2014 data
Peter F Ludman
BCIS National Audit Lead
On behalf of
British Cardiovascular Intervention Society
Basingstoke October 2015
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
Data Sources
2014 data
1.
2.
Data
New Analyses
Cleaning
analysis
Outputs
Previous year’s datasets re-analysed for year trends
Structure
2014 data
Back to contents
Angiography Only
Centres in 2014
Angio Centres Stopped
Dumfries and Galloway
New Angio Centres
None
PCI centre becomes Angiography only
Spire Southampton
Spire Leicester
2014 data
PCI
2014 data
Centres in 2014
PCI Centres stopped
None (Frenchay move to Southmead)
PCI Centres from existing angiography units
Ipswich Hospital
New PCI Centres
Luton and Dunstable University Hospital
Kent Institute of Medicine & Surgery
Spire Cardiff Hospital
120
Number of
centres
60
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2014 data
UK Centres 2014
PCI
Angio only
140
117
63
119
100
80
63
40
20
0
2014
2014 data
Angiography (63)
2014
PCI (119)
2014 data
2014 data
2014
Angiography (63)
PCI (119)
PCI Centres in 2014
2014 data
UK Countries
NHS
Private
Scotland
6
2
England
86
16
N Ireland
Wales
4
4
0
1
100
19
Total
Total
119
UK centres
2014
No No
No. cath PCI
data data
NHS
Interventional
Private
Interventional
Diagnostic
only
TOTAL
2014 data
Caths
PCIs
100
0
0
203,252
94,922
19
0
0
3,789
1,221
63
0
-
40,322
-
247,363
96,143
180
Survey Monkey
Angiography
2014 data
Performed in PCI and Angio-only centres
250000
207,041
200000
150000
Angiography centres
PCI Centres
100000
50000
40,322
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0
Population estimates
2014 data
Mid 2014
Total UK: 64.6 m
Scotland 5.348 m
Northern Ireland 1.841 m
England 54.317 m
estimate: 0.1m of N. Welsh pop
Rx in England
Total Rx in England 54.42 m
Wales 3.092 m
est: Rx in Wales: 2.992 m
Total PCI activity all UK
110000
100000
96,143 PCIs
1,488 pmp
2014 data
1600
1400
90000
80000
1200
70000
1000
Total PCI 60000
Procedures 50000
800
40000
600
30000
400
PCI
pmp
20000
200
10000
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
Survey Monkey
%
5
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
PCI pmp all UK
2014 data
Rate of Increase
25
20
15
10
3.0
0
-5
Survey Monkey
2014
2013
40
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
%
1998
PCI per Angiogram ratio
2014 data
45
37.9 38.9
35
30
25
20
15
10
5
0
Total PCIs in the UK
2014 data
by Country and Type of Institution
90000
80000
78207
70000
60000
50000
40000
30000
20000
10000
0
8436
1145
63
4235
4044
13
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Total PCIs in the UK
2014 data
by Country and Type of Institution
90000
80000
78207
70000
2010
60000
2011
50000
2012
40000
2013
30000
2014
20000
10000
0
8436
1145
63
4235
4044
13
Total PCIs in the UK
2014 data
by Country and Type of Institution
90000
80000
78207
70000
2010
60000
2011
50000
2012
40000
2013
30000
2014
20000
10000
0
8436
1145
63
4235
4044
13
Total PCIs in the UK
2014 data
by Country and Type of Institution
Zoom
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
8436
2010
2011
4235
2012
4044
2013
2014
1145
63
13
PCI pmp
2014 data
By UK Country
2500
2301
2000
1500
1458
1589
1355
1000
500
0
England
Scotland
N. Ireland
Wales
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
PCI pmp
2014 data
Rate of Increase by UK Country
25
20
15
England
Scotland
N. Ireland
Wales
10
5
0
-5
-10
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total PCI vs Isolated CABG
2014 data
120000
100000
96,143
80000
60000
PCI
CABG
40000
20000
17,513
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
0
Note: CABG data for financial year
Survey Monkey and SCTS data from ‘Blue Book online’
PCI vs Isolated CABG Ratio
6
4.9 4.9
5
5.2
2014 data
5.5 5.5
4.2
4
3.4 3.4
3.6
3
3
2
2.5
1.3
1.6
1.8
2.1
1
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
0
Survey Monkey and SCTS data from ‘Blue Book online’
Number of PCIs per Centre
NHS and Private
Number of PCIs Performed
3000
2500
2000
1500
1000
500
0
Individual centres
39 Centres performing < 400 cases (33%)
2014 data
Number of PCIs per Centre
NHS Centres
Number of PCIs Performed
3000
2500
2000
1500
1000
500
0
Individual centres
20 Centres performing < 400 cases (20%)
2014 data
Centres < 400 PCIs
2014 data
NHS
RAI: Raigmore Hospital (2010)
WEX: Wexham Park Hospital (2006)
DGE: Eastbourne Hospital (2006)
MAY: Croydon University Hospital (2006)
WAT: Watford General Hospital (2009)
AEI: Royal Albert Edward Infirmary (Wigan) (2007)
KMH: Kings Mill Hospital (2010)
PIN: Pinderfields General Hospital (2010)
PMS: Great Western Hospital (2006)
SCU: Scunthorpe General Hospital (2010)
BRD: Bradford Royal Infirmary (2005)
KSX: Tunbridge Wells Hospital (2008)
DVH: Darent Valley Hospital (2008)
IPS: Ipswich Hospital (2014)
GWH: Queen Elizabeth Hospital Woolwich (2007)
EAL: Ealing Hospital (2009)
YDH: York District General Hospital (2010)
MDW: Medway Maritime Hospital (2010)
FRY: Frenchay Hospital (2008)
LDH: Luton and Dunstable (2014)
378
363
350
347
341
335
332
314
307
296
292
261
254
245
227
225
220
214
190
134
0
100
PCI program start date
200
300
400
Centres < 400 PCIs
2014 data
Private
HHW: Wellington Hospital (< 2002)
ANT: St Anthony's Hospital (< 2002)
LBH: London Bridge Hospital (< 2002)
HBP: Spire Hospital Hull and East Riding (2004)
HSC: Harley Street Clinic (< 2002)
IND: London Independent Hospital (< 2002)
AHM: BMI Alexandra Hospital (< 2002)
MHO: Manor Hospital Oxford (< 2002)
CRO: Cromwell Hospital (< 2002)
SSP: Spire Shawfair Park Hospital (2010)
LNH: Leeds Nuffield Hospital (2003)
PHN: BMI Park Hospital (< 2002)
GHB: Spire Hospital Bristol (2012)
RHH: Ross Hall Hospital (< 2002)
PHB: BMI Priory Hospital (< 2002)
LEB: Spire Hospital Leeds (< 2002)
KIM: Kent Institute of Medicine & Surgery (2014)
BMI: BMI Meriden Hospital (2007)
SPC: Spire Cardiff Hospital (2014)
258
147
126
88
81
78
78
60
58
39
36
35
28
24
21
19
16
16
13
0
50
PCI program start date
100
150
200
250
300
Centres < 200 PCIs
In either 2012, 2013 or 2014
2014 data
Centres < 200 PCIs
In either 2012, 2013 or 2014
2014 data
Interventional Consultants
2014 data
(NHS centres)
800
700
697
731
20
18
16
600
14
500
12
10
Total 400
8
300
200
4.9
2.8
Increase (%)
6
4
2
100
0
0
-2
Note: if work at two NHS centres will be counted twice
Includes cardiologists and radiologists
Interventional Consultants
2014 data
• Actual number of PCI operators by GMC number
• NHS and private
• No double counting if work on more than one site
700
621
639
659
600
500
1.3% increase
400
Total
300
200
100
0
2012
2013
2014
No. of Consultants
2014 data
In NHS centres
25
20
15
No. of PCI
Consultants in
each centre
10
5
0
0
1000
2000
3000
Total number of PCIs performed in each centre
Note: if work at two NHS centres will be counted twice
No. of Consultants
2014 data
In NHS centres
Note: if work at two NHS centres will be counted twice
PPCI
On call rota - Weekdays
2014 data
PPCI
On call rota - Weekends
2014 data
0
AEI
ALT
AMG
BAL
BAS
BAT
BED
BFT
BHL
BHR
BLA
BOU
BRD
BRI
BRY
CGH
CHG
CHH
CHN
CLW
CMI
CRG
DER
DGE
DUD
DVH
EAL
EBH
ERI
ESU
FRE
FRM
FRY
GEO
GJH
GRL
GWE
GWH
HAI
HAM
HH
IPS
KCH
KGH
KMH
KSX
LDH
LGI
LIN
LIS
PPCI
weekdays: 1 in ....
2014 data
On call Rotas (A-L)
weekends: 1 in ...
30
25
20
15
10
5
0
MAY
MDW
MOR
MPH
MRI
NCR
NGS
NHB
NHH
NIN
NOR
NPH
NTH
PAP
PIN
PLY
PMS
QAP
QEB
RAD
RAI
RCH
RDE
RFH
RHI
RIA
RSC
RVB
SAL
SAN
SCM
SCU
SGH
SPH
STH
STO
SUN
TOR
UCL
UHW
VIC
WAL
WAT
WDH
WEX
WHH
WRC
WRG
WYT
YDH
PPCI
weekdays: 1 in ....
2014 data
On call Rotas (M-Z)
weekends: 1 in ...
