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NCVD
Percutaneous Coronary Intervention
(PCI) Registry
An update
Dato Dr Rosli Mohd Ali
Chairman of NCVD PCI Registry
Hilton Kuala Lumpur
17th April 2009
PCI Registry Participating Sites
*PH
HUSM
*QEH
(2008)
SDMC
DSH
*KPJSSH
SUNMED
*SH
*IJN
*UMMC
*HUKM
*SGH
*HSAJB
* Active sites
National Cardiovascular Disease Database (NCVD)
Current Activities
NCVD-PCI Annual Report 2007
• In the midst of report writing
• PCI Report Writing Committee
Prof Dr SIM Kui-Hian
Prof Dr Wan Azman Wan Ahmad
Dr Alan Fong Yean Yip
Dato’ Dr Omar Ismail
Dr Liew Houng Bang
Dr Lu Hou Tee
Dr Chee Kok Han
Dr Syahidah Syed Tamin
Dr Azmee Ghazali
National Cardiovascular Disease Database (NCVD)
Current Updates
as of 9th April 2009
(based on unclean data)
National Cardiovascular Disease Database (NCVD)
Percutaneous Coronary
Intervention
(PCI) Registry
National Cardiovascular Disease Database (NCVD)
Number of PCI registered (online) by
Source Data Providers (SDP)
70
61.95
60
Percentage(%)
50
40
30
20
10
0
8.04
10.82
10.09
6
1001
1.12
1002
1004
1005
1006
1009
1.44
1015
SDP
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
1.12
1019
0.1
1020
0.27
1021
Number of PCI registered (online) by
Source Data Providers (SDP)
0.66%
0.45%
9.65%
9.09%
0.18%
12.67%
57.59%
9.71%
1001
1002
1004
1005
1006
1009
1015
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
1019
1020
1021
Patient Demographics
Baseline n=8,236
Age
Min, Max
mean ± sd
22, 95 yrs
56.7 ±10.06 yrs
Age < 40 years
0.33 %
Age > 70 years
0.55 %
Male
81.99 %
Malaysian
92.67 %
Ethnic : Malay
47.23 %
Chinese
24.66 %
Indian
22.56 %
Other Malaysian
0.33 %
Foreigner
4.93 %
Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau,
Bidayuh, Other Sabahan and Other Sarawakian
National Cardiovascular Disease Database (NCVD)
For 12 cases, there is no information on ethnicity
Percentage of Ethnic Groups
Indian, 23.13%
Other Msian,
4.55%
Foreigner, 0.3%
Malay, 45.79%
Chinese, 25.88%
Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other
Sabahan and Other Sarawakian
National Cardiovascular Disease Database (NCVD)
Clinical Background & CV Risk
Factors
Baseline (n=8,236)
Dyslipidaemia
73.42 %
Hypertension
73.03 %
Diabetes
45.41 %
OHA
77.94 %
Insulin
13.60 %
Family History of premature CVD
16.57 %
MI history
38.19 %
Documented CAD
55.28 %
New onset angina (< 2 weeks)
23.08 %
Congestive Heart Failure (> 2 weeks prior)
3.68 %
Chronic Lung Disease
1.29 %
Cerebrovascular disease
1.51 %
Peripheral vascular disease
1.03 %
Chronic renal failure
6.23 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Previous Revascularization
Baseline (n=8,236)
Previous PCI
22.21 %
Previous CABG
4.02 %
Clinical Presentation
Baseline (n=8,236)
Acute Coronary Syndrome
(n=2,039)
24.76 %
STEMI
44.92 %
NSTEMI
32.81 %
Unstable Angina
19.86 %
* For 49 cases, the information on ACS stratum are Not Available
National Cardiovascular Disease Database (NCVD)
PCI status
Baseline (n=8,236)
Elective (n = 7,439)
90.32 %
Staged PCI
Cath-PCI in same setting (adhoc)
22.06 %
84.12 %
Urgent (NSTEMI/UA)
4.66 %
Rescue
2.09 %
Primary
2.48 %
Missing
0.45 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Adjunctive Pharmacotheraphy PCI
Baseline (n=8,236)
Thrombolytics
5.45 %
IIb/ IIIa Blockade
6.47%
Heparin
85.31 %
LMWH
4.83%
Ticlopidine
3.36 %
Bivalirudin
0.29 %
Aspirin
96.26 %
Clopidogrel
97.69 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Antiplatelets strategy during PCI
Baseline (n=8,236)
ASPIRIN
96.26 %
Prior
92.71%
After
0.85 %
During
1.08 %
Clopidogrel
