2003 data: Ludman
BCIS Audit ReturnsAdult Interventional Procedures
2003
Peter F Ludman
BCIS National Audit OfficerOn behalf of
British Cardiovascular Intervention Society
York 2004
2003 data: Ludman
Audit Domains
• Structure
• Appropriateness
• Process
• Outcome
2003 data: Ludman
Audit Domains
• Structure– The Centres– Work patterns– Activity
• Appropriateness• Process• Outcome
2003 data: Ludman
Audit Domains
• Structure– The Centres– Work patterns– Activity
• Appropriateness• Process• Outcome
2003 data: Ludman
7 New Angiography Centres
– Worcester– Harrogate– Prince Philip, Llanelli– Princess Alex Univ Hosp, Bromley– Chelmsford– Droitwich Spa– Wycombe
– Raigmore, Inverness*– Worthing*– Goring Hall*
New Angiography only centres 2003
*new to database, but angiography for some yrs
2003 data: Ludman
9 New PCI Centres
– Battle, Reading– Cheltenham– New Cross– Basingstoke– Northwick Park– Sandwell (restart)– St Peters, Chertsey– BUPA Southampton
Angiography centres now performing PCI in 2003
New PCI centres in 2003– Leeds Nuffield
2003 data: Ludman
UK Intervention Centres
52 52 53 54 54 5358 61 63 66 64 64
73
0
10
20
30
40
50
60
70
80
No
.ce
ntr
es
2003 data: Ludman
73
68
PCI centres
Angiography onlyCentres
2003
2003 data: Ludman
Scotland
2003 data: Ludman
Wales
2003 data: Ludman
N. Ireland
2003 data: Ludman
England - PCI
2003 data: Ludman
England
2003 data: Ludman
Audit Domains
• Structure– The Centres– Work patterns– Activity
• Appropriateness• Process• Outcome
2003 data: Ludman
Audit Domains
• Structure– The Centres– Work patterns– Activity
• Appropriateness• Process• Outcome
2003 data: Ludman
UK Interventional and Diagnostic centres2003
No. No cath data
No PCI data
Caths(% of total)
PCIs(% of total)
NHS Interventional
56 3 1 135,547(72%)
51,038(94%)
Private Interventional
17 2 0 11,115(6%)
3,469(6%)
Diagnostic only
68 2 40,457(22%)
TOTAL 141 187,119 54,507
Missing cath data estimated from 2002 figures
2003 data: Ludman
Centres not reporting diagnostic numbers
• Interventional
– Edinburgh RI– Northwick Park Hospital– New Cross Hospital
– BUPA Hospital Leeds– BMI Park Hospital, Notts
• Diagnostic only– Dumfries & Galloway RI– Royal Surrey County Hosp
2003 data: Ludman
Centres not reporting PCI numbers
• Northwick Park Hospital
2003 data: Ludman
UK Interventional and Diagnostic centres2003
No. No cath data
No PCI data
Caths(% of total)
PCIs(% of total)
NHS Interventional
56 3 1 135,547(72%)
49,542(93%)
Private Interventional
17 2 0 11,115(6%)
3,719(6%)
Diagnostic only
68 2 40,457(22%)
TOTAL 141 187,119 53,261
Missing cath data estimated from 2002 figures
2003 data: Ludman
Angiograms per PCI
5.2
4.3
5.7
3.84.1
3.5
4.3
2.8
4
2.8
3.7
2.8
3.53
0
1
2
3
4
5
6
1997 1998 1999 2000 2001 2002 2003
Angio/PCI (PCI centres)
Angio/PCI (all UK)
2003 data: Ludman
Annual Procedures per cath lab(NHS centres)
Mean Median Range
Interventional labs