30
25
20
15
10
5
No. of Consultants
2014 data
(Per NHS Centre in 2014)
8
7.3
7
6
5
Mean Number
of Operators 4
3
2
1
0
Note: if work at two NHS centres will be counted twice
PCI per Consultant
2014 data
PCI Centre case volume / Number of operators
150
Number of PCIs
145
140
135
130
125
131 130
127
123
120
115
110
NHS Centres
PCIs per Consultant
(NHS Centres 2014)
Note:
Data from institutional volume divided by No operators per institution
Some consultants work in multiple institutions
2014 data
On v Off Site Surgery
2014 data
All Centres (NHS and private)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
28
55
38
Off Site
On Site
45
53
54
63
66
69
69
72
40 %
53
53
52
50
51
51
49
48
47
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Survey Monkey
On v Off Site Surgery
2014 data
NHS Centres Only
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
26
38
37
42
50
51
Off Site
On Site
60
63
63
62
64
36 %
38
39
38
37
37
36
36
36
36
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Survey Monkey
Total Number of PCIs
2014 data
By Surgical cover NHS & Private
120000
100000
On Site
Off Site
Total
96143
80000
60000
40000
20000
0
56378
57%
39765
42%
Surgical Cover
2014 data
(NHS centres only)
On site
3500
3000
Off site
Mean
1540
617
Median
1457
513
2500
PCIs per
Centre
2000
1500
1000
500
0
Individual Centres
Survey Monkey
Day Case PCI
2014 data
• 101 of 110 Units perform planned elective day case PCI
35000
30000
25000
30
25
25
23,950
20,387
Total
Number
20000
20
As % of
15 All PCI
15000
10
10000
5000
5
0
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Data from: 110 of 119 centres
Day Case PCI
Planned Elective Procedures
Note: Some Centres incorrectly report ASC cases ‘planned elective’ day cases (giving ratios > 100%)
2014 data
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
50
40
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
50
40
69
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
Repatriation 19 (33%)
50
40
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
50
40
30
16
20
10
4
8
2
Ambulance
arrivals for PPCI
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Only self
presenters and
in patients
Barts
Liverpool
Castle Hill
Nottingham City
Frenchay
7
Golden
Jubilee
5
1
Glenfield
Harefield
Papworth
UCL
Other
No A&E on site: 10
Never
57
Exceptional only
60
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
50
MRI and Wythenshaw
Conquest and Eastbourne
40
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
50
40
30
20
10
4
8
Bath - Bristol
Cheltenham - Bristol
Great Western - Bristol
Wycombe – Harefield and John Radcliff
Wexham - Harefield
Salisbury –16
Bournemouth and Southampton
Dorset – Bournemouth
7
5
2
Raigmore
- Aberdeen and Lysis
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Never
Exceptional only
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
Sunderland
Luton and Dunstable
50
40
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
Primary PCI
2014 data
Pattern of activity offered (NHS)
60
57
Royal Brompton
Cover for Chelsea and Westminster
50
40
30
4
8
2
7
5
Never
10
Exceptional only
16
20
1
Ambulance
arrivals for PPCI
Only self
presenters and
in patients
Other
Working hrs In
patients
24/7/365 In
patients
Working hrs
Hybrid
24/7/365 hybrid
24/7/365
0
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
2014 data
PPCI 2014
PPCI as part of
ambulance network
PPCI 24/7
PPCI 24/7 Hybrid
PPCI working hrs
No PPCI as part
of ambulance
network
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
Patient Specific Data Collection
Back to contents
2014 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2014 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
Procedure Specific Analysis
Participation in NICOR
England
Wales
Total No. of
Centres
86
Data to
NICOR
86
Missing
Private
16
10
6
NHS
4
4
0
Private
1
0
1
4
4
0
NHS
6
6
0
Private
2
1
1
NHS
N Ireland
Scotland
0
2014 data
‘Front end’ Database used
2014 data
2014
Tomcat
Access database from BCIS Website
4
4
4
Cardaas
21111
22 2
Medcon
Dendrite
26
Lotus Notes
4
Bespoke in house database
5
15
10
Datacam
None
PATS
11
12
12
Philips
Cardiobase (Magnus)
Centricity
Infoflex
Prism
Cardex
For some bespoke = manual data collection
Cardioreport
IPM
Minerva
2014 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2014 data
Case Ascertainment
NICOR
Data warehouse
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
SPC: Spire Cardiff Hospital
PHN: BMI Park Hospital
LEB: Spire Hospital Leeds
HBP: Spire Hospital Hull and East Riding
MHO: Manor Hospital Oxford
KMH: Kings Mill Hospital
SSP: Spire Shawfair Park Hospital
GWE: Royal Gwent Hospital
CRO: Cromwell Hospital
CHN: Nottingham City Hospital
BLA: Royal Blackburn Hospital
BRI: Bristol Royal Infirmary
GWH: Queen Elizabeth Hospital Woolwich
NTH: Northampton General Hospital
NGS: Northern General Hospital
RHI: Calderdale Royal Hospital
SAL: Salisbury District Hospital
WEX: Wexham Park Hospital
AHM: BMI Alexandra Hospital
GEO: St George's Hospital
STH: St Thomas' Hospital
VIC: Blackpool Victoria Hospital
BHR: Royal Berkshire and Battle Hospital
HH: Harefield Hospital
PMS: Wiltshire Cardiac Centre
PLY: Southwest Cardiothoracic Centre
WYT: Wythenshawe Hospital
SCM: James Cook University Hospital
QEB: Queen Elizabeth Hospital, Birmingham
NHB: Royal Brompton Hospital
MAY: Croydon University Hospital
LBH: London Bridge Hospital
FRY: Frenchay Hospital
EBH: Birmingham Heartlands Hospital
CHG: Cheltenham General Hospital
BRY: Acute Pennine Trust Fairfield
BFT: Belfast Trust City Hospital
WRC: Worcester Royal Hospital
SGH: Southampton General Hospital
DVH: Darent Valley Hospital
DGE: Eastbourne Hospital
STO: University Hospital of North Staffordshire
RSC: Royal Sussex County Hospital
RIA: Aberdeen Royal Infirmary
HSC: Harley Street Clinic
WAL: University Hospital Coventry
MRI: Manchester Royal Infirmary
RDE: Royal Devon & Exeter Hospital
BED: Bedford Hospital
AEI: Royal Albert Edward Infirmary
ESU: East Surrey Hospital
IPS: Ipswich Hospital
AMG: Wycombe Hospital
BHL: Liverpool Cardiothoracic Centre
SUN: Sunderland Royal Hospital
GHB: Spire Hospital Bristol
UCL: Heart Hospital (UCLH)
RFH: Royal Free Hospital
RAD: John Radcliffe Hospital
KCH: Kings College Hospital
As August 2015
0
20
40
60
80
100
120
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
No Data
SPC: Spire Cardiff Hospital
PHN: BMI Park Hospital
LEB: Spire Hospital Leeds
HBP: Spire Hospital Hull and East Riding
MHO: Manor Hospital Oxford
KMH: Kings Mill Hospital
SSP: Spire Shawfair Park Hospital
GWE: Royal Gwent Hospital
CRO: Cromwell Hospital
CHN: Nottingham City Hospital
BLA: Royal Blackburn Hospital
BRI: Bristol Royal Infirmary
GWH: Queen Elizabeth Hospital Woolwich
NTH: Northampton General Hospital
NGS: Northern General Hospital
RHI: Calderdale Royal Hospital
SAL: Salisbury District Hospital
WEX: Wexham Park Hospital
AHM: BMI Alexandra Hospital
GEO: St George's Hospital
STH: St Thomas' Hospital
VIC: Blackpool Victoria Hospital
BHR: Royal Berkshire and Battle Hospital
HH: Harefield Hospital
PMS: Wiltshire Cardiac Centre
PLY: Southwest Cardiothoracic Centre
WYT: Wythenshawe Hospital
SCM: James Cook University Hospital
QEB: Queen Elizabeth Hospital, Birmingham
NHB: Royal Brompton Hospital
MAY: Croydon University Hospital
LBH: London Bridge Hospital
FRY: Frenchay Hospital
EBH: Birmingham Heartlands Hospital
CHG: Cheltenham General Hospital
BRY: Acute Pennine Trust Fairfield
BFT: Belfast Trust City Hospital
WRC: Worcester Royal Hospital
SGH: Southampton General Hospital
DVH: Darent Valley Hospital
DGE: Eastbourne Hospital
STO: University Hospital of North Staffordshire
RSC: Royal Sussex County Hospital
RIA: Aberdeen Royal Infirmary
HSC: Harley Street Clinic
WAL: University Hospital Coventry
MRI: Manchester Royal Infirmary
RDE: Royal Devon & Exeter Hospital
BED: Bedford Hospital
AEI: Royal Albert Edward Infirmary
ESU: East Surrey Hospital
IPS: Ipswich Hospital
AMG: Wycombe Hospital
BHL: Liverpool Cardiothoracic Centre
SUN: Sunderland Royal Hospital
GHB: Spire Hospital Bristol
UCL: Heart Hospital (UCLH)
RFH: Royal Free Hospital
RAD: John Radcliffe Hospital
KCH: Kings College Hospital
As August 2015
0
20
40
60
80
100
120
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
