1. C hinese D atabase for C ardiovascular S urgery Questions and Thoughts Shengshou Hu M.D. President, Cardiovascular Institute & Fuwai Hospital Director, National Center for Cardiovascular Disease Prevention and Treatment

2. STS Adult CV national database  The biggest cardiovascular surgical database  Since 1994  681 sites*  Cumulative number: >2,100,000* *Data from STS Fall 2006 Report Background

3. Adult Cardiac Surgical Database of EACTS –220,000 patients records* –12 countries* –99 hospitals* *Data from EACTS first adult cardiac surgical database report 2003 Background

5. Parsonnet EuroSCORE Cleveland OPR Actual Mortality 1.87% 1.65% 3.30% 2.82% 5.78% Prediction value for operative mortality of four different coronary artery bypass graft risk stratification models in Chinese patients Zhonghua Xin Xue Guan Bing Za Zhi;2006;34:504-7 Western’s Risk model can’t expect actual mortality of Chinese patients Background

6. Fu WaiSTSEuroSCORE LVEF +++ Cr +++ Priority +++ Cardiac Shock +++ Age -++ Female -++ Previous CVP Procedure -++ LM ++- Arrythmia ++- MI ++- PI +-- Aortic Aneurysm Procedure +-+ Tri-vessel Disease -+- Different Risk factors for CABG Risk factors for CABG—Chinese experience (Submitted)

7. Chinese patients with cardiovascular surgery Compare with database of STS or EACTS  Different characteristic of race  Different practice guideline  Indication and selection  Peri-operative therapy  Different outcome Mortality of Isolated CABG in Fu Wai Hospital Compare with STS Database STS* Fuwai Hospital *Executive summary of STS national database www.sts.org Background

8. Purpose of CV database  Define Risk factors and outcome  Application of practice guideline  Quality control improvement for surgeons and centers  Clinical trial based on the register  Research in targeted areas of cardiac surgery Questions for Database in China

9.  Arouse enthusiasm of contributing centers  Cooperative network  No database in the most centers  Software developing  Dataset  link to the world  fit to clinical practice  Collecting, monitoring and validating data  The most important step Questions for Database in China

10. Cooperative network To arouse the enthusiasm of each potential contributing center and surgeon –Responsibility –Resource share Risk factors evaluation Quality improvement Clinical analysis and Research Questions for Database in China

11. Dataset  Link with STS and Europe database  Fit to Chinese cardiovascular surgical practice  Union the definition of data Patient Data Demographics Cardiac history Co-morbidities Preoperative investigations Preoperative support Operative Data Operative priority Procedure data Outcome Data Complications Survival Questions for Database in China

12. Model of data collection in EACTS

13. Center Inspection Double input Center Database Data center Basic analysisClinical researchRisk model Collecting, monitoring and validating data Dataset

14. Database software developing Local database Submit data to data center regularly Data share online Questions for Database in China

15. Our practice: Step by Step  First stage  Retrospectively CABG register CABG during 2004~2005 Thirty-three hospital  Adult cardiac surgical register database  Second stage National cardiac database

16. Retrospectively CABG register (Oct 2006 ~ March 2007)  33 centers in Mainland  CABG in 2004~2005  More than 10000 cases  Set up CABG database  Describe risk factors and outcome of CABG

17. Adult cardiac surgery register –Supported by Ministry of Science and Technology –Call for national cooperation  Define Risk factors and outcome  Application of practice guideline  Quality control improvement  Clinical trial and research

18. National cardiac database  Supported by society or government  Nation wide participate  Special team for data collect and analysis