Procedures (pa)per lab
1224 1126 489 to 2481
PCIs (pa) per lab
412 393 28 to 844
Diagnostic labs
Caths (pa) per lab* 604 487 43 to 2800
2003 data: Ludman
Day Case Procedures• 29 of 73 Units performing day case PCI
– Total of 2492 procedures performed
• 4.6% of all PCI procedures
53
5 2 1 0 2 0 1 0 0 1 00
10
20
30
40
50
60
Nu
mb
er
of
Cen
tres
0-50 51-100
101-150
151-200
201-250
251-300
301-350
351-400
401-450
451-500
501-550
551-600
Cases per centre
2003 data: Ludman
Interventional centres providing NO DATA
• Northwick Park Hospital
2003 data: Ludman
Number of PCIs performed in NHS Centres(total per annum)
0
2
4
6
8
10
12
<200 <400 <600 <800 <1000 <1200 <1400 <1600 <1800 <2000 <2200 <2400 >2400
2000
2001
2002
2003
2003 data: Ludman
590664
759
894
0
100
200
300
400
500
600
700
800
900
Rate per Million
'85 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
Year
PCI Rates per million population (UK)
Assumes UK population of:58.8 m mid 2001, 59.2m mid 2002, 59.6 mid 2003
2003 data: Ludman
Rate of increase in Procedure numbers per million
0
5
10
15
20
25
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Rat
e o
f In
crea
se (
%)
2003 data: Ludman
Total UK PCI ProceduresYear Centres Total
Procedures Rate per million Increase
(%) 1991 52 9,933 174 1992 52 11,575 203 16.5 1993 53 12,937 227 11.8 1994 54 14,624 256 13.0 1995 54 17,344 304 18.6 1996 53 20,511 359 18.1 1997 58 22,902 402 11.7 1998 61 24,899 437 8.7 1999 63 28,133 494 13 2000 66 33,652 590 20 2001 64 38,992 664 12.5 2002 64 44,913 759 14.3 2003 73 53,261 894 17.8
2003 data: Ludman
Total PCIs in the UK Countries(2000 to 2003)
886119
42234
922137711830072618
25610
135
30785
154234852159 1131
1498
40722787
35306
3396110
44381775
1308
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
EnglandNHS
EnglandPrivate
ScotlandNHS
ScotlandPrivate
N. Ireland Wales
2000200120022003
Total No.s of PCI
2003 data: Ludman
Population estimatesMid 2003
Scotland 5.06 m
England 49.86 m
Wales 2.94 mRx in Wales: 2.21 m
Northern Ireland 1.70 m
Welsh Rx in England 0.696 m
Total UK: 59.6 m
Total Rx in England 50.55 m
2003 data: Ludman
PCIs/million UK Countries(2000 to 2004)
903 899
1044
592
0
200
400
600
800
1000
1200
England Scotland N. Ireland Wales
2000200120022003
NB Assume 2.21 m population Rx in Wales
2003 data: Ludman
PCI vs Isolated CABG Numbers (UK)Data from BCIS and SCTS Registry
0
10000
20000
30000
40000
50000
60000
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
BCISSCTS
PCI:CABG 1.3 1.6 1.8 2.1*
*assumes no increase in CABG
Note: CABG data for financial yrall PCI v NHS CABG
2003 data: Ludman
No. of Interventional Consultants(NHS centres) data from 54 of 56 centres
0
2
4
6
8
10
12
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
No of Consultants per Centre
No
of
Cen
tres
2002
2003
Mean2000 5.52001 6.12002 6.52003 6.7
Total = 362 (↑16%)Includes local and visitors, cardiologists and radiologists