Spire Cardiff Hospital
Ross Hall Hospital
BMI Park Hospital
Leeds Nuffield Hospital
No Data
Spire Hospital Leeds
London Independent Hospital
Spire Hospital Hull and East Riding
BMI Meriden Hospital
As August 2015
0
50
100
150
200
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
SPC: Spire Cardiff Hospital
PHN: BMI Park Hospital
LEB: Spire Hospital Leeds
HBP: Spire Hospital Hull and East Riding
MHO: Manor Hospital Oxford
KMH: Kings Mill Hospital
SSP: Spire Shawfair Park Hospital
GWE: Royal Gwent Hospital
CRO: Cromwell Hospital
CHN: Nottingham City Hospital
BLA: Royal Blackburn Hospital
BRI: Bristol Royal Infirmary
GWH: Queen Elizabeth Hospital Woolwich
NTH: Northampton General Hospital
NGS: Northern General Hospital
RHI: Calderdale Royal Hospital
SAL: Salisbury District Hospital
WEX: Wexham Park Hospital
AHM: BMI Alexandra Hospital
GEO: St George's Hospital
STH: St Thomas' Hospital
VIC: Blackpool Victoria Hospital
BHR: Royal Berkshire and Battle Hospital
HH: Harefield Hospital
PMS: Wiltshire Cardiac Centre
PLY: Southwest Cardiothoracic Centre
WYT: Wythenshawe Hospital
SCM: James Cook University Hospital
QEB: Queen Elizabeth Hospital, Birmingham
NHB: Royal Brompton Hospital
MAY: Croydon University Hospital
LBH: London Bridge Hospital
FRY: Frenchay Hospital
EBH: Birmingham Heartlands Hospital
CHG: Cheltenham General Hospital
BRY: Acute Pennine Trust Fairfield
BFT: Belfast Trust City Hospital
WRC: Worcester Royal Hospital
SGH: Southampton General Hospital
DVH: Darent Valley Hospital
DGE: Eastbourne Hospital
STO: University Hospital of North Staffordshire
RSC: Royal Sussex County Hospital
RIA: Aberdeen Royal Infirmary
HSC: Harley Street Clinic
WAL: University Hospital Coventry
MRI: Manchester Royal Infirmary
RDE: Royal Devon & Exeter Hospital
BED: Bedford Hospital
AEI: Royal Albert Edward Infirmary
ESU: East Surrey Hospital
IPS: Ipswich Hospital
AMG: Wycombe Hospital
BHL: Liverpool Cardiothoracic Centre
SUN: Sunderland Royal Hospital
GHB: Spire Hospital Bristol
UCL: Heart Hospital (UCLH)
RFH: Royal Free Hospital
RAD: John Radcliffe Hospital
KCH: Kings College Hospital
As August 2015
<90%
0
20
40
60
80
100
120
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
MHO: Manor Hospital Oxford
<90%
KIM: Kent Institute of Medicine & Surgery
KMH: Kings Mill Hospital
CLW: North Wales Cardiac Centre
SSP: Spire Shawfair Park Hospital
MDW: Medway Maritime Hospital
GWE: Royal Gwent Hospital
KSX: Tunbridge Wells Hospital
CRO: Cromwell Hospital
As August 2015
0
20
40
60
80
100
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
SPC: Spire Cardiff Hospital
PHN: BMI Park Hospital
LEB: Spire Hospital Leeds
HBP: Spire Hospital Hull and East Riding
MHO: Manor Hospital Oxford
KMH: Kings Mill Hospital
SSP: Spire Shawfair Park Hospital
GWE: Royal Gwent Hospital
CRO: Cromwell Hospital
CHN: Nottingham City Hospital
BLA: Royal Blackburn Hospital
BRI: Bristol Royal Infirmary
GWH: Queen Elizabeth Hospital Woolwich
NTH: Northampton General Hospital
NGS: Northern General Hospital
RHI: Calderdale Royal Hospital
SAL: Salisbury District Hospital
WEX: Wexham Park Hospital
AHM: BMI Alexandra Hospital
GEO: St George's Hospital
STH: St Thomas' Hospital
VIC: Blackpool Victoria Hospital
BHR: Royal Berkshire and Battle Hospital
HH: Harefield Hospital
PMS: Wiltshire Cardiac Centre
PLY: Southwest Cardiothoracic Centre
WYT: Wythenshawe Hospital
SCM: James Cook University Hospital
QEB: Queen Elizabeth Hospital, Birmingham
NHB: Royal Brompton Hospital
MAY: Croydon University Hospital
LBH: London Bridge Hospital
FRY: Frenchay Hospital
EBH: Birmingham Heartlands Hospital
CHG: Cheltenham General Hospital
BRY: Acute Pennine Trust Fairfield
BFT: Belfast Trust City Hospital
WRC: Worcester Royal Hospital
SGH: Southampton General Hospital
DVH: Darent Valley Hospital
DGE: Eastbourne Hospital
STO: University Hospital of North Staffordshire
RSC: Royal Sussex County Hospital
RIA: Aberdeen Royal Infirmary
HSC: Harley Street Clinic
WAL: University Hospital Coventry
MRI: Manchester Royal Infirmary
RDE: Royal Devon & Exeter Hospital
BED: Bedford Hospital
AEI: Royal Albert Edward Infirmary
ESU: East Surrey Hospital
IPS: Ipswich Hospital
AMG: Wycombe Hospital
BHL: Liverpool Cardiothoracic Centre
SUN: Sunderland Royal Hospital
GHB: Spire Hospital Bristol
UCL: Heart Hospital (UCLH)
RFH: Royal Free Hospital
RAD: John Radcliffe Hospital
KCH: Kings College Hospital
As August 2015
>100%
0
20
40
60
80
100
120
NICOR Case Ascertainment
2014 data
UK PCI data in NICOR as % of Reported Totals
LGI: Yorkshire Heart Centre
HSC: Harley Street Clinic
WAT: Watford General Hospital
WAL: University Hospital Coventry
NPH: Northwick Park Hospital
MRI: Manchester Royal Infirmary
EAL: Ealing Hospital
RDE: Royal Devon & Exeter Hospital
ANT: St Anthony's Hospital
BED: Bedford Hospital
MPH: Musgrove Park Hospital
AEI: Royal Albert Edward Infirmary
BRD: Bradford Royal Infirmary
ESU: East Surrey Hospital
MOR: Morriston Hospital
IPS: Ipswich Hospital
TOR: Torbay Hospital
AMG: Wycombe Hospital
HHW: Wellington Hospital
BHL: Liverpool Cardiothoracic Centre
FRE: Freeman Hospital
SUN: Sunderland Royal Hospital
KGH: Kettering General Hospital
GHB: Spire Hospital Bristol
CMI: Cumberland Infirmary
UCL: Heart Hospital (UCLH)
HAI: Hairmyres Hospital
RFH: Royal Free Hospital
PHB: BMI Priory Hospital
RAD: John Radcliffe Hospital
GJH: Golden Jubilee National Hospital
KCH: Kings College Hospital
As August 2015
>101%
0
20
40
60
80
100
120
Case Ascertainment
2014 data
Reported Totals v data in NICOR
UK
E
NHS
Declared
PCIs
96,143 78,207
In NICOR
96,365
Missing
Missing (%)
Extras
Extra (%)
W
NHS
S
NHS
NI
NHS
E
Private
W
Private
S
Private
4,044
8,436
4,235
1,145
13
63
1657
868
332
22
66
323
13
33
1.7
1.1
8.2
0.3
1.6
28.2
100
52.3
1881
1276
45
538
2
20
0
0
2.0
1.6
1.1
6.3
0
1.7
0
0
NICOR data as August 2015
2014 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2014 data
NICOR Minimum Data Standard
• > 90% completeness
1.03
1.06
1.07
5.05
5.06
2.16
5.35
2.18
2.04
2.03
3.09
4.04
4.03
4.01
5.31
3.02
All PCI
NHS number (E&W)
Birth date
Sex
Medical History
History of renal disease
Diabetes
Creatinine
Weight
Cardiogenic shock (Pre- PCI)
Procedure urgency
Vessels attempted
Discharge date
Status at discharge
PCI Hospital outcome
Consultant responsible GMC Number
Consultant responsible Name
2.07
5.27
2.08
5.26
PCI for all types of ACS
Date/time of symptom onset
Date/time of call for help
Date/time of arrival at first hospital
Date/time of arrival at PCI hospital
Primary PCI
(in community at symptom onset)
5.30
Location of Patient at STEMI onset
3.26
Date/time of first balloon inflation
Unchanged since November 2010
% Completeness
2014 data
12 fields required for risk adjusted outcome NWQIP
Top score potential = 1400
< 90%
< 50%
NHS number not included in ranking as only E&W
% Completeness
England NHS
Excellent
2014 data
% Completeness
England NHS
Almost
Excellent
2014 data
% Completeness
England NHS
2014 data
% Completeness
England Private
2014 data
% Completeness
Scotland NHS
Scotland Private
2014 data
% Completeness
Wales NHS
Wales Private
N. Ireland
2014 data
Time fields
Data completeness
2014 data
Primary PCI
(in community at symptom onset)
2.07
Date/time of symptom onset
5.27
Date/time of call for help
2.08
Date/time of arrival at first hospital
5.26
Date/time of arrival at PCI hospital
3.26
Date/time of first balloon inflation
> 90% completeness in each
Time fields
Excellent
2014 data
Time fields
Room for improvement
2014 data
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
Appropriateness
Back to contents
Demographics
2014 data
2007
2008
2009
2010
2011
2012
2013
2014
Age (mean)
64.3
64.4
65.0
65.1
65.3
64.9
64.9
65.1
Sex (male %)
73.6
73.8
73.9
74.0
74.0
74.1
74.3
74.3
Diabetic (%)
17.5
18.0
18.2
18.7
19.5
20.2
20.7
21.0
Previous CABG (%)
8.5
9.1
8.6
8.4
7.9
8.9
8.6
8.4
Previous PCI (%)
18.6
21.1
22.3
22.6
22.7
23.5
24.7
25.6
Previous MI (%)
29.5
30.2
28.8
28.4
27.6
26.8
27.2
27.4
Current smoker (%)
26.0
26.1
25.4
25
24.4
Ex smoker (%)
39.0
37.0
36.9
37.7
37.3
Never smoked (%)
35.1
37.0
37.7
37.3
38.2
Demographics - Age
2014 data
Demographics - Age
2014 data
Demographics - Age
2014 data
Demographics - Age
2014 data
Demographics
2014 data
Ethnic Origin
Year
2007
2008
2009
2010
2011
