2013 data
Peter F Ludman
BCIS National Audit Lead
On behalf of
British Cardiovascular Intervention Society
Blackpool October 2014
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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
1.
2.
&
Data
‘R’ statistical
analysis
Re-programmed
Cleaning
Outputs
Previous year’s datasets re-analysed for year trends
Structure
2013 data
Back to contents
Angiography Only
Centres in 2013
Angio Centres Stopped
None
New Angio Centres
Queen’s Hospital, Burton
Duchy Hospital, Cornwall
2013 data
PCI
2013 data
Centres in 2013
PCI Centres stopped
Whipp’s cross
PCI Centres from existing angiography units
None
New PCI Centres
None
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
2013 data
UK Centres 2013
PCI
Angio only
140
118
117
100
80
63
60
40
20
0
2013 data
2013
Angiography (63)
PCI (117)
2013 data
2013
Angiography (63)
PCI (117)
PCI Centres in 2013
2013 data
UK Countries
NHS
Private
Scotland
6
2
England
84
17
N Ireland
4
0
Wales
4
0
Total
98
19
Total
117
UK centres
2013
No No
No. cath PCI
data data
NHS
Interventional
Private
Interventional
Diagnostic
only
TOTAL
98
2013 data
Caths
PCIs
No Data
197,750
91,232
0
0
19
1
from
Hall Hospital,
1 Ross
4,482
1,294
Scotland
63
0
-
180
42,131
-
244,363
92,526
Survey Monkey
UK centres
2013
No No
No. cath PCI
data data
NHS
Interventional
Private
Interventional
Diagnostic
only
TOTAL
2013 data
Caths
PCIs
98
0
0
197,616
91,295
19
1
1
4,482
1,294
63
0
-
42,131
-
244,229
92,589
180
Survey Monkey
Angiography
2013 data
Performed in PCI and Angio-only centres
250000
200,881
202,098
200000
150000
Angiography centres
PCI Centres
100000
50000
42,131
40,359
0
Population estimates
2013 data
Mid 2013
Total UK: 64.1 m
Scotland 5.328 m
Northern Ireland 1.830 m
England 53.865 m
est: N. Welsh pop 0.7m
0.45m served locally
0.25m Rx in England
Total Rx in England 54.12 m
Wales 3.082 m
est: Rx in Wales: 2.832 m
Total PCI activity all UK to 2013
110000
2013 data
1600 1,444
100000
1400
90000
92,589
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
0
Survey Monkey
%
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
PCI pmp all UK
2013 data
Rate of Increase
25
20
15
10
5
0
-0.47
-5
Survey Monkey
40
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
PCI per Angiogram ratio
2013 data
37.9
35
30
25
% 20
15
10
5
0
PCI per Angiogram ratio
2013 data
By Individual PCI Units 2013
% PCI per Angiogram Ratio
120
100
80
60
40
20
0
0
500
1000
1500
2000
2500
3000
Number of PCI Procedures per PCI centre
3500
Total PCIs in the UK
2013 data
by Country and Type of Institution 2000-2013
80000
75451
70000
60000
50000
40000
30000
20000
10000
0
8482
1261
33
3563
3799
England England Scotland Scotland N. Ireland Wales
NHS
Private
NHS
Private
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Total PCIs in the UK
2013 data
by Country and Type of Institution 2010-2013
80000
70000
60000
50000
40000
2010
2011
2012
2013
30000
20000
10000
0
England England Scotland Scotland N. Ireland Wales
NHS
Private
NHS
Private
Total PCIs in the UK
2013 data
by Country and Type of Institution 2010-2013
Zoom
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
2010
2011
2012
2013
England England Scotland Scotland N. Ireland Wales
NHS
Private
NHS
Private
PCI pmp
2013 data
By UK Country
2500
1947
2000
1598
1500
1418
1341
1000
500
0
England
Scotland
N. Ireland
Wales
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
PCI pmp
2013 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
Total PCI vs Isolated CABG
2013 data
100000
90000
92589
80000
70000
60000
50000
40000
PCI
CABG
30000
20000
16791
10000
0
Note: CABG data for financial year
Survey Monkey and SCTS data from ‘Blue Book online’
PCI vs Isolated CABG Ratio
2013 data
4.9
2011
5
4.9
2010
6
5.2
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
2013
2012
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
0
Survey Monkey and SCTS data from ‘Blue Book online’
Number of PCIs in 2013
Per Centre
Number of PCIs Performed
3000
2500
2000
NHS & Private
1500
1000
500
0
Individual centres
40 Centres performing < 400 cases (34%)
2013 data
Number of PCIs in 2013
Per NHS Centre
Number of PCIs Performed
3000
2500
2000
NHS
1500
1000
500
0
Individual centres
22 Centres performing < 400 cases (22%)
2013 data
NHS Centres < 400 PCIs
2013 data
2013
TOR Torbay Hospital (2007)
BED Bedford Hospital (2010)
RAI Raigmore Hospital (2010)
ESU East Surrey Hospital (2006)
AEI Royal Albert Edward Infirmary (Wigan) (2007)
SAN Sandwell General Hospital (2003)
MAY Croydon University Hospital (2006)
WAT Watford General Hospital (2009)
SAL Salisbury District Hospital (2010)
KMH Kings Mill Hospital (2010)
DGE Eastbourne Hospital (2006)
PIN Pinderfields General Hospital (2010)
KSX Tunbridge Wells Hospital (2008)
WEX Wexham Park Hospital (2006)
SCU Scunthorpe General Hospital (2010)
DVH Darent Valley Hospital (2008)
BRD Bradford Royal Infirmary (2005)
GWH Queen Elizabeth Hospital Woolwich (2007)
YDH York District General Hospital (2010)
FRY Frenchay Hospital (2008)
EAL Ealing Hospital (2009)
MDW Medway Maritime Hospital (2010)
394
385
378
373
364
363
362
360
358
342
335
308
300
299
280
268
250
243
204
204
195
113
0
PCI program start date
200
400
600
Private Centres < 400 PCIs
2013 data
2013
HHW Wellington Hospital (< 2002)
LBH London Bridge Hospital (< 2002)
AHM BMI Alexandra Hospital (< 2002)
ANT St Anthony's Hospital (< 2002)
HSC Harley Street Clinic (< 2002)
IND London Independent Hospital (< 2002)
MHO Manor Hospital Oxford (< 2002)
HBP Spire Hospital Hull and East Riding (2004)
CRO Cromwell Hospital (< 2002)
PHB BMI Priory Hospital (< 2002)
PHN BMI Park Hospital (< 2002)
LNH Leeds Nuffield Hospital (2003)
LEB Spire Hospital Leeds (< 2002)
GHB Spire Hospital Bristol (2012)
SSP Spire Shawfair Park Hospital (2010)
BMI BMI Meriden Hospital (2007)
LBP Spire Hospital Leicester (2010)
CBS Spire Hospital Southampton (2011)
249
154
144
124
106
93
70
68
59
39
38
37
34
34
33
8
3
1
0
50
PCI program start date
100
150
200
250
300
Interventional Consultants
2013 data
(NHS centres)
800
20
700
679 678 697 18
16
600
14
500
12
10
Total 400
8
300
200
Increase (%)
6
2.8
4
2
100
0
0
-2
Note: if work at two NHS centres will be counted twice
Includes cardiologists and radiologists
Interventional Consultants
2013 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
600
500
2.9% increase
400
Total
300
200
100
0
2012
2013
No. of Consultants
2013 data
In NHS Centres 2013
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
2013 data
In NHS Centres 2013
Note: if work at two NHS centres will be counted twice
PPCI
2013 data
On call rota - Weekdays
20
18
16
14
Rota 1 in … 12
10
8
6
4
2
0
0
500
1000
1500
2000
2500
3000
Total number of PCIs performed in each centre
PPCI
2013 data
On call rota - Weekends
20
18
16
14
Rota 1 in … 12
10
8
6
4
2
0
0
500
1000
1500
2000
2500
3000
Total number of PCIs performed in each centre
2013 data
Weekday
Weekend
PPCI
On call
rotas
2013
Rota 1 in …
Rota 1Rota
in …1 in …
PPCI
2013 data
On call rotas 2013 (pt1)
Weekday
Detail
Rota 1 in …
Rota 1Rota
in …1 in …
PPCI
2013 data
On call rotas 2013 (pt2)
Weekend
Detail
Rota 1 in …
Rota 1Rota
in …1 in …
No. of Consultants
2013 data
(Per NHS Centre in 2013)
8
7.1
7
6
5
Mean
Number of 4
Operators
3
2
1
0
Note: if work at two NHS centres will be counted twice
PCI per Consultant
2013 data
PCI Centre case volume / Number of operators
150
Number of PCIs
145
140
135
130
131 130
127
125
120
115
110
NHS Centres
PCIs per Consultant
2013 data
Total Number of PCIs / Total
Number of Consultants
(NHS Centres 2013)
300
250
200
150
100
50
0
0
500
1000
1500
2000
2500
Total Number of PCIs in each unit
Note:
Data from institutional volume divided by No operators per institution
Some consultants work in multiple institutions
3000
PCIs per Consultant
