National Audit of Angioplasty Procedures - HQIP

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8OutcomeThe complications from PCI haveprogressively fallen as techniques haveevolved. Nevertheless, this has alsomeant the procedure can be offered topatients who are considerably sicker, andin whom a higher risk of complicationsis expected. The rate of requirement foremergency coronary artery bypass graft(CABG) remains very low at less than 1%.The overall rate of death before dischargefrom hospital following PCI has, however,gradually increased over the past few years.Patients are treated by PCI for a number ofreasons. The mortality risk for each of themajor reasons for PCI treatment shows thatthe outcome for each of these remainedstable (figure 12).The increase in overall mortality is due toan increasing proportion of sicker patientsbeing treated by PCI. This change in casemix is driven by the increasing use ofemergency PCI to treat STEMI, (known asprimary PCI) (figure 13).654.44.9Mortality (%)4321.610200320042005200620072008200920102003200420052006200720082009All Elective Unstable angina/NSTEMI Primary PCI RescueFigure 12Mortality following PCI according to presenting clinical syndrome0.14201020032004200520062007200820090.61201020032004200520062007200820092010200320042005200620072008200920102000019469178671500016Number of PCIs10000500002001200220032004Figure 13Increase in primary PCI2005200620072008200920102001200220032004200520062007200820092010All STEMI Primary PCI Rescue20012002200320042005200620072008200916022010
Overall, the percentage of PCI for STEMIhas doubled over the last four years; thepercentage of patients with stable anginahas decreased from approximately 50%to 40%, while those with Non ST elevationacute coronary syndromes has remainedlevel at approximately 38% (Figure 14).This analysis clearly demonstrates theimportance of risk adjustment in theassessment of outcome to help avoidmisleading conclusions. To assess theperformance of all UK units PCI centres,the outcome data for a 3 year period(2008, 2009 and 2010 data combined)were analysed. The North West QualityImprovement Program (NQWIP) 5 modelwas used to adjust for varied case mix.The results of this analysis are shown infigure 15.100%10.9613.2416.3120.2524.2STEMINSTEMI/UA80%StableOther60%37.840.4837.9538.337.740%20%50.0745.1 44.3839.836.2Figure 14Changing case mix0%2006 2007 2008 2009 20104.0Risk adjusted MACCE (%)3.53.02.52.01.51.00.5Each point represents the risk adjusted MACCE for each unit,this is calculated from:Observed MACCE of each unitUK Mean MACCE rate xPredicted MACCE of each unit+3 SD-3 SD00 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000Total number of PCIs performedFigure 15Risk adjusted major adverse cardiac and cerebrovascular events (MACCE) for each UK unit17
Page 1 and 2: NICOR: NATIONAL INSTITUTE FORCARDIO
Page 3 and 4: National Audit ofPercutaneousCorona
Page 5 and 6: ForewordThe United Kingdom is uniqu
Page 7 and 8: Key findings include:• There are
Page 9 and 10: Hospital nameDate ofbirthSexMedical
Page 11 and 12: 3InfrastructureThe number of sites
Page 13 and 14: 1800England Scotland N. IrelandWale
Page 17: 7Arterial access routeWhen performi
Page 21 and 22: 9Delays to treatmentIn the treatmen
Page 23 and 24: 100SPHBETTER% CTB
Page 26 and 27: 11GlossaryAbbreviations in alphabet

National Audit of Angioplasty Procedures - HQIP

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