2012
2013
2014
Data available
46,643
48,267
55,572
61,966
64,355
62,233
62,327
63,605
European (%)
92.3
92.0
93.0
92.3
91.8
92.1
91.6
91.4
Asian (%)
6.7
7.1
6.16
6.77
7.2
6.9
7.2
7.54
Black (%)
0.83
0.72
0.71
0.79
0.83
0.79
0.99
0.88
Oriental (%)
0.2
0.17
0.15
0.17
0.17
0.14
0.16
0.18
Clinical Syndrome
70
65.7
2014 data
65.1
60
50
% PCI
40
Performed for
each
Indication 30
20
10
0
34.9
34.4
Stable
Acute
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2014 data
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2014 data
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2014 data
Indication for PCI
2014 data
100%
11
90%
12.9
16.2
20.2
24
26.1
27.3
27.5
27.2
80%
70%
37.8
40.7
38.2
60%
38.2
37.8
37.3
36.9
37.6
37.2
34.9
34
32.8
33
50%
40%
30%
20%
50.1
45.2
44.3
39.9
36.2
10%
0%
1.9
1.8
1.8
2.1
2006 2007 2008 2009 2010 2011 2012 2013 2014
STEMI
NSTEMI/UA
Stable
Other
Indication for PCI
100%
90%
2.5
1.79
2014 data
Other
27.2
80%
2
2007
2008
2009
2010
2011
2012
2013
2014
70%
60%
50%
1.5
37.2
%
40%
1
30%
20%
0.5
33
10%
0.09
2.1 Other
0%
2014
0.17
0.03
0
Staged Hybrid
SAT
Bailout
Staged % of all PCI
2013
2014
2014 data
Staged
2014 data
Staged
2014 data
Staged
2014 data
Staged % of all PCI
2014 data
Staged % of all PCI
2014 data
Staged % of Primary PCI
2014 data
Staged % of Primary PCI
2014 data
2014 data
PCI for Stent Thrombosis
3.5
3
Total 2.95 %
2.5
0.74
2
0.26
Very Late (> 1yr)
Late (30/7 - 1yr)
Early (0-30/7)
%
1.5
1
1.94
0.5
0
2014
Indication for PCI
100%
90%
27.2
80%
70%
60%
50%
37.2
40%
30%
20%
33
10%
0%
2014
27.2 % STEMI
2014 data
PCI for STEMI
2014 data
30000
Number of procedures
25,207 25,759
25000
24,588
20000
15000
10000
5000
0
All STEMI
Primary PCI
25,276
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
619
483
2013
2014
Rescue
Primary PCI for STEMI
Absolute numbers
2013
2014
2014 data
Primary PCI for STEMI
Absolute numbers 2014
2014 data
Primary PCI for STEMI
Absolute numbers 2014
2014 data
Primary PCI for STEMI
As % of Total PCIs 2014
2014 data
Primary PCI for STEMI
As % of Total PCIs 2014
2014 data
Primary PCI for STEMI
As % of Total PCIs 2014
2014 data
Primary PCI for STEMI
As % of Total PCIs 2014
2014 data
Primary PCI for STEMI
Increase
2014 data
Primary PCI for STEMI
Increase
2014 data
Primary PCI for STEMI
2011
2014 data
2012
2012
2013
2013
2014
Primary PCI
2014 data
UK Countries – Total number of procedures
25000
21,269
20,823
20000
2007
2008
2009
2010
2011
2012
2013
2014
15000
10000
5000
2,324
2,153
958
943
725
460
0
England
Scotland
Wales
N. Ireland
NB: Scotland – first data from Hairmyres in 2013
Primary PCI
2014 data
UK Countries - pmp
500
435
450
400
394
391
391
320
350
2009
2010
2011
2012
2013
2014
300
250
200
150
100
50
0
England
Scotland
Wales
N. Ireland
UK
NB: All previous years updated with latest NICOR extract
Scotland – first data from Hairmyres in 2013
Primary PCI pmp
2014 data
By LAT over 2010 to 2014
David Cunningham
300-500 pmp
Primary PCI pmp
2014 data
By LAT over 2010 to 2014
Part 1: Lower rate pmp
David Cunningham
Primary PCI pmp
By LAT over 2010 to 2014
Part 2: Upper rate pmp
2014 data
David Cunningham
Pre PCI Ventilation
2014 data
• Total Number of emergency cases with Pre PCI ventilation
– Subset of out of hospital cardiac arrest
2000
7.0
1800
5.5
1600
5.0
4.5
3.9
3.5
3.8
4.0
% of
Total Primary
PCIs
3.0
1210
600
1346
1473
958
400
200
6.0
5.1
1400
Number 1200
Of
PCIs for 1000
Ventilated
emergencies 800
5.8
532
675
2.0
1.0
318
0
0.0
2008 2009 2010 2011 2012 2013 2014
Pre PCI Ventilation
• As % of ALL PCI activity
2014 data
Pre PCI Ventilation
• As % of ALL PCI activity
2014 data
Pre PCI Ventilation
• As % of Primary PCI cases
2014 data
Pre PCI Ventilation
• As % of Primary PCI cases
2014 data
2014 data
Out of Hospital Cardiac Arrest
2014:
46,513 PCI with data recorded
1,398 PCIs (3.0%)
0
Established
43
Acute
20
Acute after completion
of PCI procedure
1
Acute after start of PCI
procedure
98
Acute following arrest
event–initiated by PCI
team
527
Acute following arrest
event–initiated before
arrival to PCI team
100
Patient from other GA
intervention
200
ITU patient
600
Not ventilated
2014 data
Out of Hospital Cardiac Arrest
513
500
400
300
4
2014
0
Established
43
Acute
20
Acute after completion
of PCI procedure
1
Acute after start of PCI
procedure
98
Acute following arrest
event–initiated by PCI
team
527
Acute following arrest
event–initiated before
arrival to PCI team
100
Patient from other GA
intervention
200
ITU patient
600
Not ventilated
2014 data
Out of Hospital Cardiac Arrest
513
500
400
300
4
2014
2014 data
Out of Hospital Cardiac Arrest
Ventilated
before or during
n with
data
No Ventilation
n with
data
OOHA cases (n)
556
527
Cooling (%)
40.9
479
2.6
421
pH (mean)
7.14
320
7.3
100
pH (min)
6.0
18.0
7.0
pH (max)
7.52
9.1
7.6
Lactate (Mean)
6.7
270
4.1
85
30 day mortality (%)
47.6
494
6.9
480
2014 data
Out of Hospital Cardiac Arrest
• Internal Data Consistency
Pre-PCI ventilation
(old field)
OOHA
Ventilation
options
No
Yes
None
18,617
81
Pre PCI (Options 1,2,3,4)
90
683
During / After PCI (Options 5,6)
78
17
Multi-vessel Disease
2014 data
Multi-vessel Treatment
90
80
79.2
70
60
50
% of all PCI
40
30
20
10
16.4
3
0
1
2
3
Number of Vessels treated per Case
2006
2007
2008
2009
2010
2011
2012
2013
2014
2014 data
Multi-Lesion Treatment
80
70
70.5
60
50
% of all
40
PCIs
30
22.3
20
10
5.7
1.5
0
1
2
3
>3
Number of lesions Treated per Case
2006
2007
2008
2009
2010
2011
2012
2013
2014
2014 data
PCI to Multiple
Lesions and vessels
2014 data
1.7
1.62
1.6
1.49
1.5
1.45
1.41
1.37 1.37
1.4
1.39
1.37
1.39
Lesions per case
Vessels per case
1.3
1.3
1.2
1.21
1.19
1.24
1.22 1.22 1.22 1.22 1.23
1.1
1
2006 2007 2008 2009 2010 2011 2012 2013 2014
Disease Burden
Primary PCI v Non-Primary PCI Cases
Epicardial Territories with > 75% stenoses
80
70
69.5
Primary PCI
66.8
Non-Primary PCI
60
50
% 40
30
21.6 23.5
20
8.2 8.2
10
0.6 1.4
0
1 Territory
2 Territories
3 Territories
4 Territories
2014 data
Primary PCI
2014 data
Multi-vessel Rx
100
90
87.8
80
70
Territories stenosed
69.5
Vessels treated
during PPCI
60
% 50
40
30
21.6
20
9.9
10
8.2
1.5
0
1
2
3
0.6 0.9
4+
Primary PCI
2014 data
Multi-vessel Rx at time of PPCI
100
90
89.1
87.8
80
70
60
2013
2014
% 50
40
30
20
9
10
9.9
1.2 1.5
0
1
2
3
0.7 0.9
4+
All PCI
2014 data
Epicardial Territory Treated
2%
4%
31%
42%
21%
Identical to 2013
LMS
LAD
Cx
RCA
graft
Primary PCI
2014 data
Epicardial Territory Treated
1%
40%
3%
40%
16%
LMS
LAD
Cx
RCA
graft
Treated Epicardial Territory
2014 data
By Presenting Syndrome
100%
2.4
3.3
29
27.3
1.2
90%
80%
39.6
70%
60%
21
24.1
16.1
Territory 50%
Treated
40%
30%
43
40.6
40.1
20%
10%
0%
4.7
4.7
Stable
NSTEMI
3
Primary PCI
graft
RCA
Cx
LAD
LMS
Stents
2014 data
Procedures using Stents
2014 data
Procedures using Stents
2014 data
Procedures using Stents
2014 data
Procedures using Stents
2014 data
2014 data
BMS and DES use V PCI for Restenosis
100
90
14
12
80
70
60
10
8
% 50
40
30
6
4
20
10
0
2
0
% PCI with any Stent
% PCI with DES
% PCI for restenosis
Procedures using Stents
91.7
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
100
90
80
70
60
% of PCI
50
Procedures
40
30
20
10
0
2014 data
aggregate data up to 2007, NICOR for 2008 on
2014 data
PCI with Drug Eluting Stents
Mean of % use by Centres
90
81.6
80
70
62 63.5
60
53
63.5
67.1
71.1
85.7
76.2
55 57
% Cases 50
using DES 40
30
17
20
10
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
0
2002
0
Drug Eluting Stent
2014 data
% PCI with DES
100
92.1
86.5
90
80
84.2
75.1
70
60
% PCIs using
50
DES
40
30
20
10
0
Scotland
England
Wales
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
N. Ireland
Data to 2007 NHS only
Data for 2008 to present all units from NICOR
PCI with Drug Eluting Stents
2013
2014
2014 data
PCI with Drug Eluting Stents
2014 data
PCI with Drug Eluting Stents
2014 data
PCI with Drug Eluting Stents
2014 data
2014 data
PCI with Drug Eluting Stents
By Syndrome
100
87.4
90
86.9
81.9
80
2008
2009
2010
2011
2012
2013
2014
70
60
% PCI using
50
DES
40
30
20
10
0
Stable
UA / NSTEMI
PPCI
PCI with
Bioabsorbable Vascular Scaffolds
2014 data
• BVS including other stents 485 cases
• BVS only 409
70
65
60
49
50
40
31
27 29
30
20
10
0
1 1 1 1 1 1 2
8 8 8 9
5 6 7 7 7
12
53 54
32
22 22
16
ANT
GHB
LBH
NPH
RVB
SUN
SAN
HH.