2003 data: Ludman
No. of PCIs per Consultant (NHS Centres) 2003 data from 54 of 56 centres
0
5
10
15
20
25
No
of
Cen
tres
0-50 51-100 101-150 151-200 201-250 >250
No PCIs/Consultant
2001 2002 2003
Note: data from institutional volume divided by No operators per institution
Mean PCI/consultant:2000 1252001 1262002 1382003 139
2003 data: Ludman
Visiting Interventionists(NHS Centres) 2003 data from 54 of 56 centres
0
10
20
30
40
No Visitors Visitors
Type of Centre
Number of
centres
2002
2003
2003 data: Ludman
Visiting Interventionists(NHS Centres) 2003 data from 54 of 56 centres
88
139 135
020406080
100120140
Nu
mb
er
of
Op
era
tors
No visitors With visitors
Type of Centre
Local operators
Visitingoperators
2003 data: Ludman
Visiting Interventionists(NHS Centres) 2003 data from 54 of 56 centres
162155 132 130
0
50
100
150
200
PC
Is p
er
op
era
tor
No visitors Visitors
Type of Centre
MedianMean
2003 data: Ludman
Visiting Interventionists(NHS Centres) 2003 data from 54 of 56 centres
4.6 5
7.8 7
0
2
4
6
8
10
Mea
n N
o. o
f O
per
ato
rs p
er
cen
tre
No visitors Visitors
Type of Centre
Mean
Median
2003 data: Ludman
Surgical cover
On site Off siteNo of centres 55
(76%)
17(24%)
No. of PCI
(% of total)46083
(87%)
6928(13%)
Mean No. procedures
per centre 853 407
Operator volume:
PCIs per interventionist *157 90
* NHS Centres only
2003 data: Ludman
Off Site Surgical cover
0
1
2
3
4
No. of Centres
0-50
51-1
00
101-
150
151-
200
251-
300
301-
350
351-
400
451-
500
551-
600
601-
650
651-
700
>701
No. Procedures per Centre
2003 data: Ludman
PCI for STEMI(2003 data from 50 of 73 units)
2304
633
1060
416278
0
500
1000
1500
2000
2500
All STEMI PrimaryPCI
Rescue For Re-MI Shock
2001
2002
2003
Data from units reporting cath or hosp outcome
4.3% of all PCI activity
2003 data: Ludman
PCI for All STEMI2003 data from 43 centres
0
2
4
6
8
10
12
Number of Centres
No. of Procedures per Centre
All centres24-7 STEMI RxDay STEMI Rx
Total 2304 procedures
2003 data: Ludman
Primary PCI for STEMI2003 data from 43 centres
0
5
10
15
20
Nu
mb
er
of
Ce
ntr
es
0-10 11-20 21-40 41-50 51-60 61-70 71-80 81-90 91-100 >100
No Procedures per Centre
Total 633 procedures
2003 data: Ludman
Audit Domains
• Structure
• Appropriateness
• Process
• Outcome
2003 data: Ludman
Minimum Data (Q10 to 15)
Minimal or No data from:
• Northwick Park Hospital• BUPA Hospital Leeds
2003 data: Ludman
Stent procedures2003 data from 53 of 73 centres
84 86 89.4 92.1
0102030405060708090
100
% of Procedures
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
Year
2003 data: Ludman
Stenting in different centres2003 data from 53 of 73 centres
0
5
10
15
20
25
30
35
40
No
of
Cen
tres
31-40 41-50 51-60 61-70 71-80 81-90 >90
% Procedures per centre using Stents
1998
1999
2000
2001
2002
2003
2003 data: Ludman
Drug Eluting Stent cases2003 data from 64 of 73 centres
? ?