(NHS Centres 2013)
Note:
Data from institutional volume divided by No operators per institution
Some consultants work in multiple institutions
2013 data
On v Off Site Surgery
2013 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
41 %
53
53
52
50
51
51
49
48
2005 2006 2007 2008 2009 2010 2011 2012 2013
Survey Monkey
On v Off Site Surgery
2013 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
37 %
38
39
38
37
37
36
36
36
2005 2006 2007 2008 2009 2010 2011 2012 2013
Survey Monkey
Surgical Cover
2013 data
(NHS centres only)
On site
3000
Off site
Mean
1515
593
Median
1414
484
2500
2000
PCIs per
1500
Centre
1000
500
0
Individual Centres
Survey Monkey
Total Number of PCIs
2013 data
By Surgical cover NHS & Private
100000
90000
80000
On Site
Off Site
Total
92589
70000
60000
55581
60%
37008
40%
50000
40000
30000
20000
10000
0
Day Case PCI
2013 data
• 91 of 117 Units performing planned elective day case PCI
22
25000
20.7
20
17.4 17.2
20000
15.5
15
13.8
15000
As % of
All PCI
11
Total
Number
10000
20387
19114
7.8
6.6
4.6
14463
4.8
15047
13719
5
11087
5000
10
8589
2492 3018
4603
5780
0
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Data from: 105 of 117 centres
Day Case PCI
Planned Elective Procedures
2013 data
Day Case PCI
Planned Elective Procedures
2013 data
Day Case PCI
Planned Elective Procedures
Detail
2013 data
Day Case PCI
As Percentage of all PCI activity
2013 data
Day Case PCI
As Percentage of all PCI activity
2013 data
Primary PCI
2013 data
% of Centres using PPCI as default for STEMI
Working Hours
Number of centres
NHS Centres only
Working Hrs includes all 24/7 sites
2013
2012
32
2011
5
22
13 18
2010
2013
2012
2011
2010
2009
2008
2007
2006
2005
13
49 52 57 58 60
2009
28 32 38
49
2008
52
67 74 74 82 81
60
52
52 51
2007
52
39 45 42 41 38
2006
37 44 39
2005
21 23 25 17 17
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2004
29
2004
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
24/7
2013 data
PPCI 2013
No PPCI
PPCI day
PPCI 24/7
PPCI Hybrid
No PPCI
PPCI day
PPCI 24/7
PPCI Hybrid
2013 data
No PPCI
PPCI day
PPCI 24/7
PPCI Hybrid
2013 data
No PPCI
PPCI day
PPCI 24/7
PPCI Hybrid
2013 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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
Patient Specific Data Collection
Back to contents
2013 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2013 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
Procedure Specific Analysis
Participation in NICOR
Total No. of
Centres
84
Data to
NICOR
84
Missing
17
6
8
Wales
4
4
0
N Ireland
4
4
0
NHS
6
6
0
Private
2
1
1
England
NHS
Private
Scotland
0
2013 data
‘Front end’ Database used
2013 data
2013
Tomcat
4
Access database from BCIS Website
1
11 1 1
3 22
Cardaas
Medcon
27
6
Dendrite
Lotus Notes
6
Other
7
14
Bespoke in house database
PATS
9
9
12
11
Datacam
Prism
Cardiobase (Magnus)
Infoflex
Cardex
Minerva
For some bespoke = manual data collection
PIMS
Centricity
Bespoke includes manual collection by some
Philips Xper
2013 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2013 data
Case Ascertainment
NICOR
Data warehouse
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
RHH. Ross Hall Hospital
MHO. Manor Hospital
LEB. Spire Hospital Leeds
IND. London Independent Hospital
BMI. The BMI Meriden Hospital
GHB. Spire Bristol
ALT. Altnagelvin Hospital
BRI. Bristol Royal Infirmary
SUN. Sunderland Royal Hospital
RFH. Royal Free Hospital
SSP. Spire Shawfair Park Hospital
NOR. Norfolk and Norwich University Hospital
RIA. Aberdeen Royal Infirmary
KMH. Kings Mill Hospital
BAS. Basildon Hospital
HSC. Harley Street Clinic
BAT. Royal United Hospital Bath
QAP. Queen Alexandra Hospital
GEO. St George's Hospital
NHH. Basingstoke and North Hampshire Hospital
GJH. Golden Jubilee Hospital
WRG. Worthing Hospital
RCH. Royal Cornwall Hospital
CHG. Cheltenham General Hospital
ESU. East Surrey Hospital
AMG. Wycombe Hospital
HH. Harefield Hospital
KGH. Kettering General Hospital
STH. St Thomas Hospital
MDW. Medway Maritime Hospital
VIC. Blackpool Victoria Hospital
SPH. St Peter's Hospital
PMS. The Great Western Hospital
NPH. Northwick Park Hospital
MPH. Musgrove Park Hospital
FRM. Frimley Park Hospital
DER. Royal Derby Hospital
CGH. Conquest Hospital
BLA. Royal Blackburn Hospital
ANT. St Anthony's Hospital
EBH. Birmingham Heartlands Hospital
WHH. William Harvey Hospital
CRG. Craigavon Area Hospital
BED. Bedford Hospital
RSC. Royal Sussex County Hospital
KSX. Tunbridge Wells Hospital
LBH. London Bridge Hospital
AEI. Royal Albert Edward Infirmary
RVB. Royal Victoria Hospital
STO. University Hospital of North Staffordshire
DUD. Birmingham City Hospital
SAN. Sandwell General Hospital
TOR. Torbay Hospital
RHI. Calderdale Royal Hospital
FRE. Freeman Hospital
YDH. York District Hospital
GWE. Royal Gwent Hospital
GRL. Glenfield Hospital
BFT. Belfast City Hospital
As September 2014
0
50
100
150
200
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
RHH. Ross Hall Hospital
MHO. Manor Hospital
LEB. Spire Hospital Leeds
IND. London Independent Hospital
BMI. The BMI Meriden Hospital
GHB. Spire Bristol
ALT. Altnagelvin Hospital
BRI. Bristol Royal Infirmary
SUN. Sunderland Royal Hospital
RFH. Royal Free Hospital
SSP. Spire Shawfair Park Hospital
NOR. Norfolk and Norwich University Hospital
RIA. Aberdeen Royal Infirmary
KMH. Kings Mill Hospital
BAS. Basildon Hospital
HSC. Harley Street Clinic
BAT. Royal United Hospital Bath
QAP. Queen Alexandra Hospital
GEO. St George's Hospital
NHH. Basingstoke and North Hampshire Hospital
GJH. Golden Jubilee Hospital
WRG. Worthing Hospital
RCH. Royal Cornwall Hospital
CHG. Cheltenham General Hospital
ESU. East Surrey Hospital
AMG. Wycombe Hospital
HH. Harefield Hospital
KGH. Kettering General Hospital
STH. St Thomas Hospital
MDW. Medway Maritime Hospital
VIC. Blackpool Victoria Hospital
SPH. St Peter's Hospital
PMS. The Great Western Hospital
NPH. Northwick Park Hospital
MPH. Musgrove Park Hospital
FRM. Frimley Park Hospital
DER. Royal Derby Hospital
CGH. Conquest Hospital
BLA. Royal Blackburn Hospital
ANT. St Anthony's Hospital
EBH. Birmingham Heartlands Hospital
WHH. William Harvey Hospital
CRG. Craigavon Area Hospital
BED. Bedford Hospital
RSC. Royal Sussex County Hospital
KSX. Tunbridge Wells Hospital
LBH. London Bridge Hospital
AEI. Royal Albert Edward Infirmary
RVB. Royal Victoria Hospital
STO. University Hospital of North Staffordshire
DUD. Birmingham City Hospital
SAN. Sandwell General Hospital
TOR. Torbay Hospital
RHI. Calderdale Royal Hospital
FRE. Freeman Hospital
YDH. York District Hospital
GWE. Royal Gwent Hospital
GRL. Glenfield Hospital
BFT. Belfast City Hospital
No Data
0
50
100
150
200
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
Ross Hall Hospital
BMI Park Hospital
Manor Hospital
Leeds Nuffield Hospital
Spire Hospital Leeds
No Data
Leicester BUPA Hospital
London Independent Hospital
BUPA Hospital, Hull & East Riding
The BMI Meriden Hospital
0
50
100
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
RHH. Ross Hall Hospital
MHO. Manor Hospital
LEB. Spire Hospital Leeds
IND. London Independent Hospital
BMI. The BMI Meriden Hospital
GHB. Spire Bristol
ALT. Altnagelvin Hospital
BRI. Bristol Royal Infirmary
SUN. Sunderland Royal Hospital
RFH. Royal Free Hospital
SSP. Spire Shawfair Park Hospital
NOR. Norfolk and Norwich University Hospital
RIA. Aberdeen Royal Infirmary
KMH. Kings Mill Hospital
BAS. Basildon Hospital
HSC. Harley Street Clinic
BAT. Royal United Hospital Bath
QAP. Queen Alexandra Hospital
GEO. St George's Hospital
NHH. Basingstoke and North Hampshire Hospital
GJH. Golden Jubilee Hospital
WRG. Worthing Hospital
RCH. Royal Cornwall Hospital
CHG. Cheltenham General Hospital
ESU. East Surrey Hospital
AMG. Wycombe Hospital
HH. Harefield Hospital
KGH. Kettering General Hospital