Clopidogrel loading (if
prior) n = 7,408
Hours
First / load dose
97.69 %
Prior
92.07%
After
2.71 %
During
2.24 %
<6hr
6-24hr
>24-72hr
>72hr
17.40 %
29.02 %
10.14 %
35.80 %
75mg
300mg
600mg
>1200mg
36.60 %
51.32 %
5.45 %
0.01 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Percutaneous entry
Baseline (n=8,236)
Brachial
0.98 %
Radial
35.10 %
Femoral
57.81 %
Multiple site
1.49 %
Missing
4.58 %
Extent of coronary disease
Baseline (n=8,236)
Single vessel disease
44.50 %
Multiple vessel disease
54.43 %
Graft
1.18 %
Left Main
0.80 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Lesion characteristics
Baseline (n=11,508)
De novo
91.28 %
Acute stent thrombosis
0.50 %
Acute
Subacute
Late
35.09 %
21.05%
26.32 %
Restenosis (no prior stent)
0.23 %
In stent restenosis
4.52%
Missing
3.47 %
AHA-ACC Lesion Morphology Type
A
11.76 %
B1
25.14 %
B2
19.38%
C
39.45 %
Missing
4.28 %
National Cardiovascular Disease Database (NCVD)
Total Lesion= 11,508 as of 9th April 2008
Graft PCI
Location in Graft (n = 167)
Ostial
9.58 %
Mid
20.96 %
Distal
11.98 %
Anastomosis
7.78 %
Proximal
28.14 %
For 36 cases, the information on Location in Graft PCI is Not Available
Total Lesion= 11,508 as of 9th April 2008
National Cardiovascular Disease Database (NCVD)
Native vessel PCI
Location description
Ostial
6.33 %
Bifurcation
7.69 %
CTO < 3 mo
3.02 %
CTO > 3 mo
7.10 %
Thrombus
3.21 %
Not Applicable
70.20 %
Pre-PCI stenosis %,
Post-PCI stenosis %,
84.52 + 12.08
3.94 + 17.08
TIMI flow
TIMI flow
0
11.44 %
0
1.77 %
1
4.13 %
1
0.37 %
2
15.53 %
2
1.10 %
3
63.21 %
3
90.98 %
Total Lesion= 11,508 as of 9th April 2008
National Cardiovascular Disease Database (NCVD)
Procedural Characteristics
Max balloon size (mm)
3.06 + 0.58
Max stent/balloon deploy pressure
(atm)
15.77 + 3.81
Direct stenting
Stent type
18.67 %
Baseline (n=11,508)
DES
56.67 %
BMS
40.58 %
Bio-absorbable stent
0.03 %
Antibody coated
2.30 %
Other stent
0.41 %
Stent length (mm)
22.52 + 7.32
Stent diameter (mm)
2.99 + 0.46
Total Lesion= 11,508 as of 9th April 2008
National Cardiovascular Disease Database (NCVD)
Percentage of stent by total number of
stent used (n = 11,508)
Bio absorbable
stent, 0.03%
BMS, 40.58%
Antibody coated,
2.30%
Others, 0.41%
DES, 56.67%
Other stents refer to stents other than listed in the Reference Stent List
Total Stent, n =11,508 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Procedural Characteristics
Baseline (n=11,508)
Intracoronary devices used (total no of lesions treated)
Unsuccessful
2.58 %
Balloon only (POBA)
7.69 %
BMS
38.40 %
Drug eluting balloon
2.67%
Distal embolic protection (n = 15)
Filter
0.47 %
96.30%
Cutting balloon
2.20 %
DES
46.23 %
Flowire
0.01 %
IVUS
3.86 %
Rotablator
0.85 %
Others (eg. Thromboaspiration)
3.53 %
Closure device
5.12 %
National Cardiovascular Disease Database (NCVD)
Target Vessel Complications
Baseline (n = 11,508)
Acute closure
0.38 %
Dissection
4.20 %
Perforation
0.29 %
No Reflow (n = 149)
1.29 %
Transient
63.76 %
Persistent
22.82 %
Missing
13.42 %
Successful lesion
93.19 %
National Cardiovascular Disease Database (NCVD)
Procedural Complications
Baseline (n=8,236
Periprocedural MI
0.44 %
Emergency Reintervention (n = 20)
0.24 %
Stent thrombosis
Dissection
Perforation
Others
50.00 %
35.00 %
70.00 %
30.00 %
Bail-out CABG
0.04 %
Cardiogenic shock
0.53 %
Arrhythmia (VT/VF/Brady)
0.61 %
TIA/Stroke
0.05 %
Tamponade
0.05 %
Contrast reaction
0.06 %
New onset/ worsened HF
0.11 %
New renal impairment
0.16 %
National Cardiovascular Disease Database (NCVD)
Total PCI = 8,236 as of 9th April 2009
