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NCVDNCVDPercutaneous Coronary Intervention Percutaneous Coronary Intervention

(PCI) Registry(PCI) RegistryAn updateAn update

Dato Dr Rosli Mohd AliDato Dr Rosli Mohd AliChairman of NCVD PCI RegistryChairman of NCVD PCI Registry

Hilton Kuala Lumpur Hilton Kuala Lumpur1717thth April 2009 April 2009

National Cardiovascular Disease Database (NCVD)

*SGH

*HSAJB

HUSM*PH

SDMCDSH

*KPJSSHSUNMED

*SH

*IJN*UMMC*HUKM

PCI Registry Participating Sites

*QEH (2008)

* Active sites


Current ActivitiesNCVD-PCI Annual Report 2007

• In the midst of report writing

• PCI Report Writing Committee Prof Dr SIM Kui-Hian

Prof Dr Wan Azman Wan AhmadDr Alan Fong Yean YipDato’ Dr Omar IsmailDr Liew Houng Bang

Dr Lu Hou TeeDr Chee Kok Han

Dr Syahidah Syed TaminDr Azmee Ghazali


Current UpdatesCurrent Updates

as of 9as of 9thth April 2009 April 2009(based on unclean data)(based on unclean data)


Percutaneous Coronary Percutaneous Coronary InterventionIntervention

(PCI) Registry(PCI) Registry


Number of PCI registered (online) by Source Data Providers (SDP)

Total PCI = 8,236 as of 9th April 2009

6

61.95

8.04 10.82 10.09

1.12 1.44 1.12 0.1 0.27

0

10

20

30

40

50

60

70

Perc

enta

ge(%

)

1001 1002 1004 1005 1006 1009 1015 1019 1020 1021

SDP


Number of PCI registered (online) by

Source Data Providers (SDP)


0.66%0.45%

0.18%9.65%

12.67%

9.71%57.59%

9.09%

1001 1002 1004 1005 1006 1009 1015 1019 1020 1021


Patient DemographicsAge

Min, Max

mean ± sd

22, 95 yrs

56.7 ±10.06 yrs

Age < 40 years 0.33 %

Age > 70 years 0.55 %

Male 81.99 %

Malaysian 92.67 %

Baseline n=8,236

Ethnic : Malay 47.23 %

Chinese 24.66 %

Indian 22.56 %

Other Malaysian 0.33 %

Foreigner 4.93 %

For 12 cases, there is no information on ethnicity

Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other Sabahan and Other Sarawakian


Percentage of Ethnic Groups

Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other Sabahan and Other Sarawakian

Malay, 45.79%

Chinese, 25.88%

Indian, 23.13%

Other Msian, 4.55%

Foreigner, 0.3%


Clinical Background & CV Risk Factors

Dyslipidaemia 73.42 %

Hypertension 73.03 %

Diabetes 45.41 %

OHA 77.94 %

Insulin 13.60 %

Family History of premature CVD 16.57 %

MI history 38.19 %

Documented CAD 55.28 %

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 %

Chronic renal failure 6.23 %

Baseline (n=8,236)



Previous Revascularization

Previous PCI 22.21 %

Previous CABG 4.02 %

Baseline (n=8,236)

Clinical Presentation

Acute Coronary Syndrome (n=2,039)

24.76 %

STEMI 44.92 %

NSTEMI 32.81 %

Unstable Angina 19.86 %

* For 49 cases, the information on ACS stratum are Not Available

Baseline (n=8,236)


PCI status

Elective (n = 7,439)

Staged PCI

Cath-PCI in same setting (adhoc)

90.32 %22.06 %

84.12 %

Urgent (NSTEMI/UA) 4.66 %

Rescue 2.09 %

Primary 2.48 %

Missing 0.45 %

Baseline (n=8,236)



Thrombolytics 5.45 %

IIb/ IIIa Blockade 6.47%

Heparin 85.31 %

LMWH 4.83%

Ticlopidine 3.36 %

Bivalirudin 0.29 %

Aspirin 96.26 %

Clopidogrel 97.69 %

Adjunctive Pharmacotheraphy PCI


Baseline (n=8,236)