STH. St Thomas Hospital
MDW. Medway Maritime Hospital
VIC. Blackpool Victoria Hospital
SPH. St Peter's Hospital
PMS. The Great Western Hospital
NPH. Northwick Park Hospital
MPH. Musgrove Park Hospital
FRM. Frimley Park Hospital
DER. Royal Derby Hospital
CGH. Conquest Hospital
BLA. Royal Blackburn Hospital
ANT. St Anthony's Hospital
EBH. Birmingham Heartlands Hospital
WHH. William Harvey Hospital
CRG. Craigavon Area Hospital
BED. Bedford Hospital
RSC. Royal Sussex County Hospital
KSX. Tunbridge Wells Hospital
LBH. London Bridge Hospital
AEI. Royal Albert Edward Infirmary
RVB. Royal Victoria Hospital
STO. University Hospital of North Staffordshire
DUD. Birmingham City Hospital
SAN. Sandwell General Hospital
TOR. Torbay Hospital
RHI. Calderdale Royal Hospital
FRE. Freeman Hospital
YDH. York District Hospital
GWE. Royal Gwent Hospital
GRL. Glenfield Hospital
BFT. Belfast City Hospital
As September 2014
<90%
0
50
100
150
200
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
AHM. BMI The Alexandra Hospital
<90%
GHB. Spire Bristol
RAI. Raigmore Hospital
ALT. Altnagelvin Hospital
PHB. Priory Hospital
BRI. Bristol Royal Infirmary
WDH. Dorset County Hospital
SUN. Sunderland Royal Hospital
HAI. Hairmyres Hospital
RFH. Royal Free Hospital
CMI. Cumberland Infirmary
0
20
40
60
80
100
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
RHH. Ross Hall Hospital
MHO. Manor Hospital
LEB. Spire Hospital Leeds
IND. London Independent Hospital
BMI. The BMI Meriden Hospital
GHB. Spire Bristol
ALT. Altnagelvin Hospital
BRI. Bristol Royal Infirmary
SUN. Sunderland Royal Hospital
RFH. Royal Free Hospital
SSP. Spire Shawfair Park Hospital
NOR. Norfolk and Norwich University Hospital
RIA. Aberdeen Royal Infirmary
KMH. Kings Mill Hospital
BAS. Basildon Hospital
HSC. Harley Street Clinic
BAT. Royal United Hospital Bath
QAP. Queen Alexandra Hospital
GEO. St George's Hospital
NHH. Basingstoke and North Hampshire Hospital
GJH. Golden Jubilee Hospital
WRG. Worthing Hospital
RCH. Royal Cornwall Hospital
CHG. Cheltenham General Hospital
ESU. East Surrey Hospital
AMG. Wycombe Hospital
HH. Harefield Hospital
KGH. Kettering General Hospital
STH. St Thomas Hospital
MDW. Medway Maritime Hospital
VIC. Blackpool Victoria Hospital
SPH. St Peter's Hospital
PMS. The Great Western Hospital
NPH. Northwick Park Hospital
MPH. Musgrove Park Hospital
FRM. Frimley Park Hospital
DER. Royal Derby Hospital
CGH. Conquest Hospital
BLA. Royal Blackburn Hospital
ANT. St Anthony's Hospital
EBH. Birmingham Heartlands Hospital
WHH. William Harvey Hospital
CRG. Craigavon Area Hospital
BED. Bedford Hospital
RSC. Royal Sussex County Hospital
KSX. Tunbridge Wells Hospital
LBH. London Bridge Hospital
AEI. Royal Albert Edward Infirmary
RVB. Royal Victoria Hospital
STO. University Hospital of North Staffordshire
DUD. Birmingham City Hospital
SAN. Sandwell General Hospital
TOR. Torbay Hospital
RHI. Calderdale Royal Hospital
FRE. Freeman Hospital
YDH. York District Hospital
GWE. Royal Gwent Hospital
GRL. Glenfield Hospital
BFT. Belfast City Hospital
As September 2014
>100%
0
50
100
150
200
NICOR Case Ascertainment
2013 data
UK PCI data in NICOR as % of Reported Totals
HAM. Hammersmith Hospital
STO. University Hospital of North…
WAL. University Hospital Coventry
DUD. Birmingham City Hospital
EAL. Ealing Hospital
SAN. Sandwell General Hospital
MRI. Manchester Royal Infirmary
TOR. Torbay Hospital
BHL. Liverpool Heart and Chest Hospital
RHI. Calderdale Royal Hospital
BRD. Bradford Royal Infirmary
FRE. Freeman Hospital
CRO. Cromwell Hospital
YDH. York District Hospital
CLW. Glan Clwyd Hospital
GWE. Royal Gwent Hospital
KCH. King's College Hospital
GRL. Glenfield Hospital
WYT. Wythenshawe Hospital
BFT. Belfast City Hospital
0
>101%
50
100
150
200
NICOR Case Ascertainment
2013 data
Reported Totals v data in NICOR
UK
E
NHS
W
NHS
S
NHS
NI
NHS
E
Private
S
Private
Declared
PCIs
In NICOR
92589
75451
3799
8482
3563
1261
33
Missing
2082
1124
55
307
120
473
3
Missing (%)
2.4
1.5
1.4
3.6
3.4
37.5
9.1
Extras
1323
927
68
8
314
6
0
Extra (%)
1.4
1.2
1.8
0.1
8.8
0.5
0
91830
NICOR data as Sept 2013
2013 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
2013 data
Patient Specific Data Analysis
• Data
– Centre participation
– Case ascertainment
– Data completeness
Risk Adjusted Outcomes
2013 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
Added November 2010
% Completeness
2013 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
2012
Creatinine
Weight
Location
at STEMI
onset
2013 data
2013
% Completeness
England NHS
Excellent
2013 data
% Completeness
England NHS
Almost
Excellent
2013 data
% Completeness
England NHS
2013 data
% Completeness
England Private
2013 data
% Completeness
Scotland NHS
Scotland Private
2013 data
% Completeness
Wales
N. Ireland
2013 data
Time fields
Data completeness
2013 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
2013 data
Time fields
Room for improvement
2013 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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
Appropriateness
Back to contents
Demographics
2013 data
2007
2008
2009
2010
2011
2012
2013
Age (mean)
64.3
64.4
65.0
65.1
65.3
64.9
64.9
Sex (male)
73.6%
73.8%
73.9% 74.0%
74.0%
74.1%
74.3
Diabetic
17.5%
18.0%
18.2% 18.7%
19.5%
20.2%
20.7%
Previous CABG
8.5%
9.1%
8.6%
8.4%
7.9%
8.9%
8.6%
Previous PCI
18.6%
21.1%
22.3% 22.6%
22.7%
23.5%
24.7%
Previous MI
29.5%
30.2%
28.8% 28.4%
27.6
26.8%
27.2%
Current smoker
26.0%
26.1%
25.4%
25%
Ex smoker
39.0%
37.0%
36.9%
37.7%
Never smoked
35.1%
37.0%
37.7%
37.3%
Demographics - Age
Male mean = 63.6
Female mean = 68.5
2013 data
Demographics - Age
2013 data
Demographics - Age
2013 data
Demographics - Age
2013 data
Demographics
2013 data
Ethnic Origin
Year
2007
2008
2009
2010
2011
2012
2013
Data available
43,929
48,581
57,733
63,592
62,993
66,589
European
92.3%
92.0%
93.0% 92.3%
91.8%
92.1%
91.6%
Asian
6.7%
7.1%
6.16% 6.77%
7.2%
6.9%
7.2%
Black
0.83%
0.72%
0.71% 0.79%
0.83%
0.79%
0.99%
Oriental
0.2%
0.17%
0.15% 0.17%
0.17%
0.14%
0.16%
Clinical Syndrome
2013 data
70
65.6
60
64.8
50
% PCI
40
Performed for
each
Indication 30
35.2
34.4
Stable
Acute
20
10
0
2005 2006 2007 2008 2009 2010 2011 2012 2013
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2013 data
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2013 data
Clinical Syndrome
• PCI in patients with Acute Syndromes (%)
2013 data
Indication for PCI
2013 data
100%
11
90%
13.2
16.3
20.3
24.2
26.2
27.3
27.4
80%
70%
37.8
40.5
38
60%
STEMI
NSTEMI/UA
Stable
Other
38.3
37.7
37.2
36.9
37.7
34.8
34
32.9
50%
40%
30%
50.1
20%
45.1
44.4
39.8
36.2
10%
1.8
1.9
0%
2006
2007
2008
2009
2010
2011
2012
1.8
2.1
2013
Indication for PCI
100%
90%
2
1.8
27.3
80%
1.4
60%
%
1
0.8
30%
0.6
0.4
32.9
0.2
10%
2.1 Other
0%
2013
2007
2008
2009
2010
2011
2012
2013
1.2
37.7
40%
20%
Other
1.6
70%
50%
1.79
2013 data
0.09
0.17
0.03
0
Staged Hybrid
SAT
Bailout
Staged
2013 data
Staged
2013 data
Staged
2013 data
Staged
2013 data
Staged
2013 data
Staged
2013 data
Staged
2013 data
Staged
2013 data
Indication for PCI
100%
90%
27.3
80%
70%
60%
50%
37.7
40%
30%
20%
32.9
10%
0%
2013
27.3 % STEMI
2013 data
2013 data
PCI for STEMI
Number of procedures
30000
25000
24986
24379
20000
15000
10000
5000
607
0
All STEMI
Primary PCI
Rescue
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Primary PCI for STEMI
Absolute numbers 2013
2013 data
Primary PCI for STEMI
Absolute numbers 2013
2013 data
Primary PCI for STEMI
Absolute numbers 2013
2013 data
Primary PCI for STEMI
As % of Total PCIs 2013
2013 data
Primary PCI for STEMI
As % of Total PCIs 2013
2013 data
Primary PCI for STEMI
As % of Total PCIs 2013
2013 data
Primary PCI for STEMI
As % of Total PCIs 2013
2013 data
Primary PCI for STEMI
No data in 2012
2013 data
Primary PCI for STEMI
No data in 2012
