BWGIC survey Victor Legrand Yves Taeymans. PCI 2004 : procedures n= 23426.

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Presentation transcript:

BWGIC survey Victor Legrand Yves Taeymans

PCI 2004 : procedures n= 23426

Patients characteristics Age : 67+/- 12 years Male : 73.4% Diabetes : 18.3% insulin dep : 5.4% PVD : 10.8 % Renal failure : 2.7% Hx PCI : 27.6% Hx CABG : 11.6% Hx Qwave MI : 18.7% 1VD : 41.6% 2VD : 31.8% 3VD : 23.1% LVEF<35% : 7.1% Shock : 2.1%

PCI 2004 : indications n= 23426

Number of PCI per center >400 >200>1000

PCI for acute STEMI Mean : /-0.2% 7.3% to 85.7%

In-hospital outcomes No MACCE :94% Death :1.6% CVA :0.2% Qwave MI :0.9% nonQwave MI :2.3% CABG :0.4% PCI :0.7% Bleeding :0.5% Vascular complic. :0.6% CPR :0.7% Unplanned dialysis :0.1%

> 400 PCI n = < 400 PCI n = 1899 P value Age (yrs)66±1765±12NS Male15821 (73.5%)1369 (72.1 %)NS Creatinine >22mg/dl589 (2.7 %)47 (2.5 %)NS PVD2302 (10.7 %)198 (10.4 %)NS Diabetes total insuline dep (18 %) 1143 (5.3 %) 397 (20.9 %) 120 (6.3 %) Pre MI4001 (18.6 %)391 (20.6 %)0.03 Pre PCI6024 (28 %)444 (23.4 %) Pre CABG2505 (11.6 %)207 (10.9 %)NS

> 400 PCI n = < 400 PCI n = 1899 P value STEMI (post lysis) 3095 (14.4 %) 668 (3.10 %) 403 (21.2 %) 110 (5.8 %) UA II C1658 (7.7 %)135 (7.1 %)NS UA II/III B4946 (23 %)476 (25.1 %)0.04 Shock430 (2.0 %)65 (3.4 %) VD 2 VD 1 VD 5041 (23.4 %) 6921 (32.1 %) 8798 (40.9 %) 379 (19.9 %) 536 (28.2 %) 958 (50.4 %)

> 400 PCI n = < 400 PCI n = 1899 P value PCI RCA ( ) LM (5) IVA (6+7) 7154 (33.2 %) 318 (1.5 %) 7014 (32.6 %) 691 (36.4 %) 19 (1.0 %) 603 (31.7 %) NS 0.04 GP II b/III a inhibitors4229 (19.6 %)622 (32.7 %) IAPB303 (1.4 %)33 (1.7 %)NS Staged PCI 2x 3x 1672 (7.8 %) 148 (0.7 %) 118 (6.2 %) 10 (0.5 %) 0.02 NS

>400 PCI n = < 400 PCI N = 1899 P value Death302 (1.4 %)70 (3.7 %) Non QMI456 (2.1 %)81 (4.3 %) QMI173 (0.8 %)31 (1.6 %) CVA47 (0.2 %)6 (0.3 %)NS Re PCI130 (0.6 %)19 (1.0 %)0.05 CABG70 (0.3 %)16 (0.8 %) Dialysis26 (0.1 %)4 (0.2 %)NS Vasc./Bleed. complications224 (1.0 %)13 (0.7 %)NS