RIA
GJH
HHW
STH
BAS
CHN
GRL
WAL
MRI
VIC
KGH
RSC
SCM
QAP
CLW
NHB
LGI
PAP
BRI
FRE
Number of PCI procedures
BVS +/- other stents
BOU 58 but not recorded in NICOR
2014 data
Stents per Case
• Mean number of stents per case
2
1.9
1.8
1.7
1.6
1.5
1.62
1.63
1.54
1.5
1.48
1.48
1.46
1.48
1.47
1.46
1.4
1.3
1.2
1.1
1
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Mean Stents per Case
(by PCI unit)
2014 data
Mean Stents per Case
(by PCI unit)
2014 data
Mean Stents per Case
(by PCI unit)
2014 data
Procedures for
Restenosis
2014 data
Procedures for
Restenosis
2014 data
Procedures for
Restenosis
2014 data
Adjunctive therapy
All PCI Indications
2014 data
35
30
16.7
25
19.3
20
%
15
10
5
0
6.5
4.5
5.7
3.7
5.3
2007
2008
2009
2010
2011
2012
2013
2014
GP IIb/IIIa Antagonists
2014 data
Use by Syndrome
90
80
70
60
% Procedures 50
with any GP
IIb/IIIa blocker 40
40.6
30
20
12.2
10
6.8
4.1
0
Stable
UA
NSTEMI
PPCI
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2014 data
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2014 data
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2014 data
Any IIb/IIIa Antagonist
2014 data
Use in Primary PCI v No PPCIs per unit
Bivilirudin
2014 data
Use by Indication for PCI
20
18.6
17.5
18
15.6
16
14
10.7
12
% 10
7.4
8
6
4
2
0.480.70.5 0.5
0.7
2
2.7
2010
2011
2012
2013
2014
2 2.11.4
0
Stable
NSTEMI / UA
PCI for STEMI
Note: PCI for STEMI includes all indications including rescue
Bivalirudin
2014 data
Use in PCI for STEMI v activity per unit
2013
2014
Bivalirudin
2014 data
Use in PCI for STEMI v activity per unit
Note: PCI for STEMI includes all indications including rescue
Bivilirudin or
Any GP IIb/IIIa Blocker
2014 data
100
90
80
70
60
50
% 50
40
30
20
13
10
4.9
0
Stable
NSTEMI / UA
PPCI
2011
2012
2013
2014
Prasugrel
2014 data
Use by Indication for PCI
25
20
14.1
15
2010
2011
2012
2013
2014
% Procedures
10
5
2
1.6
1.9
0
Stable
NSTEMI / UA PCI for STEMI NSTEMI / UA
in Diabetics
Note: PCI for STEMI includes all indications including rescue
Prasugrel
2014 data
Use in PCI for STEMI v activity per unit
2013
2014
Prasugrel
2014 data
Use in PCI for STEMI v activity per unit
Note: PCI for STEMI includes all indications including rescue
Prasugrel
2014 data
Use in Diabetics with NSTEMI by centre
Prasugrel
2014 data
Use in Diabetics with NSTEMI by centre
Ticagrelor
2014 data
Use by Indication for PCI
35
30.1
30
25
23
21
20
%
2012
2013
2014
15.2
15
10
7
6
5
2.9
3.7
0.5
0
Stable
NSTEMI / UA
PCI for STEMI
Note: PCI for STEMI includes all indications including rescue
Ticagrelor
2014 data
Use in all NSTEMI and STEMI by Centre
2013
2014
Note: PCI for STEMI includes all indications including rescue
Ticagrelor
2014 data
Use in all NSTEMI and STEMI by Centre
Note: PCI for STEMI includes all indications including rescue
LV Support
2014 data
2.5
2
1.39
1.5
% of All PCI
Cases
0.96
1
0.5
0
Inotropes
IABP
2008
2009
2010
2011
2012
2013
2014
Shock Cases
2014 data
Treated with IABP support
2013
Mean 34.5%
2014
Mean 27.8%
Does not include Impella use
Shock Cases
2014 data
Treated with IABP support
Does not include Impella use
Shock Cases
2014 data
Treated with IABP support
Does not include Impella use
LV Support
% Cases using IABP v LV function
2014 data
Cardiogenic Shock
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
2014 data
Cardiogenic Shock
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
2014 data
Cardiogenic Shock
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
VIC
2014 data
Cardiogenic Shock
% Cases with shock by PCI unit
2013
HAM
WHH
BRI
WYT
UHW
GEO
Unadjusted for differing rates of OOHA
2014
HAM
WHH
BRI
WYT
NCR
MOR
SGH
2014 data
Primary PCI
% cases over 80
Case selection for PPCI?
2014 data
Primary PCI
2014 data
% cases over 80
Unadjusted for population demographics
2013
2014
Primary PCI
% cases over 80
Unadjusted for population demographics
2014 data
Primary PCI
% cases over 80
Unadjusted for population demographics
2014 data
Additional Interventional
Coronary Techniques
2014 data
16000
14000
13152
12000
10000
8000
6000
4000
2334
2000
1482
2008
2009
2010
2011
2012
2013
2014
0
Rotablation
Thrombectomy Cutting Balloon
Notes:
2010 onward data from NICOR
Assume DCA usually is actually rota, therefore DCA and Rota summed to give ‘Rotablation’
Laser wire and laser angioplasty summed to give ‘laser’
Rotational Atherectomy
2013
2014
2014 data
Rotational Atherectomy
2014 data
Rotational Atherectomy
2014 data
Primary PCI
2014 data
Extraction Atherectomy
100%
5.9
5.4
2.9
90%
80%
70%
Unknown (%)
44
44.8
53.1
60%
No Device Used (%)
50%
40%
30%
20%
Device Used (%)
50
49.8
2012
2013
44
10%
0%
2014
Overall Thrombectomy
Increase in use
2013 to 2014
2014 data
Overall Thrombectomy
Increase in use
2012 to 2013
2013 to 2014
2014 data
Additional Interventional
Coronary Techniques
2014 data
900
800
700
600
413
500
400
300
180
200
100
2008
2009
2010
2011
2012
2013
2014
0
Laser
Distal protection
Notes:
2010 onwards data from NICOR
Assume DCA usually is actually rota, therefore DCA and Rota summed to give ‘Rotablation’
Laser wire and laser angioplasty summed to give ‘laser’
2014 data
Interventional Diagnostic Procedure
Recording in PCI database
3 September 2013
Sent to all BCIS members and database contacts
Diagnostic Interventional Procedures
Invasive coronary angiography with the use of adjunctive invasive diagnostic
equipment such that a coronary device approaches, probes or crosses one or more
coronary lesions (including - but not limited to – a pressure wire, intravascular
ultrasound and swept laser imaging), before the intention to treat by mechanical
revascularisation has been decided. Interventional diagnostic cases should be
performed by interventional cardiologists in intervention capable centres.
It is suggested that recording all ‘Interventional Diagnostic Procedures’ should start
from Jan 2014
2014 data
Interventional Diagnostic Procedure
Database entry
•
•
•
•
Total number of lesions attempted (field 3.11) must = 0
And Total number of vessels attempted (field 3.10) must =0
And ‘Diagnostic device’ (field 3.19) should include a device
And Vessels attempted (field 3.09) should be left empty
• Demographics and adverse in-hospital outcomes should be
recorded in the same way as for a PCI procedure
Pressure Wire
2014 data
Data entry to NICOR
• How many Pressure Wire diagnostic
only cases are in NICOR?
• Compare:
Declared PW
diagnostic only
case
(Survey monkey)
Cases in NICOR where
• lesions attempted = 0
• at least a PW used
Pressure Wire
2014 data
Data entry to NICOR
• Centres with NO pressure wires studies
in NICOR (but declared cases >0)
AHM: BMI Alexandra Hospital
CGH. Conquest Hospital
DGE: Eastbourne Hospital
EAL: Ealing Hospital
ERI: Edinburgh Heart Centre
ESU: East Surrey Hospital, Surrey and Sussex NHS trust
GHB: Spire Hospital Bristol
GWH: Queen Elizabeth Hospital Woolwich
HAI: Hairmyres Hospital
HH: Harefield Hospital
KGH: Kettering General Hospital
LDH: Luton and Dunstable University Hospital
MDW: Medway Maritime Hospital
NHB: Royal Brompton Hospital
NIN: Ninewells Hospital
PHB: BMI Priory Hospital
PIN: Pinderfields General Hospital
PLY: Derriford Hospital, Southwest Cardiothoracic Centre
PMS: Great Western Hospital, Wiltshire Cardiac Centre
RDE: Royal Devon & Exeter Hospital
RIA: Aberdeen Royal Infirmary
Please enter
pressure wires
cases
350
0
GJH
HAM
RCH
RSC
WHH
BHR
WAT
BLA
WAL
KMH
BRI
GEO
RAI
FRE
BAL
NGS
SUN
NTH
SSP
RHI
UCL
QAP
CMI
KSX
ALT
TOR
RFH
MOR
AMG
HHW
CHN
RAD
YDH
KGH
CLW
KIM
NPH
BAS
IPS
UHW
LBH
LGI
MRI
PAP
CRG
AEI
ANT
LIN
RVB
SAL
WEX
WRG
BED
BHL
STO
SAN
VIC
BRD
BFT
BOU
BRY
CHG
DER
DUD
DVH
FRY
GRL
LIS
MAY
NCR
QEB
SCM
SCU
SGH
SPH
WYT
BAT
FRM
EBH
WRC
CHH
MPH
NOR
WDH
HSC
STH
CRO
GWE
Pressure Wire
2014 data
Data entry to NICOR
• Declared cases / cases in NICOR
300
250
200
150
100
50
Additional Interventional
Coronary Techniques
All when used during a PCI procedure
2014 data
Additional Interventional
Coronary Techniques
2014 data
All cases: Diagnostic only + when part of a PCI procedure
18000
16832
15394
16000
14000
2008
2009
2010
2011
2012
2013
2014
12000
10000
8000
7618
6944
6000
4000
1552
977
2000
0
IVUS
OCT
Pressure
Wire
Additional Interventional
Coronary Techniques
2014 data
2014
18000
16000
14000
7293
12000
10000
At time of PCI
Diagnostic only
8000
6000
4000
1243
2000
0
9539
5654
1290
IVUS
309
OCT
FFR
Pressure Wire
2014 data
Diagnostic ONLY Pressure Wire studies as % of PCI activity
PHB: 55 PW 21 PCIs
Pressure Wire
2014 data
Diagnostic ONLY Pressure Wire studies as % of PCI activity
Detail
Pressure Wire
2014 data
Diagnostic ONLY Pressure Wire studies as % of PCI activity
Detail
FFR use during a PCI as % of Total PCIs
Pressure Wire
2014 data
Intravascular Ultrasound
2014 data
Diagnostic ONLY IVUS studies as % of PCI activity
Detail
IVUS
IVUS at time of PCI as % of PCI activity
2014 data
IVUS
2014 data
PCI to Unprotected LMS
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
IVUS not used
IVUS used
61
59
IVUS not used
IVUS used
39
40.9
2013
61
39
2014
59
40.9
IVUS
PCI to Unprotected LMS
2014 data
Swept Laser Imaging
Diagnostic ONLY OCT studies as % of PCI activity
LBH: 10 OCT, 126 PCIs
2014 data
Swept Laser Imaging
Diagnostic ONLY OCT studies as % of PCI activity
Detail
2014 data
Arterial access
2014 data
Radial Artery Access
80
71.2
70
2014 data
75.3
65.2
58.6
60
51.6
50
43
% Cases
using Radial 40
Access
30
34.7
26.9
21.3
20
10
15.7
10.2
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
2014 data
Radial Artery Access
2013
2014
2014 data
Radial Artery Access
Radial Artery Access
By operator
• % Radial by ‘Consultant Responsible for PCI’ in 2014
• Any case with any radial (including multiple access)
2014 data
Radial Artery Access
By operator
2012
2013
2014
2014 data
Radial Artery Access
2012
2013
2013
2014 data
2014
Radial Artery Access
2013
2014
2014 data
Radial Artery Access
2013
2014
2014 data
Radial Artery Access
2014 data
Clinical Syndrome
80
75.8
75.6
71.1
70
60
2008
2009
2010
2011
2012
2013
2014
50
% Cases
using Radial 40
Access
30
20
10
0
Stable
ACS not STEMI
PPCI
Femoral closure devices
Of PCI via FA - % punctures closed with a device
70
60