2013 data
Primary PCI for STEMI
2011
2012
2012
2013
2013 data
Primary PCI
2013 data
UK Countries – Total number of procedures
25000
20823
20000
2007
2008
2009
2010
2011
2012
2013
15000
10000
5000
2153
943
460
0
England
Scotland
Wales
N. Ireland
NB: All years updated with latest NICOR extract
Scotland – first data from Hairmyres in 2013
Primary PCI
2013 data
UK Countries - pmp
450
400
350
387 384
355
404
373
322
333
380
337
329
292
300
2009
2010
2011
2012
2013
251
250
194
200
194
158
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
2013 data
Europe
Data from 2010/2011
Kristensen EHJ 2014;35:1957
2013 data
David Cunningham
Primary PCI pmp
By LAT over 2010 to 2013
2013 data
David Cunningham
Primary PCI pmp
2013 data
By LAT over 2010 to 2013
David Cunningham
Pre PCI Ventilation
2013 data
• Total Number of emergency cases with Pre PCI ventilation
– Subset of out of hospital cardiac arrest
1600
5.5
5.1
1400
5.0
4.5
1200
1000
Number
Of
PCIs for
800
Ventilated
emergencies 600
3.9
3.8
4.0
3.5
1206
1342
956
400
200
6.0
532
675
% of
3.0 Total Primary
PCIs
2.0
1.0
318
0
0.0
2008 2009 2010 2011 2012 2013
Pre PCI Ventilation
• As % of ALL PCI activity
2013 data
Pre PCI Ventilation
2013 data
• As % of ALL PCI activity
Detail
Pre PCI Ventilation
• As % of Primary PCI cases
2013 data
Pre PCI Ventilation
• As % of Primary PCI cases
Detail
2013 data
Multi-vessel Disease
2013 data
Multi-vessel Treatment
90
80
80.1
70
60
50
% of all PCI
40
30
20
10
15.8
2.8
0
1
2
3
Number of Vessels treated per Case
2006
2007
2008
2009
2010
2011
2012
2013
2013 data
Multi-Lesion Treatment
80
71.5
70
60
2006
2007
2008
2009
2010
2011
2012
2013
50
% of all
40
PCIs
30
21.7
20
10
5.4
1.5
0
1
2
3
>3
Number of lesions Treated per Case
2013 data
PCI to Multiple
Lesions and vessels
2013 data
1.7
1.62
1.56
1.6
1.51
1.5
1.45
1.37 1.37
1.4
1.39 1.38
Lesions per case
Vessels per case
1.3
1.3
1.2
1.25
1.23 1.23 1.22 1.23 1.23 1.23
1.1
1
2006 2007 2008 2009 2010 2011 2012 2013
Disease Burden
Primary PCI v Non-Primary PCI Cases
Epicardial Territories with > 75% stenoses
80
70
Primary PCI
68.9 67.5
Non-Primary PCI
60
50
% 40
30
22.1 23.2
20
8.2
10
8
0.8 1.3
0
1 Territory
2 Territories
3 Territories
4 Territories
2013 data
Primary PCI
2013 data
Multi-vessel Rx
100
90
89.1
80
70
Territories stenosed
68.9
Vessels treated
during PPCI
60
% 50
40
30
22.2
20
9
10
8.2
1.2
0.8 0.7
0
1
2
3
4+
Primary PCI
2013 data
Multi-vessel Rx
100
90
89.1
80
70
Territories stenosed
68.9
Vessels treated
during PPCI
60
% 50
40
30
22.2
20
9
10
8.2
1.2
0.8 0.7
0
1
2
3
4+
All PCI
2013 data
Epicardial Territory Treated
2%
4%
31%
42%
21%
LMS
LAD
Cx
RCA
graft
Treated Epicardial Territory
2013 data
By Presenting Syndrome
100%
2.5
3.2
29.2
27.8
1.2
90%
80%
39.9
70%
60%
21.1
23.8
15.4
Territory 50%
Treated
40%
30%
42.6
40.7
20%
10%
0%
4.4
4.5
Stable
NSTEMI
40.3
3.2
Primary PCI
graft
RCA
Cx
LAD
LMS
Stents
2013 data
Procedures using Stents
2013 data
Procedures using Stents
2013 data
Procedures using Stents
Detail
2013 data
Procedures using Stents
2013 data
100
90
80
70
60
% of PCI
50
Procedures
40
30
20
10
0
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
92
aggregate data up to 2007, NICOR for 2008 on
2013 data
PCI with Drug Eluting Stents
Mean of % use by Centres
90
81.6
80
70
53
55
57
2008
60
63.5
2007
62 63.5
67.1
71.1
76.2
% Cases 50
using DES 40
30
17
20
10
2013
2012
2011
2010
2009
2006
2005
2004
2003
0
2002
0
Drug Eluting Stent
2013 data
% PCI with DES
100
89
90
82.9
76.3
80
70
67
60
% PCIs using
50
DES
40
30
20
10
0
Scotland
England
Wales
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
N. Ireland
Data to 2007 NHS only
Data for 2008 to present all units from NICOR
PCI with Drug Eluting Stents
2013 data
PCI with Drug Eluting Stents
2013 data
PCI with Drug Eluting Stents
2013 data
PCI with Drug Eluting Stents
2013 data
2013 data
PCI with Drug Eluting Stents
By Syndrome
90
80
70
85.3
81.5
75.1
71.1
82.5
76.8
69.8
66.6
60
75.8
68.4
59.5
54.4
% PCI using 50
DES
40
30
20
10
0
Stable
UA / NSTEMI
PPCI
2008
2009
2010
2011
2012
2013
2013 data
Stents per Case
• Mean number of stents per case
2
1.9
1.8
1.7
1.62
1.63
1.6
1.54
1.5
1.5
1.48
1.48
1.46
1.48
1.48
2008
2009
2010
2011
2012
2013
1.4
1.3
1.2
1.1
1
2005
2006
2007
Mean Stents per Case
(by PCI unit)
2013 data
Mean Stents per Case
(by PCI unit)
2013 data
Mean Stents per Case
(by PCI unit)
2013 data
Procedures for
% PCI for restenosis
Restenosis
2013 data
Procedures for
% PCI for restenosis
Restenosis
2013 data
Procedures for
% PCI for restenosis
Restenosis
2013 data
2013 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
Adjunctive therapy
All PCI Indications
2013 data
35
30
25
20
19.1
18.1
Title
15
10
5
0
12.7
9.5
7.8
4.7
4.6
5.15.6
5.7
6
7.9
5.9
3.5
2007
2008
2009
2010
2011
2012
2013
GP IIb/IIIa Antagonists
2013 data
Use by Syndrome
90
80
70
60
% Procedures 50
with any GP
IIb/IIIa blocker 40
40.8
30
15.6
20
10
9.1
4.6
0
Stable
UA
NSTEMI
PPCI
2005
2006
2007
2008
2009
2010
2011
2012
2013
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2013 data
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2013 data
Any IIb/IIIa Antagonist
Use in Primary PCI v activity per unit
2013 data
Bivilirudin
2013 data
Use by Indication for PCI
20
17.5
18
18.6
15.6
16
14
12
% 10
7.4
8
6
4
2
2
2.7
2010
2011
2012
2013
2 2.1
0.48 0.7 0.5 0.5
0
Stable
NSTEMI / UA
PCI for STEMI
Note: PCI for STEMI includes all indications including rescue
Bivalirudin
2013 data
Use in PCI for STEMI v activity per unit
Bivalirudin
2013 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
2013 data
100
90
80
70
59.8 57.6 56.5
60
% 50
40
30
21.8
17.6 17
20
10
6.3 6.1 5.3
0
Stable
NSTEMI / UA
PPCI
2011
2012
2013
Prasugrel
2013 data
Use by Indication for PCI
25
22.2
22.6
20
16.1
15
2010
2011
2012
2013
% Procedures
9.3
10
5
1.3
0.38
1.9 1.9
2.6
1.5 1.9
0.54
2.8
1.7 2.1
0
Stable
NSTEMI / UA PCI for STEMI NSTEMI / UA
in Diabetics
Note: PCI for STEMI includes all indications including rescue
Prasugrel
2013 data
Use in PCI for STEMI v activity per unit
Prasugrel
2013 data
Use in PCI for STEMI v activity per unit
Note: PCI for STEMI includes all indications including rescue
Prasugrel
2013 data
Use in Diabetics with NSTEMI by centre
Prasugrel
2013 data
Use in Diabetics with NSTEMI by centre
Ticagrelor
2013 data
Use by Indication for PCI
25
21
20
15.2
15
2012
2013
%
10
7
5
2.9
3.7
0.5
0
Stable
NSTEMI / UA
PCI for STEMI
Note: PCI for STEMI includes all indications including rescue
Ticagrelor
2013 data
Use in all NSTEMI and STEMI by Centre
Note: PCI for STEMI includes all indications including rescue
Ticagrelor
2013 data
Use in all NSTEMI and STEMI by Centre
2012
2013
Note: PCI for STEMI includes all indications including rescue
Ticagrelor
2013 data
Use in all NSTEMI and STEMI by Centre
Note: PCI for STEMI includes all indications including rescue
LV Support
2013 data
2.5
1.92
2
1.83
1.59
1.5
% of All PCI
Cases
1.03
1
0.85
0.78
0.5
0
Inotropes
IABP
2008
2009
2010
2011
2012
2013
Shock Cases
2013 data
Treated with IABP support
Does not include Impella use
Shock Cases
2013 data
Treated with IABP support
Does not include Impella use
Shock Cases
2013 data
Treated with IABP support
Does not include Impella use
LV Support
% Cases using IABP v LV function
2013 data
Cardiogenic Shock
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
2013 data
Cardiogenic Shock
2013 data
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
Cardiogenic Shock
2013 data
% Cases with shock by PCI unit
Unadjusted for differing rates of OOHA
VIC
Cardiogenic Shock
2013 data
% Cases with shock by PCI unit
WHH
BHR
BRI
GEO
Low mortality
BHR responded, re-assessed cases
recognised errors and recoded cases
2012
HAM
WHH
UHW
GEO
BRI
WYT
30/7 mortality awaited
2013
Primary PCI
% cases over 80
Case selection for PPCI?
