New CathPCI Registry Report Provides a Comprehensive View of Diagnostic Cardiac Catheterization and PCI in the U.S.
In an effort to provide a perspective on current use and outcomes of invasive cardiac procedures, a new report using data from the NCDR's® CathPCI Registry® was published on Oct. 17 in the Journal of the American College of Cardiology and provides a contemporary snapshot of diagnostic cardiac catheterization and percutaneous coronary interventions (PCI) performed in the U.S.
The CathPCI Registry collects data from 85 percent of cardiac catheterization laboratories in the U.S. Over two million procedures captured between Jan. 2010 and June 2011 were analyzed in order to provide an overview of the current practice of invasive cardiology.
Highlights from the report include:
- Patient risk factors: Almost 80 percent of patients undergoing PCI were overweight, including 43 percent who were obese. Other risk factors showed 80 percent had dyslipidemia, and 82 percent had hypertension. In addition, almost 28 percent of PCI patients were current or recent smokers.
- Access to arteries for assessment and treatment: For both diagnostic procedures and PCI, femoral access was the most frequently used technique. Femoral access was used in just over 90 percent of procedures vs. use of radial artery access in 8.3 percent of diagnostic catheterization procedures and 6.9 percent of PCI procedures.
- Patient presentation: Among PCI patients, 70 percent had some type of acute coronary syndrome at presentation (unstable angina, non-ST-segment elevation myocardial infarction [STEMI]), while approximately 18 percent had stable angina and 12 percent had either atypical symptoms or no angina.
- Stress testing, calcium scores and coronary computed tomography imaging: Among patients undergoing elective PCI, 52 percent underwent a stress study before the procedure, with stress myocardial perfusion being used most frequently. Calcium scores and coronary computed tomography angiography were used very infrequently (<3 percent) before diagnostic or PCI procedures.
- Procedural volume per facility: Twenty-six percent of the facilities were low-volume, performing fewer than 200 PCI procedures annually, and these facilities accounted for approximately 4 percent of the total PCI procedures. In addition, on-site cardiac surgery was not available in 83 percent of low-volume facilities, which represent 32.6 percent of facilities reporting, but performing 12.4 percent of the PCIs in this data sample.
- Door-to-Balloon (D2B) Time: STEMI patients who arrived at an PCI-capable hospital, experienced an average D2B time of 64.5 minutes. Patients who required transfer to another hospital averaged a longer D2B time of 121 minutes.
"These data will be of interest to the cardiovascular community because they show us where we are and where we can find opportunities for quality improvement," said Gregory J. Dehmer, MD, FACC, lead author of the report. "In this era of increased transparency and public awareness, NCDR leadership felt it was appropriate to publish [this] aggregate data."
Looking forward, the authors note that the value of the NCDR will increase as the U.S. continues to move forward with public reporting. "The value of the CathPCI Registry will be demonstrated as it is used to understand further the practice of invasive cardiology and to drive a higher level of quality into individual physician practice," they said. Currently, the NCDR is developing a plan for voluntary public reporting of selected NCDR data.
In Oct. 2012, the CathPCI Registry posted updated CathPCI Registry® 2012 Second Quarter Outcomes Reports that incorporate the changes from the recently updated appropriate use criteria (AUC) for coronary revascularization. Hospitals participating in the registry will notice several changes to the report based on the effect of the AUC Update, which may include an increase in instances of inappropriate cases. To understand the impact of the 2012 Focused Update on the CathPCI Registry Appropriate Use Criteria metrics, visit www.ncdr.com/cathpci/auc.
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