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Hellenic PCI RegistryOrganization - Structure - Directions - Initial Recordingshttp://registry.hellenicpci.gr/

Georgios I. Papaioannou, MD, MPH, FACC, FSCAI

Athens Medical Center

Cardiac Catheterization Laboratory

5/12/2008

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Aim of the Hellenic PCI Registry

• Common link with ESC (ESC PCI Registry) and EAPCI• Recording of Centers/Operators/ Interventional Coronary

Procedures with regional and national analyses• Recording of basic indications, demographic, procedural

and outcomes data of patients undergoing PCI• National database for educational and professional

requirements (in accordance to ESC/ACC)• Quality and Outcomes Research

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Registries & Clinical Practice

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Greek Participation in the ESC PCI Registry

• Advantages– Existing structure

– Simple process

– Direct participation in ESC PCI

– Instant comparison with ESC data

– No expenses on time, structure and analyses

• Disadvantages– Certain format of

database

– No independent access and analyses of center data

– No independent access and analyses of regional & national data

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Hellenic Heart Registry on PCI

• Initial attempt in 1998 – paper based• Current decision of the WG of HSC for a f/u

attempt• Analyses at a national level & submission of data

to the ESC• Web-based database with secure data entry by

individual users (user ID/password)• Central analyses of data by the WG of HSC• Each center may use the database for their own

data analyses upon request

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Timetable of the PCI Registry

• 5/2006: WG decision• 7/2006: Funding for the initial phase • 9/2006: Collaboration with Philip Lees (Webmaster)• 12/2006: Early design of database• 3/2007: Testing version in a separate domain (Phase

I)• 7/2007: Phase II – Pilot cases entry (>300 patients, 9

centers)• 2/2008: Phase III – Official start of Registry

retrospectively from 1/1/2008 with a 3-5 year plan (>1000 patients entered so far in 2008)

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Database Organization

• Users (case entry)

• Local Administrators (case entry – contact person in each center)

• National Administrators (new center entry – new user entry – validation process)

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Users

• New User entry from National Administrators after User’s request

• Users: Registry enter with unique personal User ID/Password (automatic generation via software)

• Unique (not shared) e-mail address

• Users may change their own information subsequently

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Tables (8)

• Patient (Automatic entry ID-Demographics-Patient initials)

• Workup (History-Risk factors-Indication-Times-Admission Medications)

• PCI Angiogram (Angiographic findings based on the 15-segment model of ESC)

• PCI Procedure (Periprocedural medications-Additional diagnostic or theurapeutic devices-Complications)

• PCI Lesions (Lesion characteristics-PCI device-Result)

• Outcome (In-hospital outcome)

• Follow up (1 year/3 years/5 years)

• Submit (Automatic initial validation)

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ESC 15 Segment Model

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User Obligations

• List of cases entered that corresponds to the unique system ID (case is entered with initials only for patient confidentiality)

• Communication Information

• Watch for color coding

• F/U submission

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Case submitted…

• National Administrator confirms valid submission or rejects the entry and explains the reason via e-mail

• Case is permanent

• No edit of entered data can be performed

• The only open table is the F/U form

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Local Administrators

• Enter cases as regular Users

• Complete the form with Center Data for the previous year

• Contact Person for Center issues

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National Administrators

• New Users entry• New Centers entry• Validation process• National Administrators do not have any

authority to change or edit any data individual Users enter

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Recording Tips and Caution

• Patient history (Prior CAD, CHF, CRI) – under reporting• Medications on admission (Aspirin, antiplatelets) – over

reporting• Timelines

– STD: (0-3-6 hrs in STEMI) and (0-24-48 in NSTEMI)

– DTB: Please record as much as possible accurate STEMI times due to small numbers / The majority of EU and USA centers have a DTB time >90 min

• In hospital events – Be accurate• Explanation question boxes: Take a look!