50.7
53.5
60.1 61.3
58.9
57.1 55.6 57
50
% FA 40
Punctures
Device
closed 30
39.6
20
10
0
2006 2007 2008 2009 2010 2011 2012 2013 2014
2014 data
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
Time Delays to Treatment
Back to contents
Delays to PCI in NSTEMI
2014 data
Delays to PCI in NSTEMI
2014 data
Note:
• For NSTEMI overall delays are
calculated from FIRST hospital arrival to
treatment
• For PPCI the timing for the ‘Direct’
admissions is from PCI door (which in
transferred patients is door 2)
Delays to PCI in NSTEMI
2014 data
Admission Route – Direct to PCI Centre
Better
=2.5 days
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
Admission Route – Direct to PCI Centre
2013
2014
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
Admission Route – Direct to PCI Centre
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
Admission Route – Direct to PCI Centre
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
Admission Route – IHT
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
Admission Route – IHT
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
All Admission Routes (Direct and IHT)
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
All Admission Routes (Direct and IHT)
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2014 data
All Admission Routes (Direct and IHT)
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2.5 days
90
3.5 days
82.1
80
70
60
60.6
50
Hrs
40
2014
30
20
10
0
Direct
IHT
2014 data
Delays to PCI in NSTEMI
90
82.1
80
70
60.6
60
50
Hrs
2014
40
30
20
10
0
Direct
IHT
2014 data
Delays to PCI in NSTEMI
2014 data
Direct AND IHT
80
70.3
70
64.4
63.3
61.4
58.7
60
Better
50
49
67.4
52
54.3
51.5
< 96 hr
< 72 hr
% 40
30
20
10
0
2010
2011
2012
2013
2014
Delays to PCI in NSTEMI
Better
Direct AND IHT % < 96hr
2014 data
Delays to PCI in NSTEMI
Better
Direct AND IHT % < 96hr
2014 data
Delays to PCI in NSTEMI
Better
Direct AND IHT % < 72 hr
54.3
2014 data
Delays to PCI in NSTEMI
Better
Direct AND IHT % < 72 hr
2014 data
Delays to PCI in NSTEMI
Longer delay Shorter delay
Direct and IHT combined
2014 data
Delays to PCI in NSTEMI
Longer delay Shorter delay
Direct and IHT combined
2014 data
Delays to PCI in NSTEMI
2014 data
Better
Direct AND IHT
No exclusion of centres with < 90% data completeness
Delays to PCI in NSTEMI
2014 data
Better
Direct AND IHT
No exclusion of centres with < 90% data completeness
Delays to PCI in NSTEMI
• Caveats
– Time delay is from First hospital admission to PCI
• NOT admission to angiography
– Centres have differing proportions of patients
treated after inter-hospital transfer versus direct
admission
– This proportion changes over time
– Only procedures with time / date data are
displayed. For 2012 and 2013 centres with < 90%
timing data for NSTEMI pathway are excluded
from analysis
2014 data
Primary PCI
2014 data
Primary PCI
Rx for STEMI (NHS centres)
• Funnel analysis for TIMING DELAYS
–
–
–
–
All units performing > 10 cases of PPCI
Patients with onset of symptoms in the community
Excludes patients in cardiogenic shock
Excludes those needing pre-PCI ventilation
2014 data
PCI for Acute Sx
Four admission scenarios
Admitted from
the community
2014 data
Already
in hospital
Admission to
Non-PCI centre
Direct admission
to PCI centre
Transfer
to PCI centre
Hospital is a
PCI centre
Hospital is a
Non-PCI centre
PCI for Acute Sx
Four admission scenarios
Admitted from
the community
Admission to
Non-PCI centre
Direct admission
to PCI centre
Transfer
to PCI centre
2014 data
PCI for Acute Sx
Variety of analysis methods
• Direct and Inter-hospital transfer (IHT)
– Call to ‘balloon’ time as % < 150 min
• Graphics: funnel, cf last year (plotted against vol and last yrs %)
– Door to ‘balloon’ time as % < 90 min
• Graphics: funnel, cf last year (plotted against vol and last yrs %)
– Door to ‘balloon’ time as % < 60 min
• Direct only
– Door to ‘balloon’ time as % < 90 min
– Door to ‘balloon’ time as % < 60 min
• Median time delays
– IHT v Direct admission
2014 data
PCI for Acute Sx
Four admission scenarios
Admitted from
the community
Admission to
Non-PCI centre
CTB
D1
D2
Direct admission
to PCI centre
Transfer
to PCI centre
device
2014 data
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2014 data
Direct and IHT: Call to Balloon times < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI Changes
2014 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
PCI for Acute Sx
Four admission scenarios
2014 data
Admitted from
the community
Admission to
Non-PCI centre
D1
D2
Direct admission
to PCI centre
Transfer
to PCI centre
DTB
device
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excld shock/vent)
2014 data
Direct and IHT
92
90.6 90.3
90
88.7
88
% Patients 84
treated
82
within time
limits
80
2012
2013
2014
79.5 79
78.8
78
76
74
72
CTB < 150 (%)
DTB < 90(%)
Better
86
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI Changes
2014 data
Better
Direct and IHT: DTB < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Direct and IHT: PCI Door to Balloon < 60 min
PCI for Acute Sx
Four admission scenarios
2014 data
Admitted from
the community
Admission to
Non-PCI centre
D1
D2
Direct admission
to PCI centre
Transfer
to PCI centre
DTB
device
Primary PCI (excl shock/vent)
2014 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2014 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2014 data
Direct only : PCI Door to Balloon < 60 min
PCI for Acute Sx
Four admission scenarios
2014 data
Admitted from
the community
Admission to
Non-PCI centre
D1
CTB
D2
Direct admission
to PCI centre
Transfer
to PCI centre
DTB
device
PCI for Acute Sx
Four admission scenarios
2014 data
Admitted from
the community
Admission to
Non-PCI centre
D1
CTB
D2
Direct admission
to PCI centre
V
Transfer
to PCI centre
DTB
device
Primary PCI (exclude shock/vent)
According to admission route
2014 data
Primary PCI (excld shock/vent)
2014 data
According to admission route
100
90
90.5
85.3
89.5
80
70
50
49.3
2013
2014
40
30
20
10
0
CTB < 150 CTB < 150 DTB < 90 D2TB < 90
Direct (%)
IHT (%)
Direct (%)
IHT (%)
Better
60
PPCI Call to Balloon time
2014 data
(excluding shock/vent)
By Admission Route
180
155
160
140
120
113
109
(min)
80
60
40
20
0
Direct
IHT
All
Better
2011
2012
2013
2014
Median CTB 100
Primary PCI
Admission routes
% Patients admitted directly or by IHT for PPCI
100%
90%
22.5
18.6
17.8
17.9
77.5
81.4
82.2
82.1
2011
2012
2013
2014
80%
70%
60%
50%
40%
30%
20%
10%
0%
2014 data
PPCI Call to Balloon time
2014 data
(excluding shock/vent)
By Admission Route
180
46 Min
140Delay
155
160
120
113
109
(min)
80
60
40
20
0
Direct
IHT
All
Better
2011
2012
2013
2014
Median CTB 100
PPCI Door to Balloon time
2014 data
(exclude shock/vent)
By Admission Route
45
40
41 40
42 41
41 40
35
30
Median
D2TB (min) 20
15
10
5
0
Direct
IHT
All
Better
2011
2012
2013
2014
25
PPCI Direct from Community
2014 data
Median Length of stay in PCI Centre (exc shock and vent)
LOS = First device time to discharge (assuming discharge at midday)
PPCI Direct from Community
2014 data
Median Length of stay in PCI Centre (exc shock and vent)
LOS = First device time to discharge (assuming discharge at midday)
2014 data
PPCI Summary Stats
2014
Call to ‘Balloon’
PCI Door to ‘Balloon’
All
All
Direct
IHT
< 150 min
78.8 %
85.3 %
49.3 %
Median
109 min
113 min
155 min
< 90 min
90.3 %
90.5 %
89.5 %
< 60 min
77.3 %
76.7 %
Median
? min
40.3 min
LOS
? min
2.6 days
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
Outcome
Back to contents
Data sources
• Success, Mortality CVA and Emergency CABG
• QMI
– Denominator: Total PCI procedures except PCI for STEMI
• NQMI
– Denominator: Total PCIs for stable symptoms
2014 data
MACCE - All PCIs
Year
Procedure
Success
(%)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
92
92
90
92
94
92
92
93.5
90.2
95.5
92.1
91.9
91.2
92.0
91.8
90.6
91.4
91.5
NQMI
Em
QMI
CVA
(stable) CABG
%
(%)
(%)
(%)
1.2
0.8
0.57
0.6
0.5
0.57
0.36
0.30
0.24
0.15
0.15
0.14
0.11
0.18
0.13
0.11
0.09
0.13
0.74
0.59
0.51
0.46
0.57
0.37
0.34
0.3
0.25
1.1
0.7
0.48
0.4
0.4
0.28
0.29
0.21
0.12
0.09
0.08
0.07
0.08
0.05
0.05
0.05
0.05
0.06
0.05
0.08
0.09
0.12
0.08
0.09
0.09
0.09
2014 data
Mortality
(%)
30 day
Mortality (%)
(Tracked)
0.89
0.80
0.61
0.64
0.75
0.54
0.53
0.56
0.59
0.74
0.92
1.03
1.24
1.5
1.6
1.9
1.8
1.9
1.5
1.6
2.0
2.1
2.4
2.7
2.7
2.8
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Adverse Outcome
% 1.5
1
0.5
0
2014 data
Death and emergency surgery
3
2.5
2
Mortality
em CABG
Adverse Outcomes
Death
• Mortality to Discharge (self reported)
2014 data
Adverse Outcomes
Death
• Mortality to Discharge (self reported)
unadjusted
2014 data
Adverse Outcomes
Death
• Mortality to 30/7 (from ONS track)
unadjusted
2014 data
Adverse Outcomes
Death
• Mortality to 30/7 (from ONS track)
unadjusted
2014 data
Adverse Outcomes
2014 data
Death
unadjusted
Adverse Outcomes
CVA
• % of all cases with CVA (not TIA)
2014 data
Adverse Outcomes
CVA
• % of all cases with CVA (not TIA)
2014 data
Adverse Outcomes
Surgery
• % of all cases needing emergency cardiac surgery
2014 data
Adverse Outcomes
Surgery
• % of all cases needing emergency cardiac surgery
2014 data
Peri-procedural Complications
2014 data
2
1.8
1.6
1.29
1.4
1.2
%
0.89
1
0.8
0.6
0.57
0.4
0.2
0
0.42
0.38
0.04
0.12
0.19
0.21
2009
2010
2011
2012
2013
2014
Peri-procedural Complications
No flow / Slow flow by syndrome
2014 data
Access site complications
2014 data
Complications to hospital Dx:
False aneurysm, haemorrhage, arterial occlusion / dissection
Any other surgical intervention
1.4
1.2
1
% of all cases
0.8
0.6
0.4
0.2
0
0.8
0.6
0.2
0.2
2009
2010
2011
2012
2013
2014
Complication by Access route
2014 data
Complications to hospital Dx:
False aneurysm
Haemorrhage (retroperitoneal, delay Dx, surgery)
Art occlusion / dissection
Any need for surgery
1.4
1.3
1.2
1
0.8
% of all
cases 0.6
0.4
0.4
0.2
0
Femoral
Radial
2007
2008
2009
2010
2011
2012
2013
2014
2014 data
Complication by Access route
CVA
0.18
0.16
0.14
0.12
0.12
% Cases with 0.1
in hospital
CVA
0.08
0.09
0.06
0.04
0.02
0
Femoral
Radial
2010
2011
2012
2013
2014
Outcome 2014
2014 data
Elective Patients
All as %
No.