17
28
0
10
20
30
40
50
% D
ES
ca
se
s
2002 2003
MeanMedian
2003 data: Ludman
Drug Eluting Stent cases2003 data from 64 of 73 centres
0
5
10
15
20
25
30
Number of Centres
0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
% Procedures per centre using DES
All
NHS
Private
2003 data: Ludman
Drug Eluting Stent cases2003 data from 64 of 73 centres
5.3
18.3
28.6
49.76
0
10
20
30
40
50%
DE
S C
as
es
Scotland England Wales N. Ireland
Country
2003 data: Ludman
PCI for Restenosis(2003 data from 58 of 73 centres)
0%
10%
20%
30%
40%
50%
60%
70%
% of Centres
0-5 5.1-10 10.1-15 >15
% procedures for Restenosis
199819992000200120022003
Mean 2003: 4.3%
2003 data: Ludman
PCI in patients with past CABG(Data from 57 of 73 centres)
0
5
10
15
20
25
30
No of Centres
0 to 5 5.1 to 10 10.1 to 15 15.1 to 20 20.1 to 25 25.1 to 30
% of procedures per centre in patient with CABG
Note: Includes procedures on native vessels and grafts
Mean 2002 8.4%2003 6.8%
2003 data: Ludman
Use of GP IIb/IIIa blockers2003 data from 66 of 73 centres
48.4
05
101520253035404550
% of Procedures
1997 1998 1999 2000 2001 2002 2003
with Abciximabwith any GPIIb/IIIa
Overall mean % use
2003 data: Ludman
Abciximab in different centres 1999 - 2003
2003 data from 66 of 73 centres
0
5
10
15
20
25
30
No. of Centres
0 to
10
11 to
20
21 to
30
31 to
40
41 to
50
51 to
60
61 to
70
71 to
80
81 to
90
>90
% Procedures per centre using Abciximab
1999
2000
2001
2002
2003
2003 data: Ludman
Abciximab use by Clinical Presentation
35.6
55.8
36.1
55.4 56
67
01020304050607080
% Procedures with
Abciximab 20022003
2003 data: Ludman
Multivessel Treatment• Non STEMI cases
79 77 73 72
21 23 27 28
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003
% C
ases MV
SV
2003 data: Ludman
Multivessel Treatment
1.21 1.23 1.231.27
11.11.21.31.41.51.61.71.81.9
2
2000 2001 2002 2003
Ves
sels
/C
ase
(cen
tre
dat
a)
Mean (Range)
2003 data: Ludman
Additional Interventional CoronaryTechniques (1)
2003 data from 70 of 73 centres
Units No∆ % cf 2002
* % of all procs
Mean** Range
Rotablation 31 288 +69% 0.54 9.3 1-69
Atherctmy (DCA) 7 15 +15% 0.03 2.1 1-6
TEC 3 3 -75% 0.006 1 1
Laser 3 22 +47% 0.04 7.3 1-12
Cutting balloon 49 1330 +8.5% 2.5 27.1 1-198
*% of all UK interventional procedures**Mean number in units using the technique
2003 data: Ludman
Additional Interventional CoronaryTechniques (2)
2003 data from 70 of 73 centres
Units No∆ cf 2002
% of all procs
Mean Range
Thrombectomy ¥ 30 347 +136% 0.65 11.6 1-92
Distal protection 32 345 0.65 10.8 1-101
Brachytherapy 8 118 -17.5% 0.22 14.75 1-33
¥PercuSurge, Rescue, Angiojet, X-sizer
2003 data: Ludman
OtherInterventional Techniques
2003 data from 70 of 73 centres
Units No*∆ cf 2002
% of all procedures
Mean Range
PTMR 2 18 0.03 9 1-17
Septal ablation 16 57 0.1 3.6 1-20
*Not requested last yr, so comparison misleading and omitted
2003 data: Ludman
Other Diagnostic Techniques2003 data from 70 of 73 centres
Units No∆ cf 2002
% of all procedures
Mean Range