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Centers/Operators/CABG on site - 2007

Athens Metro Arean=25

1 2 9 O pe ra to rs1 2 w ith C A B G on s ite

Thessaloniki Metro Arean=8

5 7 O p e ra to rs7 w ith C A B G on s ite

Rest of Greecen=7

2 2 O p e ra to rs5 w ith C A B G on s ite

PCI Centersn=40

2 0 8 O pe ra to rs2 4 w ith C A B G on s ite

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PCI Centers - 2007

40

25

8 7

1814

3 1

138

41

9

3 15

05

1015202530354045

Total AthensMetro

Thess/nikiMetro

Rest ofGreece

HospitalsGovernmentPrivateUniversity

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COR/PCI Procedures - 2007

56529

30216

17496

8817

19311

99886929

2394

0

10000

20000

30000

40000

50000

60000

Total Athens Metro Thess/nikiMetro

Rest ofGreece

CORPCI

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COR/PCI Procedures - 2007

53%

31%

16%

Athens Metro

Thess/niki Metro

Rest of Greece

52%

36%

12%

Coronary Angiograms Percutaneous Coronary Interventions

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COR & PCI Procedures / 106 population - 2007

8300

2485

5346

1599

5383

1839

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

COR PCI

USAEuropeGreece

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PCI Volume per Center - 2007

10

106

14<200/year201-400/year401-600/year>600/year

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PCI Centers & Primary PCI - 2007

C A B G o n s iten =9

N o C A B G on s iten =2

O n ca ll - 2 4 /7n = 11

C A B G o n s iten = 14

N o C A B G on s iten =8

W o rk ing H o u rsn = 22

P rim a ry P C I*n = 33

C A B G o n s iten =1

N o C A B G on s iten =6

N o P rim a ry P C I*n =7

P C I C e n te rsn = 40

*Technical ability to perform primary PCI

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Primary PCI numbers* - 2007

850

1087

159249

13

155

1491

1022

0

200

400

600

800

1000

1200

1400

1600

Actual (27 Centers) Projected (33 centers)

GreeceAthens MetroThess/niki MetroRest of Greece

* Data from 27 Centers (6 Centers with data missing )

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Volume of Primary PCI in Centers with and without CABG on site - 2007

19311

14212

5099

02000400060008000

100001200014000160001800020000

All Hospitals(n=33)

CABG on site(n=23)

Without CΑBGon site (n=10)

Total PCIPrimary PCI

7,7% 69% 31%

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Volume of Primary PCI per Center - 2007

5

13

12

3

<10/year10-30/year31-100/year>100/year

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ESC PCI Registry (>28,000 pts) – Greece vs Europe (Δεδομένα έως 26/11/2008)

Greece (%) Europe (%) OR

Males 85.00 73.69 0.49*

Smokers 43.14 26.06 0.46*

Prior MI 20.92 35.90 2.12*

Prior CHF 1.05 14.37 >5*

STEMI 22.72 22.78 NS

Primary PCI 3.83 15.93 >5*

Resc/Fac PCI 2.64 1.50 0.4*

CS 0.54 1.60 NA

STEMI STD (hrs) 2.00 2.92 NE

STEMI DTB (hrs) 1.58 0.92 NE

*p<0.05 for OR

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ESC PCI Registry (>28,000 pts) – Greece vs Europe (Δεδομένα έως 26/11/2008)

Greece (%) Europe (%) OR

NSTEMI STD 2.75 7.50 NE

NSTEMI DTB 76.00 30.15 NE

Femoral Vascular access 99.34 78.17 0.02*

DES Implantation 32.10 37.95 NS

Stent length (11-20 mm) 64.21 56.02 0.71*

Stent length>20 mm 26.58 35.21 1.50*

Stent thrombosis 1.05 0.59 NS

*p<0.05 for OR

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Benefits of HHR PCI Registry• Physicians may record their own patients

electronically

• Hospitals may establish their own database

• National status on PCI based on HSC

• Policy making for professional and educational reasons

• Direct participation and strengthening of Greek participation into the ESC/EAPCI

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Difficulties & Problems

• Motivation of physicians (multifactorial)• Politics• Clear understanding of the role and the benefits of

the registry with broad participation in analyses• Establish a structure especially in high-volume

centers for secretarial help• Loss of enthusiasm of existing users if a wide

participation can not be achieved

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Hellenic Heart Registry on Percutaneous Coronary

Interventions

• Link: http://registry.hellenicpci.gr/

• Επικοινωνία:• admin@hellenicpci.gr

• gpapaio@otenet.gr

• athanasios_kotsanis@hotmail.com

Thank you for your participation!