Vascular Complications
Bleeding
Yes (n = 28)
0.74 %
Minor
Major
Minimal
NA
13.11 %
8.20%
68.85 %
6.56 %
No
97.29 %
* For 162 cases, the information on Bleeding complication are Missing
National Cardiovascular Disease Database (NCVD)
In-hospital Outcome
Baseline (n= 8,236)
Outcome
Alive
98.14%
Death
1.03 %
Transferred
0.04 %
Missing
0.79 %
Cause of death
Cardiac
88.24 %
Vascular
4.71 %
Renal
1.18 %
Pulmonary
1.18 %
Missing
2.35 %
Location
In lab
5.88 %
Out of Lab
90.59 %
National Cardiovascular Disease Database (NCVD)
Total PCI = 8,236 as of 9th April 2009
Medications at discharge
Baseline (n=8,236)
Aspirin
92.20 %
Clopidogrel
93.14 %
Ticlopidine
5.62 %
Statin
90.18 %
Beta blocker
71.01 %
ACE inhibitor
53.64 %
ARB
13.65 %
Warfarin
1.10 %
Others
68.71 %
Total PCI = 8,236 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Follow up at
30days & 1year
National Cardiovascular Disease Database (NCVD)
Overall Follow Up Management
Total
30 days FU
6 months FU
12 months FU
(+7 days)
(+14 days)
(+30 days)
N
%
N
%
N
%
Expected
visits
6181
100
4892
100
3403
100
Visit done
2337
38
786
16
427
13
Missed FU
3844
62
4106
84
2976
87
Results as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Overall Follow Up done at 30days & 1year
7000
6181
No. of FU Done
6000
Expected visits
Visit done
4892
5000
4000
3000
3403
2337
2000
786
1000
427
0
30 days FU
6 months FU
Type of Follow Up
National Cardiovascular Disease Database (NCVD)
12 months FU
Follow Up done at 30days & 1year by SDP
100
92
90
% of FU visit done
65
40
6 months
73
12 months
61
60
50
82
80
80
70
30 days
86
80
61
45
35
35
30
20
15
8
10
5
32
0
1001
1002
1004
1005
1006
1009
1015
1019
1020
1021
SDP
Total 30 days FU = 3,470 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Total 6 months FU =1,700 as of 9th April 2009
Percentage of 30 days Follow Up completed
by Source Data Providers (SDP)
50
50
45
40
Percentage (%)
35
30
22.59
25
20
13.72
15
9.77
10
2.85
5
0.32
0.12
0.63
0
1001
1002
1004
1005
1006
1009
1015
1019
SDP
Total 30 days FU completed = 3,470 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Percentage of 6 months Follow Up
completed by Source Data Providers (SDP)
35.76
40
32.12
Percentage (%)
35
30
25
20
18.88
12.59
15
10
0.65
5
0
1001
1002
1004
1005
1006
SDP
Total 6 months FU completed = 1,700 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
Outcome at 30 days FU & 6
months FU
Outcome
30 days FU
6 mths FU
Alive
98.14 %
96.54 %
96.06 %
Death
1.03 %
0.69 %
0.41 %
0.06 %
0.06 %
-
2.71 %
3.47 %
0.78 %
-
-
Transferred
Lost to FU
Missing
1.04 %
Total 30 days FU = 3,470 as of 9th April 2009
Total 6 months FU =1,700 as of 9th April 2009
National Cardiovascular Disease Database (NCVD)
At 30 days and 6 months
30 days FU
6 months FU
(n = 244)
(n = 114)
Readmission
7.03 %
6.71 %
CHF
1.64 %
2.63 %
Recurrent Angina
11.07 %
7.89 %
PCI – planned
56.97 %
42.11 %
PCI – unplanned
2.87 %
6.14 %
AMI
1.64 %
4.39 %
CABG
0.82 %
2.63 %
Others
14.75 %
27.19 %
Missing
9.84 %
4.39 %
Duration
National Cardiovascular Disease Database (NCVD)
Total 30 days FU = 3,470 as of 9th April 2009
Total 6 months FU =1,700 as of 9th April 2009
Readmission Reason at 30 days FU &
6 months FU
60
56.97
50
30days FU
6mths FU
Percentage (%)
42.11
40
27.19
30
20
10
14.75
2.63
4.39
1.64
1.64
11.07
7.89
9.84
6.14
2.87
2.63
2.63
0.82
0.41
4.39
0
CHF
AMI
Recurrent
angina
PCI planned
PCI unplanned
CABG
Arrhythmia
Others
Readmission Reason
National Cardiovascular Disease Database (NCVD)
Total PCI = 8,236 as of 9th April 2009
Missing
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