cases
Success
Stable SV
(no CTO)
19,835
95.55
MV
(no CTO)
6,295
93.11
SV CTO
3041
73
MV CTO
871
73.48
Partial
success
5.03
21.01
Fail no
comp
RePCI
QMI
3.27
0.17
0.11
0.05
0.03
0.11
1.5
0.14
0.1
0
0.1
0.19
24.96
0.2
0.1
0.13
0.07
0.19
4.48
0
0
0.23
0
0.9
5.12
0.16
0.1
0.05
0.04
0.16
Em
CABG
CVA
Death
In Hosp
Death
30/7
Track
OVERALL STABLE
All Stable
30,042
92.12
0.39
2014 data
Outcome 2014
All as %
No.
NSTEMI / UA
33,538
no shock
Success
Partial
success
Fail
no
comp
Re-PCI
93.71
2.2
3.1
0.3
Death
In hosp
Death
30/7 CR
0.2 0.04 0.06
0.68
1.37
QMI
Em
CABG
CVA
All STEMI
no shock
22,532
93.21
1.61
2.49
0.69
0.08 0.14
2.49
3.63
*Primary PCI
24,797
89.97
1.71
2.84
0.65
0.09 0.15
5.25
6.94
*Rescue PCI
214
86.45
0
5.61
0.93
0.47
7.01
10.39
Shock
2,659
58.78
2.41
2.75
0.64
0.26 0.34
35.37
41.59
0
*all PPCI (includes shock / ventilation and onset in community or in hospital)
All Elective Stable Cases
SV no CTO, MV no CTO, SV CTO, MV CTO
2014 data
NSTEMI, no Shock
2014 data
All Primary PCI
(includes shock)
2014 data
Summary: Mortality
Risk Stratified by Syndrome
2014 data
Summary: Mortality
Risk Stratified by Syndrome
2014 data
Primary PCI
2014 data
(shock/vent INCLUDED)
6.9 %
Cardiogenic Shock
Tracked 30/7 mortality
2014 data
2014 data
Bypass grafts
PCI of SVG and Arterial
In0.08
Hosp
Death
30/7
Death
(CR)
0
0.78
1.64
0.09
0.02
0.58
1.3
0.23
0.23
0
1.22
1.68
5.46
0.19
027
0
0.94
1.48
3.65
6.79
0.47
0.33
0
1.39
2.63
88.71
4.72
4.51
0.28
0.07
0.07
1.8
2.58
2512
86.78
5.69
5.97
0.36
0.08
0
1.37
2.0
2579
84.88
7.13
5.74
0.39
0.08
0.08
2.03
2.8
All
as %
No.
Success
Partial
success
Fail no
comp
RePCI
QMI
2007
3900
88.49
2.72
7.79
0.23
0.21
2008
4284*
90.97
3.2
5.11
0.21
2009
2599
88.88
3.69
5.93
2010
2602
90.81
2.34
2011
2741
87.81
2012
2904
2013
2014
Em
CABG
*Centre x = 1860 of 2111 cases in 2008
Bypass Grafts
(all types - SVG and IMA etc)
2014 data
Unprotected LMS
2014 data
Unprotected LMS
2014 data
Including Shock and STEMI
All as
%
No.
2006
In
Hosp
Death
Death
30/7
(CR)
Success
Partial
success
Fail no
comp
RePCI
QMI
583
86.8
4.5
0.9
0.3
0.51
0.17
2007
854
83.72
7.14
1.99
0.12
0.35
0.7
6.58
8.81
2008
1085
83.69
5.35
2.12
0.65
0.37
0.46
7.92
10.85
2009
1458
84.84
3.84
3.16
0.34
0.27
0.34
7.59
9.37
2010
1504
86.1
3.06
2.19
0.47
0.13
0.07
8.1
9.59
2011
1984
86.04
3.93
2.17
0.3
0.35
0.2
7.37
10
2012
2373
85.55
4.59
1.22
0.42
0.17
0.08
8.2
11.33
2013
2531
85.82
4.23
1.54
0.36
0.16
0.12
7.92
11.08
2014
2836
86.53
1.69
0.28
0.25
0.14
3.35
Em
CABG
7.0
7.95
11.39
Chronic Total Occlusion
2014 data
Stable only
All
as %
No.
Success
Partial
success
Fail no
comp
RePCI
QMI
In
Em
Hosp
CABG
Death
Death
30/7
(CR)
2011 3976 70.47
6.24
22.96 0.13 0.03 0.05 0.25
0.44
2012 4208
71.6
6.39
21.65 0.26 0.07
0.21
0.47
2013 3875 72.52
5.55
21.63 0.1 0.05 0.05 0.15
0.34
2014 4040 73.27
5.87
20.27 0.15 0.07 0.17 0.34
0.57
0.1
Chronic Total Occlusion
Stable only
14
13
13.4
2011
2012
12.4
12.4
2013
2014
12
Number of
CTO cases
as % of all
PCI for
stable
coronary
syndromes
10
8
6
4
2
0
2014 data
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
Adult Non Coronary
Intervention
Back to contents
2014 data
Adult Non-Coronary Intervention
180
160
140
120
92
100
80
66
60
38
40
20
TV plasty
PV plasty
MV plasty
HOCM
Septal
ablation
0
1
2007
2008
2009
2010
2011
2012
2013
2014
Note: PV plasty NOT as part of valve implantation procedure
HCM
Alcohol Mediated Septal Ablation
18
16
14
12
10
8
Number of
procedures 6
2014
4
2
CLW
NHB
PHN
QEB
STO
WAL
GJH
LGI
NGS
FRE
IND
STH
UCL
ERI
PAP
BAL
BHL
0
Number of centres: 17
2014 data
2014 data
Mitral Balloon Valvuloplasty
18
16
14
12
10
Number of
procedures
2014
8
6
4
2
ERI
QEB
SAN
LGI
NPH
PAP
RSC
WAL
GRL
NHB
STH
BAL
BHL
BRI
CHN
FRE
HAM
RAD
RFH
EBH
SGH
STO
WYT
0
Number of centres: 23
Percutaneous Valves
Mitra-Clip
90
83
80
70
63
60
47
Number of 50
procedures 40
28
30
19
20
10
0
33
3
2008
2009
2010
2011
2012
2013
2014
2014 data
Percutaneous Valves
Mitra-Clip
7
6
5
4
3
Number of
procedures
2
2014
1
0
NHB
Number of centres: 6
HSC
HAM
UCL
STO
FRE
2014 data
Adult Non-Coronary
Intervention
2014 data
1200
1000
2007
2008
2009
2010
2011
2012
2013
2014
800
545
600
428
400
200
130
0
ASD
PFO
LAA Occlusion
Number of
procedures
2014
0
NHB
LGI
PAP
UCL
BRI
BHL
MRI
RAD
SGH
HAM
RVB
ERI
GJH
FRE
UHW
CHN
IND
RSC
STO
BAL
GRL
QEB
VIC
WYT
BAS
GEO
HH
KCH
CHH
CRO
GHB
HSC
LNH
NGS
PHB
2014 data
ASD Closure
70
60
50
40
30
20
10
Number of centres: 35
Number of
procedures
2014
0
BHL
RSC
HH
STH
BRI
GHB
CHN
ERI
STO
KCH
PAP
MRI
WYT
GRL
IND
HAM
NCR
CRO
FRE
UHW
NHB
QEB
RAD
RVB
SGH
BAL
GEO
BAS
HSC
LBH
LNH
UCL
VIC
CHH
GJH
HHW
LGI
2014 data
PFO Closure
60
50
40
30
20
10
Number of centres: 37
2014 data
LAA Closure
40
35
30
25
20
Number of 15
procedures
2014
10
5
NHB
RSC
RAD
HH
ERI
FRE
HSC
LBH
PAP
RVB
MHO
UCL
BAL
HHW
STO
BAS
CRO
GRL
QEB
0
Number of centres: 19
Adult Non-Coronary
Intervention
2014 data
90
80
80
70
2007
2008
2009
2010
2011
2012
2013
60
50
40
30
20
16
14
10
0
VSD congen
VSD post MI
Paravalvular leak
closure
Prosthetic paravalular
leak closure
25
21
20
15
Number of
procedures
2014
10
13
10
9 9
6
5
0
Number of centres: 18
3 3 3
2
1 1 1 1 1 1 1 1
2014 data
Adult Great Vessel
Intervention
2014 data
140
120
100
2007
2008
2009
2010
2011
2012
2013
2014
77
80
60
40
20
13
0
Coarct / Re-coarct
Carotid
Renal Denervation
200
40
180
180
2014 data
35
160
30
140
25
120
100
Number of
100
Procedures
25
Number of
20 Centres
80
15
60
14
40
32
20
6
42
10
9
5
0
0
2011
2012
2013
2014
2014 data
Renal Denervation
16
14
12
10
8
Number of
procedures
2014
6
4
2
0
NHB
CRG
Number of centres: 9
DGE
AMG
HH
BRI
CGH
LGI
MRI
Percutaneous
Pulmonary Valves
70
2014 data
10
62
57
60
9
8
50
46
7
41
Number of
Procedures
40
30
20
36
6
5
29
4
17
3
2
10
1
0
0
2008 2009 2010 2011 2012 2013 2014
Number of
Centres
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
TAVI
Back to contents
Transcatheter Valves
Case ascertainment
2014 data
TAVI
Total = 7,417
2014 data
Data extract 01-06-2015
2000
1860
1800
1530
1600
1400
1288
1200
1039
Number of TAVI
Procedures 1000
Performed
780
800
559
600
400
200
295
66
0
2007 2008 2009 2010
2011
2012 2013 2014
TAVI
Total Procedures by unit and year
2014 data
2014 data
TAVI
Total Procedures by unit and year
2014 data
TAVI
Rate pmp by Country
2014 data
TAVI
Rate pmp by LAT
2014 data
TAVI
2014 data
UK Survey June 2015
What is the number of patients on your waiting list now for
elective TAVI at your centre?