IVUS 37 771 12% 1.5 20.8 1-131
Press wire 38 926 1.7 24.4 1-139
Flow wire 6 8 0.01 1.3 1-2
2003 data: Ludman
Adult non coronary intervention2003 data from 70 of 73 centres
Units No∆ cf 2002
% of all procedures
Mean Range
MV plasty 35 230 +15% 0.43 6 1-29
AV plasty 8 17 +183% 0.03 2.1 1-4
PV plasty 10 25 -3.8% 0.05 2.5 1-5
TV plasty 0
PDA 9 38 +65% 0.07 4.2 1-11
ASD 27 450 +34% 0.85 16.7 2-54
PFO 22 195 +110 0.37 8.9 1-73
VSD 13 32 0.06 2.5 1-10
2003 data: Ludman
Mitral Balloon Valvuloplasty
21
6 5
1 00
5
10
15
20
25
Number of centres
1-5 6-10 11-15 16-20 21-25
No. of Procedures per Centre
20022003
2003 data: Ludman
Adult great vessel intervention2003 data from 70 of 73 centres
Units No∆ cf 2002
% of all procedures
Mean Range
Coarct / Re-coart 13 89 +170% 0.16 6.8 1-24
Carotid 4 27 -64% 0.05 6.8 1-22
Aorta 4 12 0.02 3 1-6
Pulm art 8 31 0.06 3.9 1-8
SVC 10 59 0.11 5.9 1-24
2003 data: Ludman
Other procedures2003 data from 70 of 73 centres
Units No∆ % cf 2002
% of all procs
Mean Range
Foreign body removal
3 28 +75% 0.05 9.3 2-23
Embolisation 9 45 +87% 0.08 3 1-9
Balloon
Pericardiotomy
3 14 0.02 4.7 1-11
Spinal cord stimulator
4 13 0.02 3.3 1-6
2003 data: Ludman
Femoral artery closure devices2003 data from 55 of 73 centres
0123456789
10
Nu
mb
er
of
Ce
ntr
es
0-10 11-20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91-100
% Use of Device per Centre
Mean: 47%
2003 data: Ludman
Audit Domains
• Structure
• Appropriateness
• Process
• Outcome
2003 data: Ludman
ANY Outcome Data (form C)
Inadequate or No Data
• Freeman Hospital• London Chest Hospital• St Bartholomew's• Northwick Park Hospital• St Peter's Hospital• University Hospital of
Wales
• BMI Priory Hospital• BUPA Hospital Leeds• London Independent
Hospital• Ross Hall Hospital• St Anthony's
2003 data: Ludman
Data to end of Procedure onlyfrom 35 of 73:
Battle Hospital
Belfast City Hospital
Birmingham City Hospital
Birmingham Heartlands Hospital
City General Hospital
Derriford Hospital
Eastbourne Hospital
Glasgow Royal Infirmary
Glasgow Western Infirmary
Hairmyres Hospital
London Chest Hospital
Manchester Royal Infirmary
Morriston Hospital
North Hampshire Hospital
Northern General Hospital
Northwick Park Hospital
Royal Cornwall Hospital
Royal Free Hospital
St Bartholomew's Hospital
St Mary's Hospital
St Peter's Hospital
University Hospital of Wales
Victoria Hospital
BMI Alexandra Hospital
BMI Priory Hospital
BUPA Cambridge Lea Hospital
BUPA Hospital Leeds
BUPA Hospital Leicester
Cromwell Hospital
Golden Jubilee National Hospital (formerly HCI)
Leeds Nuffield Hospital
London Independent Hospital
Ross Hall Hospital
St Anthony's Hospital
The Yorkshire Clinic
Wellington Hospital
2003 data: Ludman
All PCI Procedures: Mortality Year Data
From: Total with
mortality data Mortality % Range %
1991 9,071 (9,933) 0.48
1992 43/52 10,483 (11,575) 0.71 0-3.5
1993 44/53 11,859 (12,937) 0.59 0-2.7
1994 44/54 12,598 (14,624) 0.60 0-2.7
1995 35/54 11,365 (17,344) 0.69 0-3.4
