|Mühlberger V et al.|
Herzkathetereingriffe in Österreich im Jahr 2016 (mit Audit 2017) // Cardiac Catheterization, Coronary Angiography (CA) and Percutaneous Coronary Interventions (PCI) in Austria during the Year 2016 (Registry Data including Audit 2017)
Journal für Kardiologie - Austrian Journal of Cardiology 2018; 25 (1-2): 9-15
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Keywords: CA, Kardiologie, Koronarangiographie, PCI, Statistik, Österreich
Our independent, purely academic activity is located in the area of health services research, and has also the option to generate benchmarks for individual centres. Participation in our surveys is voluntary, but no centre is missing. Since 1992, every year, without interruption 90–100 parameters are applicable. The questionnaire will be optimized and adapted to current conditions. This is done in cooperation with the participating centres. To provide comparability we make only minimal and absolutely most necessary modifications. The data are collected and summarized at the end of the year by each centre itself. During the year the centres are visited or contacted to perform audits and to keep personal feedback with all of them.
Concerning international comparison for the year 2015/2016, Austria (A /AU/AUT) is situated with 6306/6468 Diagnostic Coronary Angiographies (CA), 2591/2603 Percutaneous Coronary Interventions (PCI), 381/397 Electrophysiologic Ablations, 77/95 Transarterial Aortic Valve Implantations (TAVI) per one million inhabitants under the top nations in Europe, concerning TAVI in the middle range. The absolute numbers concerning coronary diagnoses (CA) increased by +3.5%, coronary therapy (PCI) increased less in 2016, therefore the relation PCI/CA decreased from 41.1 to 40.2% compared to 2015. The presumed reasons are more cases without coronary heart disease coming for diagnostics on a CT-base on the one hand side and more cases with acute or complex interventions taking more time in the CathLab on the other hand, so PCI in bifurcation of large side branches since 2011 has increased from 6.7% to 11.4% in 2016 and left main stents increased from 2.0 to 3.2% at the same time.
Emergency coronary bypass surgery due to failed PCI increased to n = 27 cases during 2016, which was not expected, leading to a lethal outcome in five cases (18.5%), higher mortality of 29–30% (in Switzerland and Austria) in PCIpatients due to pre-existing shock in ST-Segment- elevation-myocardial infarction (STEMI) is within the international range. Complications of PCI are underreported in Austria. Some centres in Austria – like most of them in Switzerland – publish their rates of complications. Myocardial infarction due to PCI is reported in 1.07% (174/16295) in Austria’s reporting centres and underreporting still is present, within centres and within our community, but from year to year the percentage of reported parameters increases. A phenomenon are n = 2532 cases with intracoronary (i. c.) devices but without following therapeutic intervention (12.8% of PCI during 2016 and 13.1 % during 2015). This results to a rate of 49.2% (2532/5146) of all i. c.-devices without following therapeutic intervention (like pressure wire – with or without adenosine – i. c.-ultrasound, optical coherence tomography; n = 3631/808/707) in reporting centres in 2016. The continuous increase in CA-cases using non-femoral (mostly radial) puncture techniques showed increasing n = 18441 to n = 31850 non-femoral CA cases during the years 2013–2016. At the same time peripheral bleeding complications decreased from n = 309 to n = 192/year and the percentage of peripheral bleeding complications necessitating operation or transfusion decreased from 24.5% to 14.6% during 2010 to 2016.
In acute PCI-Cases non-femoral puncture techniques increased from 30.7 to 41.4% of PCI during the years 2014 to 2016. A sometimes necessary switch to femoral techniques during all the PCI cases increased from 8.9 to 33.7% in those reported cases of PCI. At the same time “ad hoc” PCI (CA at the same time with PCI) decreased from 84.4 to 77.3%, which means that patients are dismissed to perform PCI for a femoral approach later on.
The question is causation/association (or hidden confounders) between documented increasing radial puncture, decreasing peripheral bleeding complications, decreasing glycoprotein IIb/IIIA, decreasing direct thrombin inhibitors, increasing switch to femoral techniques and/or decreasing “ad hoc” PCI? Prolongation of cath-door to cath-balloon-time is reported by single centres at the same time.
Reintervention (REDO due to restenosis) – reporting centres observed rather an increase than a reduction during 2010–2015 from 4.6% to 4.7% in such cases, but in 2016 a reduction to 3.7% of their PCI cases (n = 794 REDOs). From 2010 (15.2%) to 2015 (15.4%) the relative percentage of late, chronic stent thromboses stayed constant in those REDO cases. But in 2016 a reduction to 11.0% of their REDO cases (n = 71 chronic stent thromboses) took place. Perhaps the use of dual antiplatelet therapy (DAPT) finally is effective even in all-comers.
Innovations within the Cath Labs in Austria are rare in 2016 (e. g. n = 16 cases in 2016 compared to n = 241 cases with new devices in 2009). Innovations of former days do not hold the promise, like biodegradable vascular scaffolds (BVS) decreased from n = 1693 in 2014 to n = 593 in 2016, at the same time clot catcher and intraaortic balloon pump decreased as well. Percutaneous Renal Denervation suffered the expected downslope. One innovation of former years, the drug eluting balloon, still increases (from n = 370 in 2010 to n = 1169 in 2016).
In electrophysiology there is one innovation, the leadless pacemaker, which is coming through from 2014 (with a pioneer centre in Austria) to 2016 and also electrophysiologic ablations for atrial or ventricular arrhythmias increased from 2014 to 2016.
Trans arterial or aortic valve replacement (TAVR in the US) called implantation (TAVI in Europe) increased in 2016, at the same time implantation of MitraClip and interventions on peripheral vessels (like renal or leg angioplasty) increased within cathLabs, but not carotid angioplasty in cathLabs and renal denervation is going to disappear. Left atrial appendage closure (LAA) has a light renaissance in Austria. Data are presented in Vienna (December 1st– 2nd, 2017) at the autumn meeting of the working group “Interventional Cardiology of the Austrian Society of Cardiology” (ÖKG), as a basis for discussion. The presentation 2016/2017 is also placed under the website http://iik.i-med.ac.at
Kurzfassung: Im internationalen Vergleich mit dem Vorjahr liegt Österreich (A/AU/AUT) im Jahr 2015/2016 mit 6306/6468 diagnostischen Koronarangiographien (CA), 2591/2603 perkutanen koronaren Interventionen (PCI), 381/397 elektrophysiologischen Ablationen und 77/95 transarteriellen Aortenklappenimplantationen (TAVI) bezogen auf eine Million Einwohner weiterhin im Europäischen Spitzenfeld, bzw. bei TAVI im Mittelfeld.