2013 data
Primary PCI
% cases over 80
Unadjusted for population demographics
2013 data
Primary PCI
% cases over 80
Unadjusted for population demographics
2013 data
Primary PCI
% cases over 80
Unadjusted for population demographics
2013 data
Additional Interventional
Coronary Techniques
16000
2013 data
14590
14000
12000
10000
8000
6000
4000
3083
2168
2008
2009
2010
2011
2012
2013
2000
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 data
Rotational Atherectomy
2013 data
Rotational Atherectomy
2013 data
Primary PCI
2013 data
Extraction Atherectomy
100%
5.9
5.4
90%
80%
70%
Unknown (%)
44
44.8
60%
No Device Used (%)
50%
40%
30%
20%
Device Used (%)
50
49.8
2012
2013
10%
0%
Overall Thrombectomy
Increase in use
2013 data
Additional Interventional
Coronary Techniques
2013 data
900
800
700
600
476
500
400
300
186
200
2008
2009
2010
2011
2012
2013
100
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’
Additional Interventional
Coronary Techniques
2013 data
18000
15394
16000
14000
12000
2008
2009
2010
2011
2012
2013
10000
7618
8000
6000
4000
2000
977
0
No. of Centres using device
IVUS
OCT
Pressure
Wire
95
38
110
All cases: Diagnostic only + when part of a PCI procedure
Additional Interventional
Coronary Techniques
2013 data
18000
16000
14000
6278
12000
10000
At time of PCI
Diagnostic only
8000
6000
4000
2000
5169
9116
574
2449
0
IVUS
403
OCT
FFR
IVUS
2013 data
Diagnostic ONLY IVUS studies as % of PCI activity
IVUS
2013 data
Detail
IVUS
IVUS at time of PCI as % of PCI activity
2013 data
IVUS
2013 data
PCI to Unprotected LMS
100%
90%
80%
70%
61
60%
IVUS not used
IVUS used
50%
40%
30%
20%
10%
0%
39
IVUS
PCI to Unprotected LMS
2013 data
IVUS
PCI to Unprotected LMS
2013 data
Pressure Wire
2013 data
Diagnostic ONLY Pressure Wire studies as % of PCI activity
Pressure Wire
2013 data
Diagnostic ONLY Pressure Wire studies as % of PCI activity
Detail
Pressure Wire
Pressure Wire at time of PCI
2013 data
Swept Laser Imaging
Diagnostic ONLY OCT studies as % of PCI activity
2013 data
Arterial access
2013 data
Radial Artery Access
2013 data
80
71.2
70
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
2013 data
Radial Artery Access
2013 data
Radial Artery Access
Radial Artery Access
By operator
• % Radial by ‘Consultant Responsible for PCI’ in 2013
• Any case with any radial (including multiple access)
2013 data
Radial Artery Access
By operator
2012
2013
2013 data
Radial Artery Access
2013 versus 2012
2013 data
Radial Artery Access
2013 versus 2012
2013 data
Radial Artery Access
2012 versus 2011
2013 data
Radial Artery Access
2013 data
Clinical Syndrome
80
70
71.9
71.5
66.4
60
2008
2009
2010
2011
2012
2013
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
57.1 55.6
57
58.9 60.1
50
% FA 40
Punctures
Device
closed 30
39.6
20
10
0
2006 2007 2008 2009 2010 2011 2012 2013
2013 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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
Time Delays to Treatment
Back to contents
Delays to PCI in NSTEMI
2013 data
Delays to PCI in NSTEMI
2013 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)
Errors in coding
•
Some units incorrectly code patents as already in PCI centre
(when actually they were admitted directly or by IHT)
2013 data
Delays to PCI in NSTEMI
2013 data
Admission Route – Direct to PCI Centre
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2013 data
Admission Route – Direct to PCI Centre
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2013 data
Admission Route – Direct to PCI Centre
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2013 data
Admission Route – IHT
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
2013 data
Admission Route – IHT
Better
Centres with < 90% data completeness excluded
Delays to PCI in NSTEMI
100
89.6
90
80
70
60
54.6
Hrs 50
2013
40
30
20
10
0
Direct
IHT
2013 data
Delays to PCI in NSTEMI
100
89.6
90
80
70
60
54.6
Hrs 50
2013
40
30
20
10
0
Direct
IHT
2013 data
Delays to PCI in NSTEMI
2013 data
% < ‘NICE’ Targets
80
70
61.2
67.5
62.7
62.6
60
Better
50
55.1
48.5
50
51
< 96 hr
< 72 hr
% 40
30
20
10
0
2010
2011
2012
2013
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Better
% < 96hr
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Better
% < 96hr
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Better
% < 72 hr
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Better
% < 72 hr
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Longer delay Shorter delay
Direct and IHT combined
Admission route: Direct and IHT
Delays to PCI in NSTEMI
2013 data
Longer delay Shorter delay
Direct and IHT combined
Admission route: Direct and IHT
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
2013 data
Primary PCI
2013 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
• Please also see MINAP analysis of data
by financial year (2012-2013)
– 12th MINAP public report
– http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP2013-14/MINAP-Audit-Report-2013-LOW.pdf
2013 data
PCI for Acute Sx
Four admission scenarios
Admitted from
the community
2013 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
2013 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
2013 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
2013 data
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: Call to Balloon times < 150 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: Call to Balloon times < 150 min
79%
Primary PCI (excl shock/vent)
2013 data
Direct and IHT: Call to Balloon times < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
Primary PCI 2011 v 2012
2013 data
(excluding pre-procedure shock/vent)
Better
Direct and IHT: CTB < 150 min
PCI for Acute Sx
Four admission scenarios
2013 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)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Direct and IHT: PCI Door to Balloon < 90 min
Primary PCI (excld shock/vent)
2013 data
Direct and IHT
100
89.7
90
80
75.3
77.3
87.3
89.7
91.9
90.6
79.5 79
2009
2010
2011
2012
2013
% Patients 60
treated
50
within time
limits
40
30
20
10
0
CTB < 150 (%)
DTB < 90(%)
Better
70
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI 2010 v 2011
2013 data
Better
Direct and IHT: DTB < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct and IHT: PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Direct and IHT: PCI Door to Balloon < 60 min
PCI for Acute Sx
Four admission scenarios
2013 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)
2013 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Better
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Direct ONLY: PCI Door to Balloon < 90 min
Primary PCI (excl shock/vent)
2013 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Direct only : PCI Door to Balloon < 60 min
Primary PCI (excl shock/vent)
2013 data
Direct only : PCI Door to Balloon < 60 min
PCI for Acute Sx
Four admission scenarios
2013 data
Admitted from
the community
Admission to
Non-PCI centre
CTB
D1
D2
Direct admission
to PCI centre
Transfer
to PCI centre
DTB
device
PCI for Acute Sx
Four admission scenarios
2013 data
Admitted from
the community
Admission to
Non-PCI centre
CTB
D1
D2
Direct admission
to PCI centre
V
Transfer
to PCI centre
DTB
device
Primary PCI (exclude shock/vent)
According to admission route
2013 data
Primary PCI (excld shock/vent)
2013 data
According to admission route
100
90
90.3
86
91.7
80
60
50.9
50
40
30
20
10
0
CTB < 150 CTB < 150 DTB < 90 D2TB < 90
Direct (%)
IHT (%)
Direct (%)
IHT (%)
2011
2012
2013
Better
70
PPCI Call to Balloon time
2013 data
(excluding shock/vent)
By Admission Route
160
150 151 151