1996 37/53 14,476 (20,511) 0.72 0-3.2
1997 41/58 17,577 (22,902) 0.91 0-10
1998 44/61 16,946 (24,899) 0.80 0-9.1
1999 48/63 20,975 (28,133) 0.61 0-4
2000 48/66 24,323 (33,652) 0.64 0-2.6
2001 45/64 29,001 (38,992) 0.75 0-2.8
2002 53/64 37,437 (44,913) 0.54 0-1.9
2003 64/73 49,194 (53,261)
0.53 0-2.0
Includes all centres reporting cath lab outcome or hospital outcome
2003 data: Ludman
Mortality2003 data from 64 of 73 centres
0
5
10
15
20
25
Nu
mb
er
of
Ce
ntr
es
Mortality (%)
2003 data: Ludman
All Procedures: Outcome
0.0
0.5
1.0
1.5
2.0
2.5
3.0
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
%Mortality
em CABG
2003 data: Ludman
All PCI procedures: OutcomeYear Success
(%) MI (%)
Re PCI for acute closure (%)
Em. CABG (%)
Mortality (%)
1991 86 1.6 2.6 0.48
1992 88 1.4 2.0 0.71 1993 89 1.1 1.9 0.59 1994 90 1.0 1.6 0.60 1995 89 1.4 1.9 0.69 1996 90 1.4 1.7 0.72 1997 92 1.2 1.1 0.89 1998 92 0.8 0.7 0.80
1999 90 0.57 0.48 0.61
2000 92 0.6 0.4 0.64
2001 94 0.5 0.4 0.75
2002 92 (51 of 64)
0.57 (49 of 64)
0.33 (50 of 64)
0.28 (53 of 64)
0.54 (53 of 64)
2003 92 (62 of 73)
0.36 (56 of 73)
0.17 (62 of 73)
0.29 (64 of 73)
0.53 (64 of 73)
Includes all centres reporting cath lab outcome or hospital outcome
2003 data: Ludman
Stenting and the need for emergency CABG
(2002 data from 53 of 64 centres)
0
10
20
30
40
50
60
70
80
90
100
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
Year
% s
ten
t
0
0.5
1
1.5
2
2.5
% E
m C
AB
G
% Stent
% Em.CABG
2003 data: Ludman
Stenting and procedures for restenosis
(2002 data from 48 of 64 centres)
0
10
20
30
40
50
60
70
80
90
100
'92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03
Year
%
0
2
4
6
8
10
12
14
%
% Stent
% Restenosis
2003 data: Ludman
Data on HOSPITAL outcome(2003 data 36 of 73 sites)
Aberdeen Royal Infirmary
Bristol Royal Infirmary
Cheltenham General Hospital
Edinburgh Royal Infirmary
Freeman Hospital
Glenfield Hospital
Hammersmith Hospital
Harefield Hospital
Heart Hospital
Hull Royal and Castle Hill Hospital
John Radcliffe Hospital
King Edward VII
Kings College Hospital
Liverpool Cardiothoracic Centre
New Cross Hospital
Nottingham City Hospital
Papworth Hospital
Queen Elizabeth Hospital, Birmingham
Royal Brompton & Harefield NHS Trust
Royal Devon & Exeter Hospital
Royal Sussex County Hospital
Royal Victoria Hospital
Sandwell District General Hospital
Southampton General Hospital
St George's Hospital
St Thomas' Hospital
Taunton & Somerset
The James Cook University Hospital
Walsgrave Hospital
Western General Hospital
Wythenshawe Hospital
Yorkshire Heart Centre
BMI Park Hospital
BUPA Hospital Bristol
BUPA Hospital Southampton
Harley Street Clinic
London Bridge Hospital
2003 data: Ludman
Hospital Outcome 2003Data from 35 centres
No.
Success Partial Success
Failed Repeat PCI
CABG MI Death (Range)
32,950 92.3% 2.9% 3.6% 0.2% 0.32% 0.4% 0.63%
(83-100) (0-11) (0-7.6) (0-1.0) (0-4.5) (0-2.5) (0-2.0)
All Patients
2003 data: Ludman
Hospital Outcome 2003Data from 35 centres
No.