ASPIRIN 96.26 %

Prior 92.71%

After 0.85 %

During 1.08 %

Clopidogrel 97.69 %

Prior 92.07%

After 2.71 %

During 2.24 %

Antiplatelets strategy during PCI

Clopidogrel loading (if prior) n = 7,408

<6hr 6-24hr >24-72hr >72hr

Hours 17.40 % 29.02 % 10.14 % 35.80 %

75mg 300mg 600mg >1200mg

First / load dose 36.60 % 51.32 % 5.45 % 0.01 %


Baseline (n=8,236)


Percutaneous entry

Brachial 0.98 %

Radial 35.10 %

Femoral 57.81 %

Multiple site 1.49 %

Missing 4.58 %

Extent of coronary disease

Single vessel disease 44.50 %

Multiple vessel disease 54.43 %

Graft 1.18 %

Left Main 0.80 %

Baseline (n=8,236)

Baseline (n=8,236)



Lesion characteristics

De novo 91.28 %

Acute stent thrombosis Acute

Subacute

Late

0.50 %35.09 %

21.05%

26.32 %

Restenosis (no prior stent) 0.23 %

In stent restenosis 4.52%

Missing 3.47 %

Baseline (n=11,508)

Total Lesion= 11,508 as of 9th April 2008

AHA-ACC Lesion Morphology Type

A 11.76 %

B1 25.14 %

B2 19.38%

C 39.45 %

Missing 4.28 %


Location in Graft (n = 167)

Ostial 9.58 %

Mid 20.96 %

Distal 11.98 %

Anastomosis 7.78 %

Proximal 28.14 %

Graft PCI

For 36 cases, the information on Location in Graft PCI is Not Available



Location description

Ostial 6.33 %

Bifurcation 7.69 %

CTO < 3 mo 3.02 %

CTO > 3 mo 7.10 %

Thrombus 3.21 %

Not Applicable 70.20 %

Native vessel PCI

Pre-PCI stenosis %, 84.52 + 12.08

Post-PCI stenosis %, 3.94 + 17.08

TIMI flow 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 %



Procedural Characteristics

Max balloon size (mm) 3.06 + 0.58

Max stent/balloon deploy pressure (atm)

15.77 + 3.81

Direct stenting 18.67 %

Stent type

DES 56.67 %

BMS 40.58 %

Bio-absorbable stent 0.03 %

Antibody coated 2.30 %

Other stent 0.41 %

Baseline (n=11,508)

Stent length (mm) 22.52 + 7.32

Stent diameter (mm) 2.99 + 0.46



Percentage of stent by total number of stent used (n = 11,508)

Total Stent, n =11,508 as of 9th April 2009

Other stents refer to stents other than listed in the Reference Stent List

DES, 56.67%

BMS, 40.58%Others, 0.41%

Antibody coated, 2.30%

Bio absorbable stent, 0.03%


Intracoronary devices used (total no of lesions treated)

Unsuccessful 2.58 %

Balloon only (POBA) 7.69 %

BMS 38.40 %

Drug eluting balloon 2.67%

Distal embolic protection (n = 15)

Filter

0.47 %

96.30%

Cutting balloon 2.20 %

DES 46.23 %

Flowire 0.01 %

IVUS 3.86 %

Rotablator 0.85 %

Others (eg. Thromboaspiration) 3.53 %

Closure device 5.12 %

Baseline (n=11,508)

Procedural Characteristics


Target Vessel Complications

Acute closure 0.38 %

Dissection 4.20 %

Perforation 0.29 %

No Reflow (n = 149) 1.29 %

Transient 63.76 %

Persistent 22.82 %

Missing 13.42 %

Successful lesion 93.19 %

Baseline (n = 11,508)


Periprocedural MI 0.44 %

Emergency Reintervention (n = 20)

Stent thrombosis

Dissection

Perforation

Others

0.24 %50.00 %

35.00 %

70.00 %

30.00 %

Bail-out CABG 0.04 %

Cardiogenic shock 0.53 %

Arrhythmia (VT/VF/Brady) 0.61 %

TIA/Stroke 0.05 %

Tamponade 0.05 %

Contrast reaction 0.06 %

New onset/ worsened HF 0.11 %

New renal impairment 0.16 %

Procedural ComplicationsBaseline (n=8,236



Bleeding Yes (n = 28) 0.74 %

Minor

Major

Minimal

NA

13.11 %

8.20%

68.85 %

6.56 %

No 97.29 %

Vascular Complications

* For 162 cases, the information on Bleeding complication are Missing


In-hospital OutcomeOutcome

Alive 98.14%

Death 1.03 %

Transferred 0.04 %

Missing 0.79 %

Baseline (n= 8,236)