140
120
105
113
110 112
107 108
2011
2012
2013
Median CTB
80
(min)
60
40
20
0
Direct
IHT
All
Better
100
PPCI Call to Balloon time
2013 data
(excld shock/vent)
By Admission Route
160
150 151 151
140
120
105
113
110 112
107 108
2011
2012
2013
Median CTB
80
(min)
60
40
20
0
Direct
IHT
All
Better
100
PPCI Door to Balloon time
2013 data
(exclude shock/vent)
By Admission Route
45
41 41
41
40
38
36
35
40 40
41
35
30
2011
2012
2013
15
10
5
0
Direct
IHT
All
Better
Median 25
D2TB (min) 20
Primary PCI
Admission routes
% Patients admitted directly or by IHT for PPCI
100%
90%
22.5
18.6
18.5
77.5
81.4
81.5
2011
2012
2013
80%
70%
60%
50%
40%
30%
20%
10%
0%
2013 data
PPCI Direct from Community
2013 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
2013 data
Median Length of stay in PCI Centre (exc shock and vent)
LOS = First device time to discharge (assuming discharge at midday)
2013 data
PPCI Summary Stats
Call to ‘Balloon’
PCI Door to ‘Balloon’
All
All
Direct
IHT
79 %
86 %
50.9 %
Median
113 min
108 min
151 min
< 90 min
90.6 %
90.3 %
91.7 %
< 60 min
76.7 %
75.5 %
Median
39 min
41 min
< 150 min
LOS
38 min
2.65 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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 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
2013 data
2013 data
No Tracked Mortality Data
• HSCIC delays
• Unable to provide ONS data
– All UK wide audits affected
– Cause:
Care.data
2013 data
Care.data
• NHS England create new national database
– Identifiable patient data
– Pulled from hospitals, GP records, community care and others
– Stored in a ‘Safe Haven’ – HSCIC
• Linked to create new Care Episode Statistics
• Aims
– Determine where investment in NHS is needed
– Highlight excellent care and identify local problems
Care.data
2013 data
Care.data
2013 data
Care.data
2013 data
2013 data
No ONS tracked data available
MACCE - All PCIs
Year
Procedure
Success
(%)
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
92
92
90
92
94
92
92
93.5
90.2
95.5
92.1
91.8
91.3
92.0
91.9
90.6
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
0.14
0.25
0.13
0.17
0.13
0.11
0.09
0.74
0.62
0.51
0.47
0.56
0.36
0.34
0.29
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
0.08
0.08
0.12
0.07
0.09
0.09
2013 data
30 day
Mortality
Mortality (%)
(%)
(Tracked)
0.89
0.80
0.61
0.64
0.75
0.54
0.53
0.56
0.59
0.74
0.89
1.03
1.21
1.6
1.6
1.9
1.8
2.0
2.1
2.4
2.6
AWAITED
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Adverse Outcome
% 1.5
1
0.5
0
2013 data
Death and emergency surgery
3
2.5
2
Mortality
em CABG
Adverse Outcomes
Death
• Mortality to Discharge (self reported)
2013 data
Adverse Outcomes
Death
• Mortality to Discharge (self reported)
2013 data
Adverse Outcomes
Death
• Mortality to 30/7 (from ONS track)
AWAITED
2013 data
Adverse Outcomes
CVA
• % of all cases with CVA (not TIA)
2013 data
Adverse Outcomes
CVA
• % of all cases with CVA (not TIA)
2013 data
Adverse Outcomes
Surgery
• % of all cases needing emergency cardiac surgery
2013 data
Adverse Outcomes
Surgery
• % of all cases needing emergency cardiac surgery
2013 data
Peri-procedural Complications
2013 data
1.8
1.6
1.4
1.2
%
1
0.8
0.6
0.4
0.2
0
2009
2010
2011
2012
2013
Peri-procedural Complications
No flow / Slow flow by syndrome
2013 data
Access site complications
2013 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
0.8
0.6
0.4
0.2
0
0.3
0.1
2009
2010
2011
2012
2013
Complication by Access route
2013 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
0.3
0.2
0
Femoral
Radial
2007
2008
2009
2010
2011
2012
2013
2013 data
Complication by Access route
CVA
0.18
0.16
0.14
0.12
0.11
% Cases with 0.1
in hospital
CVA
0.08
0.08
0.06
0.04
0.02
0
Femoral
Radial
20102
2011
2012
2013
Outcome 2013
2013 data
Elective Patients
Success
Stable SV
(no CTO)
19,217
95.8
MV
(no CTO)
5,797
93.0
SV CTO
2927
71.13
MV CTO
841
75.9
Partial
success
5.3
20.0
Fail no
comp
RePCI
QMI
2.93
0.1
0.07
0.06
0.01
0.16
1.4
0.19
0.09
0
0
0.2
27.2
0.07
0.07
0.07
0.03
0.1
3.6
0.24
0
0
0.36
0.24
5.1
0.12
0.07
0.05
0.02
0.16
Em
CABG
CVA
Death
In Hosp
OVERALL STABLE
All Stable
28,782
92.1
Death
30/7
Track
AWAITED
All as %
No.
cases
2013 data
Outcome 2013
No.
NSTEMI / UA
32,524
no shock
Success
Fail
no
comp
Re-PCI
93.2
2.4
3.5
0.3
QMI
Em
CABG
CVA
Death
In hosp
0.12
0.04
0.06
0.69
All STEMI
no shock
21,794
93.0
1.7
2.7
0.8
0.02
0.18
2.5
*Primary PCI
23,854
90.2
1.7
2.9
0.7
0.05
0.2
4.9
*Rescue PCI
339
90.0
1.5
2.0
0.6
0
0.6
6.2
Shock
2,687
62.2
2.8
2.7
0.6
0.3
0.6
31.2
Death
30/7
CR
AWAITED
All as %
Partial
success
*all PPCI (includes shock / ventilation and onset in community or in hospital)
All Elective Stable Cases
2013 data
SV no CTO, MV no CTO, SV CTO, MV CTO
0.45
0.4
0.35
0.3
0.25
%
0.2
0.12
0.16
0.15
AWAITED
0.07
0.1
0.05
0.05
0.02
0
Re-PCI
QMI
EmCABG
CVA
Death
30/7
death
2006
2007
2008
2009
2010
2011
2012
2013
2013 data
NSTEMI, no Shock
1.6
1.4
1.2
1
0.7
% 0.8
0.6
0.3
0.2
0.1
0.04
AWAITED
0.4
0.06
0
Re-PCI
QMI
EmCABG
CVA
Death
30/7 death
2006
2007
2008
2009
2010
2011
2012
2013
All Primary PCI
2013 data
(includes shock)
7
6
4.9
5
4
%
3
1
AWAITED
2
0.6
0.2
0.05
0
Re-PCI
QMI
EmCABG
CVA
Death
30/7 death
2006
2007
2008
2009
2010
2011
2012
2013
Summary: Mortality
2013 data
Risk Stratified by Syndrome
8
7
6.2
6
4.9
5
In Hospital
Mortality as 4
reported (%)
3
1.8
2
0.7
1
0.16
0
All
Elective
UA / NSTEMI
Primary PCI
Rescue
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Summary: Mortality
2013 data
Risk Stratified by Syndrome
40
35
35
31
30
In Hospital
Mortality as
reported (%)
25
20
15
10
5
0
Shock
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2013 data
Tracked Mortality at 30/7
• 30 day Mortality by centre (England and Wales)
–
–
–
–
Primary PCI excluding shock and ventilation pre PCI
Primary PCI direct admission only (excluding shock and ventilation)
Primary PCI (including patients with pre-PCI shock and ventilated)
Cardiogenic shock (all presenting syndromes)
2013 data
Primary PCI
(shock/vent EXCLUDED)
AWAITED
%
2013 data
Primary PCI - Direct admission
(shock/vent EXCLUDED)
AWAITED
%
Primary PCI
2013 data
(shock/vent INCLUDED)
AWAITED
x%
Cardiogenic Shock
2013 data
AWAITED
x%
2013 data
Bypass grafts
PCI of SVG and Arterial
In
Hosp
Death
30/7
Death
(CR)
All
as %
No.
Success
Partial
success
Fail no
comp
RePCI
QMI
2006
1486
91.6
3.2
3.8
0.1
0.27
0
1.2
2007
5008
89.6
2.6
6.8
0.2
0.18
0
0.90
2008
4308*
91.0
3.2
5.2
0.3
0.16
0.02
0.56
2009
2506
88.9
3.8
6.0
0.2
0.2
0
1.3
1.7
2010
2645
89.3
2.6
5.4
0.2
0.2
0
0.95
1.5
2011
2802
87.8
3.7
6.7
0.5
0.4
0
1.4
2.7
2012
2956
88.8
4.7
4.6
0.2
0.07
0.07
1.8
2.5
2013
2492
86.8
5.7
5.9
0.4
0.08
0
1.4
AWAITED
Em
CABG
*Centre x = 1860 of 2111 cases in 2008
Bypass Grafts
2013 data
(all types - SVG and IMA etc)
25
19.3
20
Grafts
treated
using distal
protection
as % of all
grafts
treated
18.4
16.8
15.5
15
16.4
14.3
10
5
0
2008 2009 2010 2011 2012 2013
Unprotected LMS
3
2.5
2.5
2.3
2.1
1.91 1.9
2
uLMS Cases
as % of all 1.5
PCIs
1.43 1.37
1.55
1
0.5
0
2006 2007 2008 2009 2010 2011 2012 2013
2013 data
2013 data
Unprotected LMS
Including Shock and STEMI
All
as %
No.
Success
Partial
success
Fail no
comp
RePCI
QMI
2006
2007
2008
2009
2010
2011
2012
2013
583
842
1084
1462
1516
2009
2398
2522
86.8
83.8
83.9
84.9
85.3
86.0
85.3
85.6
4.5
7.4
5.3
4.0
4.1
3.9
4.8
4.2
0.9
2.6
2.6
3.4
2.2
2.3
1.3
1.6
0.3
0.1
0.6
0.3
0.5
0.3
0.4
0.4
0.51
0.48
0.46
0.27
0.13
0.4
0.2
0.2
Death
In
Em
Hosp
30/7
CABG
Death (CR)
0.17
0.7
0.5
0.31
0.07
0.20
0.08
0.12
7.0
7.0
8.0
7.5
8.0
7.4
8.2
8.0
9.2
9.6
10.0
11
AWAITED
Chronic Total Occlusion
2013 data
Stable only
All
as %
No.