Success Partial Success
Repeat PCI
CABG MI Death (Range)
Stable Single Vessel (no CTO)
12035 96% (87-100)
1.2% (0-7)
0.1% (0-0.6)
0.17% (0-1.4)
0.3% (0-3)
0.1% (0-1.5)
Stable Multivessel (no CTO)
3807 93.9% (78-100)
5.1% (0-22)
0.1% (0-2)
0.29% (0-0.3)
0.7% (0-1)
0.07% (0-1)
Single Vessel CTO
1580 64% (9-92)
4.9% (0-42)
0.04% (0-1.4)
1.9% (0-5.4)
0.5% (0-7)
0.05% (0-1.7)
Multivessel Inc. CTO
1097 73% (0-100)
21% (0-100)
0%
0.7% (0-20)
0.2% (0-5)
0.04% (0-1.1)
Elective Patients
2003 data: Ludman
Hospital Outcome 2003Data from 35 centres
No.
Success Partial Success
Repeat PCI
CABG MI Death (Range)
CABG pts 2259 88.9%
(0-100) 3.5% (0-23)
0.26% (0-5.1)
0.1% (0-1.8)
0.6% (0-4.8)
0.3% (0-2.7)
Restenosis
1490 93%
(50-100) 1.7%
(0-9) 0.6% (0-15)
0.08% (0-1.5)
0.13% (0-2.4)
2.1% (0-50)
Does not account for clinical syndromeCABG patients includes Rx of native and grafts
Patients with previous bypass graftsPatients treated for restenosis
2003 data: Ludman
Hospital Outcome 2003Data from 30 centres
No. Success Partial Success
Repeat PCI
CABG Q MI Death (Range)
ACS 10743 93.3% 3.0% 0.27% 0.15% 1.7% 0.71%
(88-100) (0-8) (0-2.7) (0-0.96) (0-29) (0-2.2)
Acute coronary syndromes (UA/NSTEMI)
Includes all classified as treated for UA and post MI angina (stable and unstable)
2003 data: Ludman
Hospital Outcome 2003Data from 22 centres
No. Success Partial Success
Repeat PCI
CABG Q MI Death (Range)
Acute closure
124 74.8% 16.1% 12.3% 1.0% 7.9% 9.4%
(0-100) (0-100) (0-100) (0-16) (0-83) (0-66)
Patients Rx for acute vessel closure
? SAT rate 0.23%
2003 data: Ludman
Hospital Outcome 2003Data from 22 centres
No.
Success Partial Success
Repeat PCI
CABG re-MI Death (Range)
Primary PTCA
475 83% (0-100)
2.7% (0-20)
1.1% (0-14)
0.4% (0-0.6)
0.5% (0-6)
4.5% (0-20)
Rescue PTCA
784 89% (40-100)
3.2% (0-14)
0.7% (0-6.7)
0.5% (0-7.7)
0.6% (0-8)
5.4% (0-60)
Re-MI PTCA
345 94.8% (80-100)
2.0% (0-50)
0.4% (0-7)
0.8% (0-20)
1.5% (0-20)
0.24% (0-6)
Shock 218 61% (0-100)
3.7% (0-33)
3.0% (0-67)
4.3% (0-67)
12% (0-100)
36.3% (0-100)
Patients Rx for STEMI
2003 data: Ludman
Hospital MACE Overview 2003(Data from 35 centres; 32,950 patients)
0.630.32 0.120.180.71
0.15
9.4
1
4.5
0.4
5.4
0.5
0123456789
10
% Mortality
em CABG
2003 data: Ludman
Hospital MACE Overview 2003(Data from 35 centres; 32,950 patients)
0
5
10
15
20
25
30
35
40
%
All
Elect
ive
UA/NSTEM
ISAT
PPTCA
Rescu
e
Shock
Mortality
em CABG
2003 data: Ludman
CCAD
• Pilot
• Governance
• Current position
• First Wave Roll Out
2003 data: Ludman
CCAD
• Pilot
• Governance
• Current position
• First Wave Roll Out
2003 data: Ludman
Stable Syndromes
Acute STEMI syndromes
Clarification of Indication for InterventionDataset 5.1.2 - Question 2.02
Confusion
2003 data: Ludman
Should include ALL ACS that are not acute STEMIi.e.Unstable anginaNSTEMIConvalescent STEMI
Misleading
2003 data: Ludman
New explanation:Acute coronary syndrome with or without enzyme release and a history typical of acute myocardial infarction.