> 1000 PCI n = PCI n = PCI n = PCI n = 823 Age (yrs)66 ± 2065 ± 1564 ± 1266 ± 12 Male8285 (73.3 %)7536 (73.7 %)799 (74.2 %)570 (69.2 %) Creat.>22mg289 (2.6 %)300 (2.9 %)16 (1.5 %)31 (3.8 %) PVD1104 (9.8 %)1198 (11.7 %)113 (10.5 %)85 (10.3 %) Diabetes insuline dep (16.8 %) 560. (4.9 %) 1969 (19.3 %) 583 (5.7 %) 231 (21.5) 80 (7.4 %) 166 (20.2) 40 (4.9 %) Pre MI1971 (17.4 %)2030 (19.9 %)253 (23.5 %)138 (16.8 %) Pre PCI2901 (25.6 %)3123 (30.6 %)278 (25.8 %)166 (20.2 %) Pre CABG1300 (11.5 %)1205 (11.8 %)123 (11.4 %)84 (10.2 %)

> 1000 PCI n = PCI n = PCI n = PCI n = 823 STEMI (post lysis) 1643 (14.5 %) 410 (25 %) 1452 (14.2 %) 258 (17.8 %) 198 (18.4 %) 31 (15.6 %) 207 (25.1 %) 79 (38.2 %) UA II C829 (7.3 %)829 (8.1 %)77 (7.1 %)58 (7.0 %) UA II/III B2629 (23.2 %)2317 (22.7 %)273 (25.4 %)203 (24.7 %) Shock227 (2 %)203 (2 %)40 (3.7 %)25 (3.0 %) 3 VD 2 VD 1 VD 2676 (23.7 %) 3687 (32.6 %) 4497 (39.8 %) 2365 (23.1 %) 3234 (31.6 %) 4301 (42.1 %) 193 (17.9 %) 293 (27.2 %) 566 (52.6 %) 186 (22.6 %) 243 (29.5 %) 392 (47.6 %)

> 1000 PCI n = PCI n = PCI n = PCI n = 823 PCI RCA(1-4) LM(5) IVA (6+7) 3607 (31.9 %) 200 (1.8 %) 3850 (34.0) 3547 (34.7 %) 118 (1.1 %) 3164 (31.0) 361 (33.6 %) 12 (1.1 %) 375 (34.8 %) 330 (40.1 %) 7 (0.8 %) 228 (27.7 %) GPIIb/IIIa1722 (15.7 %)2507 (24.5 %)346 (31.6 %)276 (33.5 %) IABP148 (1.3 %)155 (1.5 %)19 (1.8 %)14 (1.7 %) Staged PCI 2x 3x 997 (8.8 %) 98 (0.9 %) 675 (6.6 %) 50 (0.5 %) 75 (7.0 %) 6 (0.5 %) 43 (5.2 %) 4 (0.5 %)

>1000 PCI n = –1000 PCI n = – 400 PCI n = PCI n = 823 Death161 (1.42 %)141 (1.38 %)41 (3.81 %)29 (3.52 %) Non QMI246 (2.17 %)210 (2.06 %)51 (4.74 %)30 (3.64 %) QMI36 (0.37 %)137 (1.34 %)20 (1.86 %)11 (1.34 %) CVA28 (0.25 %)19 (0.18 %)4 (0.37 %)2 (0.24 %) Re PCI71 (0.63 %)59 (0.58 %)12 (1.11 %)7 (0.85 %) CABG30 (0.26 %)40 (0.39 %)11 (1.0 %)5 (0.61 %) Dialysis8 (0.07 %)18 (0.18 %)2 (0.18 %)2 (0.24 %) Vasc./ Bleed.67 (0.59 %)157 (1.54 %)11 (1.0 %)2 (0.24 %)

Predictors of death multivariate logistic analysis BS.E.WalddfpExp(B) Volume Volume 1 Volume2 Volume3 ASTEMI PCI1Age Sex Cardshk constant Variables entered on step 1 : Volume,ASTEMI,PCI1Age,Sex,Cardshk

Predictors of mortality

Predictors of MACCE* multivariate logistic analysis BS.E.WalddfpExp(B) Volume Volume 1 Volume2 Volume3 ASTEMI Sex Cardshk PCI1Age constant Variables entered on step 1 : Volume,ASTEMI,Sex,Cardshk,PCI1Age *excluding death

Predictors of MACCE* *excluding death