Success
Partial
success
Fail no
comp
RePCI
QMI
Death
In
Em
Hosp
30/7
CABG
Death (CR)
2011 4069 69.8
6.1
22.3 0.1 0.03 0.05 0.25 0.42
2012 4273 71.4
6.23
21.2 0.3 0.07 0.09 0.23 0.44
2013 3885 72.3
5.5
21.9 0.1 0.05 0.05 0.15
AWAITED
Chronic Total Occlusion
Stable only
14
13
13.4
2011
2012
12.4
12
Number of
CTO cases
as % of all
PCI for
stable
coronary
syndromes
10
8
6
4
2
0
2013
2013 data
Risk Adjusted Outcome
2013 data
NICOR Interim IT Plans
Data in
Direct or csv
Local
Lotus Notes
Checks for completeness and consistency
2013 data
NICOR Interim IT Plans
Data in
Direct or csv
Web
Front End
Checks for completeness and consistency
Assessment of possible duplicates
2013 data
NICOR Interim IT Plans
Data in
Direct or csv
Web
Front End
Combined front end
BCIS to populate MINAP
2013 data
NICOR Interim IT Plans
2013 data
Data in
Direct or csv
Web
front end
Live Data
Combined front end
BCIS to populate MINAP
Cleaned Data
Archived Data
Mortality tracking (? Scotland and N Ireland)
• Operator requested reports
(appraisal / revalidation)
• Auto generated emailed reports
• Centre v National views
• Annual audit
• Operator Public reports
• Research
• Cross links:
Datasets
HES
CPRD etc
NICOR Interim IT Plans
2013 data
Data in
Direct or csv
Web
front end
Live Data
Combined front end
BCIS to populate MINAP
Cleaned Data
Archived Data
Mortality tracking (? Scotland and N Ireland)
• Operator requested reports
(appraisal / revalidation)
• Auto generated emailed reports
• Centre v National views
• Annual audit
• Operator Public reports
• Research
• Cross links:
Datasets
HES
CPRD etc
2013 data
Appraisal / Revalidation Reports
• Personal log based on GMC number to
generate personal reports
– Complex breakdown of clinical activity including
mortality tracked outcomes
– Cumulative funnel plots of risk adjusted MACCE
– Requires timely upload of data
NICOR Interim IT Plans
2013 data
Data in
Direct or csv
Web
front end
Live Data
Combined front end
BCIS to populate MINAP
Cleaned Data
Archived Data
Mortality tracking (? Scotland and N Ireland)
• Operator requested reports
(appraisal / revalidation)
• Auto generated emailed reports
• Centre v National views
• Annual audit
• Operator Public reports
• Research
• Cross links:
Datasets
HES
CPRD etc
Consultant Outcome
2013 data
Public Reports
Specialty
Adult cardiac surgery
Neurosurgery
Clinical audit/registry title
National Adult Cardiac Surgery Audit
Open heart surgery
National Bariatric Surgery Register
Surgery concerning the causes, prevention and treatment of obesity
National Bowel Cancer Audit Programme
Surgery relating to the last part of the digestive system
National Head and Neck Cancer Audit (known as DAHNO)
Surgery concerning the treatment of head and neck cancer
Adult Coronary Interventions
Treatment of heart disease with minimally invasive catheter based treatments
National Joint Registry
Joint replacement surgery for conditions affecting the musculoskeletal system
BAETS national audit
Surgery on the endocrine glands to achieve a hormonal or anti-hormonal effect in the body
National Oesophago-Gastric Cancer Audit
Surgery relating to the stomach and intestine
BAUS cancer registry
Surgery relating to the urinary tracts
National Vascular Registry
Surgery relating to the circulatory system
National Lung Cancer Audit
Treatment of lung cancer through surgery, radiotherapy, and chemotherapy
National Neurosurgery Audit Programme
Urogynaecology
BSUG Audit Database
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
Consultant Outcome
Public Reports
Data and context
2013 data
PCI Reports
• 2012 + 2013 data
– Operator and Centre Data
• Outcomes report
– Excludes all cases with pre – PCI ventilation
– NQWIP model
2013 data
PCI Reports
• For 2015
– 3 years data - rolling
– Outcomes
• 30 day mortality and NWQIP
• OOHA excluded
• Tracked data from Scotland?
2013 data
NICOR Interim IT Plans
2013 data
Data in
Direct or csv
Web
front end
Live Data
Combined front end
BCIS to populate MINAP
Cleaned Data
Archived Data
Mortality tracking (? Scotland and N Ireland)
• Operator requested reports
(appraisal / revalidation)
• Auto generated emailed reports
• Centre v National views
• Annual audit
• Operator Public reports
• Research
• Cross links:
Datasets
HES
CPRD etc
DMAG
BCIS Data Monitoring and Analysis Group
2013 data
• Successful program of research
• To apply: audit data for research
NICOR web site www.ucl.ac.uk/nicor
Publications 2013 to Present
2013 data
Influence of arterial access site selection on outcomes in primary percutaneous coronary intervention; are the results of
randomized trials achievable in clinical practice? Mammas M et al J Am Coll Cardiol Intervention 2013;6:698–706
Mortality in South Asians and Caucasians after percutaneous coronary intervention in the UK; an observational cohort study of
279,256 patients from the BCIS National database Jones DA, Gallagher et al J Am Coll Cardiol Intervention 2014;7:362-371
Baseline bleeding risk and arterial site access in relation to procedural outcomes following percutaneous intervention. Mamas
AM et al J Am Coll Cardiol Intervention 2014
Contemporary clinical outcomes of patients treated with or without rotational coronary atherectomy — An analysis of the UK
central cardiac audit database. James Cockburn et al International Journal of Cardiology 2014;170:381–387
Comparative Outcomes After Unprotected Left Main Stem Percutaneous Coronary Intervention. A National Linked Cohort
Study of 5,065 Acute and Elective Cases From the BCIS Registry (British Cardiovascular Intervention Society). Almudarra S et
al J Am Coll Cardiol Intervention 2014;7:717
Arterial access site utilization in cardiogenic shock in the United Kingdom; is radial access feasible? Mamas MA et al Am.
Heart J 2014;167(6):900-8
Long-term follow-up of elective chronic total occlusion angioplasty: analysis from the U.K. Central Cardiac Audit Database.
Sudhakar George et al. J Am Coll Cardiol. 2014;64:235-243.
Outcomes after Emergency Percutaneous Coronary Intervention in patients with Unprotected Left Mainstem Occlusion: The
BCIS (British Cardiovascular Intervention Society) National Audit of Percutaneous Coronary Intervention 6-Year Experience.
