Available 16.95 % National Cardiovascular Disease Database (NCVD)

PCI Status Elective (n=7,439) Staged PCI 90.32 % 22.06 % Baseline (n=8,236) Elective (n=7,439) Staged PCI 90.32 % 22.06 % Urgent (NSTEMI/UA) 4.66 % Rescue 2.09 % Primary 2.48 % Missing 0.45 % Cath/ PCI in same setting (ad hoc) 84.12 % National Cardiovascular Disease Database (NCVD)

PCI Procedures AHA-ACC Lesion Morphology Type A 11.76 % B1 25.14 % B2 Baseline (n=11,508) AHA-ACC Lesion Morphology Type A 11.76 % B1 25.14 % B2 19.38 % C 39.45 % Missing 3.47 % National Cardiovascular Disease Database (NCVD)

PCI Procedures Lesion Description Ostial 6.33 % Bifurcation 7.69 % Baseline (n=11,508) Lesion Description Ostial 6.33 % Bifurcation 7.69 % CTO < 3 mo 3.02 % CTO > 3 mo 7.10 % Thrombus 3.21 % Not Applicable 70.20 % National Cardiovascular Disease Database (NCVD)

PCI Procedures Pre-stenosis %, 84.52 ± 12.08 Post-stenosis %, Baseline (n=11,508) Pre-stenosis %, 84.52 ± 12.08 Post-stenosis %, 3.94 ± 17.08 TIMI Flow 0 11.44 % 0 1.77 % 1 4.13 % 1 0.37 % 2 15.53 % 2 1.10 % 3 63.21 % 3 90.98 % National Cardiovascular Disease Database (NCVD)

PCI Procedures Intracoronary Devices Used (% of lesions treated) No device used 2.58 % Balloon only (POBA) 7.69 % Bare Metal Stent 38.40 % Drug Eluting Balloon 2.67 % Distal Embolic Protection (n=15) Filter 0.47 % 96.30 % Cutting Balloon 2.20 % National Cardiovascular Disease Database (NCVD)

PCI Procedures Intracoronary Devices Used (% of lesions treated) Drug Eluting Stent 46.23 % Flowire 0.01% IVUS 3.86 % Rotablator 0.85 % Others (eg. Thromboaspiration) 3.53 % Closure Device 5.12 % National Cardiovascular Disease Database (NCVD)

*‘Other’ refers to stent other than listed in the Reference Stent List PCI Procedures Stent type used Drug Eluting Stent 56.67 % Bare Metal Stent 40.55 % Bio-absorbable stent 0.04 % Antibody-coated 2.30 % Other stent 0.41 % Baseline (n=13,150) *‘Other’ refers to stent other than listed in the Reference Stent List National Cardiovascular Disease Database (NCVD)

Percentage of stent type by total number of stents used (n=13,150) *‘Other’ refers to stent other than listed in the Reference Stent List National Cardiovascular Disease Database (NCVD)

PCI Procedures Procedural Characteristics Stent length (mm) 22.52 ± 7.32 Stent diameter (mm) 2.99 ± 0.46 Lesion length (mm) 23.87 ± 14.7 Max balloon size (mm) 3.06 ± 0.58 Max stent/balloon deploy pressure (mm) 15.77 ± 3.81 Direct stenting 18.67 % Baseline (n=11,508) National Cardiovascular Disease Database (NCVD)

Procedural Complications Baseline (n=8,236) Periprocedural MI 0.44 % Emergency Reintervention (n=20) Stent thrombosis Dissection Perforation Others 0.24 % 50.00 % 35.00 % 0.00 % 30.00 % Bail-out CABG 0.04 % Cardiogenic Shock 0.53 % Arrhythmia (VT/VF/Brady) 0.61 % TIA/ Stroke 0.05 % Tamponade National Cardiovascular Disease Database (NCVD)

Procedural Complications Baseline (n=8,236) Contrast Reaction 0.06 % New onset/ worsened heart failure 0.11 % New renal impairment 0.16 % Vascular Complications Bleeding Yes (n=28) 0.74 % Minor 13.11 % Major 8.20 % Minimal 68.85 % No 97.29 % *For 162 cases, the information on Bleeding Complications are Missing National Cardiovascular Disease Database (NCVD)

In Hospital Outcome Outcome Alive 98.14 % Death 1.03 % Baseline (n=8,236) Outcome Alive 98.14 % Death 1.03 % Transferred to other centre 0.04 % Missing 0.79 % National Cardiovascular Disease Database (NCVD)

In Hospital Outcome Cause of Death (n=85) Cardiac 88.24 % Vascular 4.71 % Renal 1.18 % Pulmonary Missing 2.35 % Location In lab 5.88 % Out of lab 90.59 % National Cardiovascular Disease Database (NCVD)

Location lesion treated Percentage of lesion treated (%) *There is missing information for 340 lesions treated ** Based on real-time data in NCVD-PCI Registry

Left Main Stem PCI & Outcomes (n=210) In-hospital (%) 30 days FU (%) Alive 94.8 34.8 Death 5.2 - Follow Up Not Available 65.2 National Cardiovascular Disease Database (NCVD)

Acute Coronary Syndrome (ACS) & Outcome Total Procedure n % ACS 2039 24.8 STEMI 916 44.9 NSTEMI 669 32.8 UA 405 19.9 Missing 49 2.41 Stable CAD 6080 73.8 117 1.42 Total 8236 100 National Cardiovascular Disease Database (NCVD)

Acute Coronary Syndrome & Outcome ACS stratum Outcome at discharge (%) (N=8,236) Outcome at 30 days FU (%) (N=8,123) Alive Death Missing Lost to FU ACS 23.9 0.7 0.15 10.9 13.4 Stable 73.0 0.2 0.5 29.1 45.0 1.3 0.04 0.21 0.6 National Cardiovascular Disease Database (NCVD)

Follow Up Outcome Outcome At Discharge At 30 Days At 6 months Alive 98.14 % 96.54 % 96.06 % Death 0.69 % 0.41 % Transferred 1.04 % 0.06 % Lost to FU - 2.71 % 3.47 % Missing 0.78 % Total 30 Days FU done = 3,470 as of 9th April 2009 Total 6 months FU done = 1,700 as of 9th April 2009 National Cardiovascular Disease Database (NCVD)

Follow Up Outcome Follow Up Duration At 30 Days (n=244) At 6 months Readmission 7.03 % 6.71 % Readmission Reason CHF 1.64 % 2.63 % Recurrent Angina 11.07 % 7.89 % PCI – planned 56.97 % 42.11 % PCI – unplanned 2.87 % 6.14 % AMI 4.39 % CABG 0.82 % Others 14.75 % 27.19 % Missing 9.84 % National Cardiovascular Disease Database (NCVD)

Inaugural Annual Report of the NCVD-PCI Registry 2007 Will be available soon at www.acrm.org.my/ncvd Inaugural Annual Report of the NCVD-PCI Registry 2007

Acknowledgements Ministry of Health Malaysia National Heart Association of Malaysia (NHAM) Clinical Research Centre (CRC), Hospital Kuala Lumpur National Cardiovascular Disease Database (NCVD) team NCVD-PCI Registry Participating Centres  Datamed Computing Services Sdn Bhd ClinResearch Sdn Bhd Nurses, Doctors, Coordinators, RAs & all ground staff involved in data collection National Cardiovascular Disease Database (NCVD) National Cardiovascular Disease Database (NCVD) 31

THANK YOU Prepared by: NCVD Management Team, July 2009 National Cardiovascular Disease Database (NCVD)