80
70
60
Mean 25
Median 19
50
40
30
20
10
0
1
3
5
7
9
11 13 15 17 19 21 23 25
TAVI
2014 data
UK Survey June 2015
What is your current average wait from referral to elective
TAVI procedure in your centre. (days)
Referral is the time when MDT decides that the patient should be offered TAVI?
300
250
Mean 87
Median 75
200
150
100
50
0
1
3
5
7
9
11 13 15 17 19 21 23 25
TAVI
2014 data
UK Survey June 2015
What number of cases have your commissioners agreed to
fund this year?
7: No formal agreement
1: 25 pmp
1: No limit
180
160
140
120
100
80
60
40
20
0
1
3
5
7
9
11 13 15 17 19 21 23 25
TAVI
Female (%)
2014 data
TAVI
Mean Age (years)
2014 data
TAVI
2007-2014
2014 data
TAVI
2007-2014
2014 data
TAVI
Mean Logistic EuroSCORE
2014 data
TAVI
Diabetic (%)
2014 data
TAVI
2014 data
Renal failure pre TAVI (%)
Definition: creatinine > 200, and/or on dialysis
TAVI
Previous cardiac surgery (%)
2014 data
TAVI
2014 data
Of patients treated by TAVI: Prior Aortic balloon Valvuloplasty
TAVI
LVEF pre TAVI
2014 data
TAVI
Valve Manufacturer
2014 data
TAVI
Delivery Approach
2014 data
TAVI
2014 data
Pacing - All
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
2014 data
Pacing – Edwards Sapien
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
2014 data
Pacing – Medtronic CoreValve
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
Complications: CVA up to Dx (%)
2014 data
TAVI
2014 data
Conversion to Surgery in Lab (n)
New Dataset (V4)
‘Conversion to full
Sternotomy’
Principle reason:
Old Dataset (V3)
‘Emergency surgery’
2014
Haemorrhage (14)
Valve surgery (10)
other (2)
TAVI
Emergency Valve-in-Valve in lab (n)
2014 data
TAVI
Device Embolisation in lab (n)
2014 data
TAVI
2014 data
New Haemofiltration or dialysis post procedure (%)
TAVI
Mortality (Tracked at 30 days as %)
2014 data
TAVI to treat other valves
Mitral
3
2
Number of
procedures
2014
1
0
NCR
Number of centres: 7
BHL
CHN
ERI
MRI
QEB
STH
2014 data
TAVI to treat other valves
Tricuspid
3
2
Number of
procedures
2014
1
0
RSC
Number of centres: 3
MOR
QEB
2014 data
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
2014 data
NICOR IT Developments
• Web based interface
• Modular unified structure
• Regular reports to all
– Stop approach to outlier status
– Needs uploads quarterly
• New platform Qreg5
PCI Web entry
http://web.nicor.org.uk
2014 data
2014 data
NICOR IT Developments
Back to contents
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
Data for research
2014 data
• To apply: audit data for research
NICOR web site www.ucl.ac.uk/nicor
Back to contents
PCI Procedures UK
2014 data
745,000 PCI procedures
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
110000
100000
90000
80000
70000
No of PCI 60000
Procedures 50000
40000
30000
20000
10000
0
TAVI
2014 data
5,515 Procedures
1800
1534
1600
1400
1271
1200
1018
Number of
TAVI
Procedures
1000
771
800
561
600
400
200
294
66
0
2007 2008 2009 2010 2011 2012 2013
2014 data
Linkage
ONS
Patients in
NICOR
databases
England & Wales
All cause mortality
Scottish
Register
Northern
Irish
register
2014 data
Peer Reviewed Publications
As May 2015
10
9
8
7
6
PCI
TAVI
5
4
3
2
1
0
2011
2012
2013
2014
2015
PCI as May 2015
2014 data
TAVI as May 2015
2014 data
Contents
•
Structure
–
–
–
–
–
–
–
–
–
–
•
NICOR data collection
–
–
–
–
•
Angio and PCI centres and maps
Total angio and PCI numbers
No of PCIs per centre and per angio
PCI pmp and by country and v CABG
Centre PCI volumes
PCI operators, by centre, by PPCI
On call rotas for PPCI
On site v off site surgical cover
Day case activity
Primary PCI units
Centre participation
Databases used
Case ascertainment
Data completeness
•
Demographics
Indication for PCI / Clinical syndrome
PPCI activity (by unit, pmp, by vessel)
PCI for out of hospital arrest
PCI territories / vessels / lesions
Stents (BMS and DES)
Adjunctive pharmacotherapy
LV support and shock
Primary PCI for > 80 yrs
Extraction / Rota / IVUS / OCT / FFR / Laser etc.
Arterial access
Process of care
–
–
–
–
–
Delays to treatment
NSTEMI (direct v IHT)
Primary PCI DTB / CTB
IHT versus Direct admission
Length of stay
–
–
–
MACCE
Peri-procedural complications and by access
Tracked 30 day mortality
• Outcome by syndrome
• Outcome by lesion subset
•
Outcome
•
Adult non coronary intervention
•
TAVI
•
•
•
•
NICOR IT developments
Research Output
Public Reports and risk adjusted outcomes
Conclusions and summary
Appropriateness
–
–
–
–
–
–
–
–
–
–
–
2014 data
–
–
–
–
–
–
–
–
–
–
–
–
Septal ablation for HOCM
Mitral valvuloplasty
Mitraclip /PFO / ASD closure / LAA occlusion
Para-prosthetic leak closure
Renal Denervation
Percutaneous Pulmonary valve
Activity by centre
Demographics
Valve types
Delivery approaches by valve type
Pacing
Complications
Appendix: PCI Centre NICOR / CCAD Centre codes
Public Reports
Risk Adjusted Outcome
2014 data
Back to contents
Public Report - History
• 2013
Adult cardiac surgery
Bariatric surgery
Colorectal surgery
Head and neck surgery
Interventional cardiology
Orthopaedic surgery
Thyroid and endocrine surgery
Upper gastro-intestinal surgery
Urological surgery
Vascular surgery
• 2014 and 2015
Adult cardiac surgery
Bariatric surgery
Colorectal surgery
Head and neck surgery
Interventional cardiology
Orthopaedic surgery
Thyroid and endocrine surgery
Upper gastro-intestinal surgery
Urological surgery
Vascular surgery
Lung cancer
Neurosurgery
Urogynaecology
2014 data
2014 data
‘New’ for 2015 reports
•
•
•
•
•
•
•
No new audits
Add more measures
Operator not teams
Aim for ‘patient meaningful’ measures
Add ‘positive’ outliers
No big bang publication
NHS Choices website revamp
2014 data
Web publication of results
Data and context
2014 data
Web publication of results
Data and context
Development of PCI reports
• 2015 report (2012, 2013, 2014 data)
–
–
–
–
Operators and Centres
Total cases
Data completeness
Case mix
– Radial / Femoral
– Centre DTB times
– Risk adjusted outcomes (OOHA excluded)
• NWQIP model MACCE
• Mortality at 30/7 (tracked)
• Risk factor and data completeness information
2014 data
PCI Reports 2015
2014 data
PCI Reports 2015
2014 data
PCI Reports 2015
2014 data
2014 data
Risk Adjusted Outcomes Analysis
• Options for statistical of analysis
– Exact Binomial
• 2 versus 3 SD cut points
• Adjustment for Multiple comparisons
– Random effects
– Display (funnels versus dot and error bars)
– False discovery rates
2014 data
Risk Adjusted Outcomes Analysis
? outliers
2014 data
Risk Adjusted Outcomes Analysis
2 SD (95%)
2014 data
Risk Adjusted Outcomes Analysis
2 SD
3SD (99.8%)
2014 data
Risk Adjusted Outcomes Analysis
2 SD
and
Correction for
multiple
comparisons
False Discovery Rate
2014 data
3 SD
99.8%
0.1% above, 0.1% below
Chance of being here
0.001 ?
1000 comparisons
Expect 1 by chance
False Discovery
False Discovery Rate
2014 data
(e.g. 1000 operators
At 2SD = 2.5% of 1000 = 25 (above)
At 3 SD = 0.01% of 1000 = 1 above)
FDR =
expected number of false findings
number of outliers found
False Discovery Rate
FDR =
2014 data
expected number of false findings
number of outliers found
Probability genuine outlier = 1 – FDR
Likelihood genuine as ratio (FDR) approaches 0
More stringent p (3 SD rather than 2SD)
Fewer being assessed
Number of outliers found
False Discovery Rate
PCI Public Reports 2015
• 104 hospitals
Potential results:
– If 1 adverse outlier at 3 SD: 90% genuine
– If 2 adverse outliers at 3 SD: 95% genuine
– If 3 adverse outliers at 2 SD: 13% genuine
2014 data
False Discovery Rate
PCI Public Reports 2015
• 645 PCI operators
Potential results
– If 1 adverse outlier at 3 SD: 36% genuine
– If 2 adverse outliers at 3 SD: 68% genuine
– If 21 adverse outliers at 2 SD: 23% genuine
2014 data
Summary 2014
2014 data
slides available on the BCIS website www.bcis.org.uk
• 119 PCI centres in UK (100 NHS)
– 96,143 PCIs (1,488 PCI pmp)
• All NHS centres uploading to NICOR
–
–
–
–
Radial access rates continue to improve
BVS starting
OOHA data
Delays unchanged
• NSTEMI unsatisfactory
• TAVI increasing rapidly
– UK wide 30 pmp but up to 61 pmp
– Beginning to see shift to lower risk cases?
• Future plans
– Increasingly broad public reports
– Upgrades to IT infrastructure at NICOR
– Research outputs
Acknowledgments
• Database and programming
– Darragh O’Neill
– Andrew Donald
• Project Management
– Lucia Gavalova
2014 data
UK PCI Centre Codes 2014
Back to contents
2014 data
UK PCI Centre Codes 2014
Back to contents
2014 data
UK PCI Centre Codes 2014
Back to contents
2014 data
2014 data
Thank you