Cause of death

Cardiac 88.24 %

Vascular 4.71 %

Renal 1.18 %

Pulmonary 1.18 %

Missing 2.35 %

Location

In lab 5.88 %

Out of Lab 90.59 %Total PCI = 8,236 as of 9th April 2009


Aspirin 92.20 %

Clopidogrel 93.14 %

Ticlopidine 5.62 %

Statin 90.18 %

Beta blocker 71.01 %

ACE inhibitor 53.64 %

ARB 13.65 %

Warfarin 1.10 %

Others 68.71 %

Medications at discharge

Baseline (n=8,236)



Follow up atFollow up at

30days & 1year30days & 1year


Overall Follow Up Management

Total

30 days FU 6 months FU 12 months FU

(+7 days) (+14 days) (+30 days)

N % N % N %

Expected visits 6181 100 4892 100 3403 100

Visit done 2337 38 786 16 427 13

Missed FU 3844 62 4106 84 2976 87

Results as of 9th April 2009


Overall Follow Up done at 30days & 1year

6181

4892

3403

2337

786427

0

1000

2000

3000

4000

5000

6000

7000

30 days FU 6 months FU 12 months FU

Type of Follow Up

No

. o

f F

U D

on

e

Expected visits

Visit done


65

3

92

5

82

73

45

15

28

86

35

61

80

61

35

80

0

10

20

30

40

50

60

70

80

90

100

1001 1002 1004 1005 1006 1009 1015 1019 1020 1021

SDP

% o

f F

U v

isit

do

ne

30 days

6 months

12 months

Follow Up done at 30days & 1year by SDP

Total 30 days FU = 3,470 as of 9th April 2009

Total 6 months FU =1,700 as of 9th April 2009


Percentage of 30 days Follow Up completed by Source Data Providers (SDP)

Total 30 days FU completed = 3,470 as of 9th April 2009

9.77

50

0.63

22.59

13.72

0.122.85 0.32

0

5

10

15

20

25

30

35

40

45

50

Per

cen

tag

e (%

)

1001 1002 1004 1005 1006 1009 1015 1019

SDP


Percentage of 6 months Follow Up completed by Source Data Providers (SDP)

Total 6 months FU completed = 1,700 as of 9th April 2009

12.59

35.76

0.65

32.12

18.88

0

5

10

15

20

25

30

35

40

Pe

rce

nta

ge

(%

)

1001 1002 1004 1005 1006

SDP


Outcome at 30 days FU & 6 months FU

30 days FU

96.54 %

0.69 %

0.06 %

2.71 %

-

Outcome

Alive 98.14 %

Death 1.03 %

Transferred 1.04 %

Lost to FU -

Missing 0.78 %



6 mths FU

96.06 %

0.41 %

0.06 %

3.47 %

-


At 30 days and 6 months

Duration 30 days FU(n = 244)

Readmission 7.03 %

CHF 1.64 %

Recurrent Angina 11.07 %

PCI – planned 56.97 %

PCI – unplanned 2.87 %

AMI 1.64 %

CABG 0.82 %

Others 14.75 %

Missing 9.84 %

6 months FU(n = 114)

6.71 %

2.63 %

7.89 %

42.11 %

6.14 %

4.39 %

2.63 %

27.19 %

4.39 %




Readmission Reason at 30 days FU & 6 months FU

1.64 1.64

11.07

2.870.82 0.41

9.84

4.397.89 6.14

27.19

56.97

14.75

2.63

42.11

2.63 2.63 4.39

0

10

20

30

40

50

60

CHF AMI Recurrentangina

PCI -planned

PCI -unplanned

CABG Arrhythmia Others Missing

Readmission Reason

Per

cen

tag

e (%

)

30days FU

6mths FU


THANKTHANK YOU YOU

*sgh

Documents

sdpid tabulation

outcome tabulation

months fu tabulation

hukmpci registry

up30 days

year fu outcometotal