Patients whose initial presentation was STEMI, but whose PCI is being performed later during the hospital stay are included in this group.
(Excludes patients having PCI for an ongoing STEMI which are coded 4 to 8).
New Description:3. ACS - UA, NSTEMI or convalescent STEMI
2003 data: Ludman
New text in red
2003 data: Ludman
CCAD
• Pilot
• Governance
• Current position
• First Wave Roll Out
2003 data: Ludman www.BCIS.org.uk and NHSIA web site
2003 data: Ludman
Governance of CCADTripartite PCI Oversight Group
Healthcare CommissionJohnathan BoyceTBA
Department of HealthRoger BoyleGavin Larner
BCISPresident – Keith Dawkins / Martyn ThomasAudit secretary – Peter LudmanScottish Representative – Keith Oldroyd
Observers:NCASP / CCADDavid Cunningham
2003 data: Ludman
Tripartite PCI Oversight Group
• Safeguard confidentiality of– patients / professionals / institutions
• Make CCAD an authoritative source of PCI data
• Provide HC with information and analysis– to give public accurate / accessible information on PCI
outcomes
• Consider modifications to the dataset
Terms of reference
2003 data: Ludman
Tripartite PCI Oversight Group
• Confidentiality– Data / analyses will not be communicated without explicit
consent of Group– Data used to demonstrate / promote CCAD will have patients
/ professionals and institutions anonymised– CCAD will log all central uses of the local encryption keys
• Respect – data will not be used to unfairly represent an individual or
institution
Principles
2003 data: Ludman
Tripartite PCI Oversight Group
• Publication– presented in such a way as to promote greater
public understanding and improve patient care
• Defensive Practice– Analyses will be sensitive to the risks of
promoting defensive practice to the detriment of patients
• Independence– data analyses by independent and authoritative
unit
• UK wide if possible
Principles (cont)
2003 data: Ludman
Service Level Agreement
NHS Information AuthorityNational Clinical Audit Support Programme (NCASP)
BCIS
2003 data: Ludman
Service Level Agreement
• Nuts and bolts– Harvesting / transmission / validation / cleaning of data
• Provision of real time feedback– PCI centres can compare themselves against national
anonymised data
• Administration and coordination of the service– CCAD (on behalf of NCSP)
2003 data: Ludman
Tripartite PCI Oversight group
NHS centresUK? Private Centres
CCAD tool
Data
Independent analysis
Annual Presentation (Autumn meeting)Other analyses
(Mortality ONS, re-PCI, CABG)
BCISDoHHCPublic
NHSIA
2003 data: Ludman
CCAD
• Pilot
• Governance
• Current position
• First Wave Roll Out
2003 data: Ludman
Centres downloading to CCADas of Oct 2004
James Cook University Hosp Regular
Queen Elizabeth Birmingham Regular
Leeds General Infirmary Regular
Torbay Regular
Bristol Intermit
King College, London Intermit
Royal Brompton Intermit
2003 data: Ludman
CCAD
• Pilot
• Governance
• Current position
• First Wave Roll Out
2003 data: Ludman
CCAD 1st wave roll out
2003 data: Ludman
CCAD tool: Local v National
N.B. test data only
2003 data: Ludman
BCIS - CCAD
• Try to have all PCI units returning data via CCAD by April 2005
2003 data: Ludman
Summary• 73 PCI centres in UK• 894 PCI pmp in UK• Cath : PCI = 3.53 : 1• PCI : CABG = 2.1 : 1• MACE
– Stable syndromes• mortality 0.12%, CABG 0.18%
– UA / NSTEMI• Mortality 0.71%, CABG 0.15%
• BCIS – CCAD– great progress