Niket Patel et al. J Am Coll Cardiol Intervention 2014
Outcomes in Patients with Cardiogenic Shock Following Percutaneous Coronary Intervention in the Contemporary Era: An
Analysis from the British Cardiovascular Intervention Society (BCIS) Database. Kunadian V et al. J Am Coll Cardiol
Intervention 2014
Access site practice and procedural outcomes in relation to clinical presentation in 439,947 patients undergoing percutaneous
coronary intervention in the United Kingdom. Ratib K et al J Am Coll Cardiol Intervention 2014 in press
Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention; insights
from the British Cardiovascular Intervention Society. Mamas MA et al. European Heart Journal 2014 in press
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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
Adult Non Coronary
Intervention
Back to contents
2013 data
Adult Non-Coronary Intervention
180
160
140
120
100
80
84
70
60
40
23
20
TV plasty
PV plasty
MV plasty
HOCM
Septal
ablation
0
10
2007
2008
2009
2010
2011
2012
2013
Note: PV plasty NOT as part of valve implantation procedure
HCM
Alcohol Mediated Septal Ablation
14
12
10
Number of 8
procedures
2013
6
4
2
0
Individual Centres
2013 data
HCM
Alcohol Mediated Septal Ablation
2013 data
Mitral Balloon Valvuloplasty
2013 data
Percutaneous Valves
Mitra-Clip
90
83
80
70
63
60
47
Number of 50
procedures 40
28
30
20
10
0
3
33
2008
2009
2010
2011
2012
2013
2013 data
Percutaneous Valves
Mitra-Clip
2013 data
Adult Non-Coronary
Intervention
2013 data
1200
1000
2007
2008
2009
2010
2011
2012
2013
800
698
624
600
400
200
127
0
ASD
PFO
LAA Occlusion
ASD Closure
2013 data
PFO Closure
2013 data
LAA Closure
2013 data
Adult Non-Coronary
Intervention
2013 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
2013 data
Adult Great Vessel
Intervention
2013 data
140
120
100
91
2007
2008
2009
2010
2011
2012
2013
80
60
40
20
10
0
Coarct / Re-coarct
Carotid
Renal Denervation
200
180
180
2013 data
40
35
160
30
140
25
120
100
Number of
100
Procedures
25
80
20
15
60
14
40
32
20
6
10
5
0
0
2011
2012
2013
Number of
Centres
Renal Denervation
2013 data
Percutaneous
Pulmonary Valves
70
2013 data
10
62
9
60
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
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
Risk adjusted outcome
Operator reported outcomes
Outcome
–
–
•
Adult non coronary intervention
•
TAVI
•
Conclusions and summary
Appropriateness
2013 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
2013 data
TAVI
Back to contents
Transcatheter Valves
2013 data
Centres
No
Max
Cases
16
431
78
Subclavian
10
42
16
Direct Aortic
6
35
11
Survey monkey Data
Medtronic CoreValve: Femoral
Other (carotid 1, TA 5)
6
Edwards Sapien: Femoral
25
613
63
Apical
23
174
25
Direct aortic
12
62
24
Other (subclavian)
1
SJM, Portico
2
Direct Flow Medical
6
Engager
1
Lotus
21
Evolute
1
Belfast ‘total 105 - don’t have breakdown’
NCR (other unspecified)
105
2
Total = 1502
Transcatheter Valves
2013 data
TAVI
Total = 5515
2013 data
1800
1534
1600
1400
1271
1200
1018
Number of
1000
TAVI
Procedures
800
Performed
771
561
600
400
200
294
66
0
2007 2008 2009 2010 2011 2012 2013
TAVI
2013 data
Total Procedures by unit and year
140
120
100
80
60
BAL
BHL
BRI
CHN
ERI
FRE
GEO
GRL
HAM
HH
HHW
HSC
KCH
LBH
LGI
MOR
MRI
NCR
NHB
PAP
PLY
QEB
RAD
RSC
RVB
SCM
SGH
STH
STO
UCL
UHW
VIC
WYT
40
20
0
2007
2008
2009
2010
2011
2012
2013
2013 data
Maps by
David Cunningham
TAVI
Implant
Rate
(per million
population)
2010
2013 data
Maps by
David Cunningham
TAVI
Implant
Rate
(per million
population)
2011
2013 data
Maps by
David Cunningham
TAVI
Implant
Rate
(per million
population)
2012
2013 data
Maps by
David Cunningham
TAVI
Implant
Rate
(per million
population)
2013
2010
2011
2012
2013
Maps by
David Cunningham
TAVI
Implant
Rate
(per million
population)
2013 data
TAVI
2013 data
Female (%)
70.0
60.6
60.0
50.0
44.6
47.8
46.6
47.2
47.6
46.5
2009
2010
2011
2012
2013
40.0
30.0
20.0
10.0
0.0
2007
2008
TAVI
2013 data
Mean Age (yrs)
90.0
83.2
81.8
81.7
81.4
81.0
81.2
81.0
2007
2008
2009
2010
2011
2012
2013
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
TAVI
2007-2013
2013 data
TAVI
2007-2013
2013 data
TAVI
2013 data
Mean Logistic Euroscore
30.0
25.6
25.0
21.8
20.8
21.2
2009
2010
22.2
22.2
2011
2012
20.8
20.0
15.0
10.0
5.0
0.0
2007
2008
2013
TAVI
2013 data
Diabetic (%)
30.0
24.3
25.0
23.4
23.2
22.4
2011
2012
23.6
20.3
20.0
16.7
15.0
10.0
5.0
0.0
2007
2008
2009
2010
2013
TAVI
2013 data
Renal failure (%)
10.0
8.9
9.0
8.2
7.6
8.0
7.0
6.0
7.4
6.5
6.1
4.9
5.0
4.0
3.0
2.0
1.0
0.0
2007
2008
2009
2010
2011
2012
2013
Definition: creatinine > 200, and/or on dialysis
TAVI
2013 data
Previous cardiac surgery (%)
40.0
35.0
29.6
30.0
25.0
32.0
33.9
32.5
33.2
32.3
2011
2012
2013
22.7
20.0
15.0
10.0
5.0
0.0
2007
2008
2009
2010
TAVI
2013 data
Of patients treated by TAVI:
Prior Aortic Balloon Valvuloplasty
14
12.4
12
12.0
11.5
9.7
10
8.3
8
6
5.1
4
2
1.5
0
2007
2008
2009
2010
2011
2012
2013
TAVI
2013 data
Good (LVEF >=50%) as %
Fair (LVEF = 30-49%) as %
Poor (LVEF <30%) as %
80.0
67.8
70.0
64.8
61.9
57.7
60.0
50.0
63.2
58.8
47.0
43.9
40.0
30.0
25.7
25.2
28.2
32.8
31.0
27.7
20.0
10.0
6.1
5.8
9.3
9.7
9.4
10.2
9.1
0.0
2007
2008
2009
2010
2011
2012
2013
TAVI
2013 data
Valve Manufacturer
1000
900
872
800
Direct Flow
700
Edwards Sapien
600
573
JenaValve
Medtronic
500
St Jude
400
Boston
300
3
200
100
0
55
19
2007 2008 2009 2010 2011 2012 2013
TAVI
2013 data
Delivery Approach
1400
1200
Femoral
Subclavian
Transapical
Direct Aortic
Carotid
Other
1000
800
600
400
200
0
2007
2008
2009
2010
2011
2012
2013
TAVI
2013 data
Pacing - All
40.0
35.0
4.5
30.0
25.0
6.2
20.0
15.0
10.0
5.0
4.8
30.3
Paced before TAVI
Paced due to TAVI
6.1
18.5
5.0
5.8
7.6
19.0
11.5
11.1
9.6
10.0
0.0
2007 2008 2009 2010 2011 2012 2013
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
2013 data
Pacing – Edwards Sapien
50.0
45.0
40.0
35.0
30.0
Paced before TAVI
Paced due to TAVI
25.0
20.0
15.0
3.9
10.0
5.0
0.0
4.0
0.0
6.7
4.7
2.6
9.0
5.2
6.6
4.1
4.9
5.8
6.8
6.2
2007 2008 2009 2010 2011 2012 2013
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
2013 data
Pacing – Medtronic CoreValve
50.0
45.0
40.0
5.9
35.0
8.5
30.0
5.7
25.0
20.0
15.0
10.0
5.0
8.3
5.4
37.3
7.1
27.3
8.9
Paced before TAVI
Paced due to TAVI
28.9
16.9
19.3
14.5
15.4
0.0
2007 2008 2009 2010 2011 2012 2013
Due to TAVI = Pre TAVI in preparation and post TAVI as required
TAVI
2013 data
Complication of CVA up to Discharge (%)
5.0
4.5
3.9
4.0
3.4
3.0
3.0
2.7
2.4
1.8
2.0
1.0
0.0
2007
2008
2009
2010
2011
2012
2013
TAVI
2013 data
Conversion to Surgery in Lab (n)
25
21
‘Conversion to full Sternotomy’
Principle reason:
20
15
Old Dataset (V3)
‘Emergency surgery’
10
5
5
4
5
New Dataset (V4)
6
1
0
2007 2008 2009 2010 2011 2012 2013
Haemorrhage (12)
Valve surgery (6)
CABG (1)
other (2)
TAVI
2013 data
Emergency Valve-in-Valve in lab (n)
50
45
45
40
36
35
34
30
25
20
15
10
5
3
3
2007
2008
9
9
2009
2010
0
2011
2012
2013
TAVI
2013 data
Device Embolisation in lab (n)
14
13
13
2012
2013
12
12
10
8
8
6
4
3
2
2
0
2007
2008
2009
2010
2011
TAVI
2013 data
New Haemofiltration or dialysis post
procedure (%)
8.0
6.9
7.0
6.0
5.0
4.5
4.5
3.8
4.0
3.0
2.0
2.5
2.9
1.5
1.0
0.0
2007
2008
2009
2010
2011
2012
2013
TAVI
2013 data
Mortality (Tracked at 30 days as %)
16.0
14.0
13.6
12.0
10.0
8.8
8.0
5.6
6.0
6.1
6.0
5.4
4.3
4.0
2.0
0.0
2007
2008
2009
2010
2011
2012
2013
TAVI to treat other valves
Degenerate Prosthetic Tricuspid Valve
Units
No
1
1
2013 data
Summary 2013
2013 data
• 117 PCI centres in UK (98 NHS)
– 92,589 PCIs (1,444 PCI pmp → 0.5% reduction)
– PCI to CABG ratio 5.5 : 1
• All NHS centres uploading to NICOR
– NSTEMI delays improved
– PPCI delays largely unchanged
• TAVI increasing 250 pa
– Large regional range up to 50 pmp
– No evidence of shift to lower risk cases
• Future plans
– New PCI model to be tested
– Upgrades to IT infrastructure at NICOR
slides available on the BCIS website www.bcis.org.uk
Acknowledgments
• Database and programming
– Darragh O’Neill
– Andrew Donald
• Administrative support
– Lucia Gavalova
2013 data
UK PCI Centre Codes 2013
Back to contents
2013 data
UK PCI Centre Codes 2013
Back to contents
2013 data
UK PCI Centre Codes 2013
Back to contents
2013 data
Corrections
2013 data
History of Changes to Slide Set
• 04-10-2014
– Original slide set
• 11-10-2014
– Correction of errors in DTB calculation for Direct + IHT < 90 min
– Correction of errors in DTB calculation for Direct and IHT < 60 min
• 03-11-2014
– Correction of diagnostic only IVUS use as % of PCI activity
• 2 centres updated incorrect data
• 23-11-2014
– Correction of labels of centres performing Mitraclip
– Inclusion to 30 day mortality for TAVI in 2013
Thank you
2013 data