national cardiovascular disease database (ncvd) ncvd acute coronary syndrome (acs) registry an...

National Cardiovascular Disease Database (NCVD)

NCVD NCVD Acute Coronary Syndrome (ACS) RegistryAcute Coronary Syndrome (ACS) Registry

An UpdateAn Update

Dato’ Dr Azhari RosmanDato’ Dr Azhari RosmanChairman of NCVD ACS RegistryChairman of NCVD ACS Registry

Sentral Accord Room, Hilton Kuala LumpurSentral Accord Room, Hilton Kuala Lumpur1919thth April 2009 April 2009


*SGH

*HSAJB

*PHHSJ

*IJN*UMMC*HKL

*HTAR

ACS Registry Participating Sites

*QEH

* Active sites

*HI

HSNZ

*HRPZ II*HTF *HSB

*HTJ

*HTAA

*HMMMC

(2009)


1. Report:NCVD-ACS Registry Annual report year 2006Downloadable online at http://www.acrm.org.my/ncvd/publications.htm

Current Activities

http://www.acrm.org.my/ncvd/publications.htm


2. NCVD-ACS Registry Annual Report year 2007

• Currently in the midst of data-cleaning stage

Current Activities


Current Updates

as of 9th April 2009(based on unclean data)


Acute Coronary Syndrome

(ACS) Registry


ACS cases registered online by Source Data Providers (SDP)

22.17

11.58 10.93

7.62

0.972.12

4.8

2.070.5

1.79

7.78

1.95

0.11

3.44

8.31

13.85

0

5

10

15

20

25

1001 1002 1003 1004 1005 1006 1007 1009 1010 1011 1012 1014 1015 1016 1017 1018

SDP

Per

cen

tag

e (%

)

Results as of 9th April 2009, n= 10,864Total SDP = 15 sites


Patient’s Demographics

Age

Min, Max

mean + sd

18.33, 99.52 yrs

59.05 + 11.99 yrs

Male 75.31 %

Ethnic : Malay 47.47 %

Chinese 22.96 %

Indians 23.25 %

Other Malaysian 3.88 %

Foreigner 1.33 %

* Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli, Melanau, Murut, Bajau, Bidayuh

** For 121 cases, there are no information on ethnicity

Baseline (n= 10,730)



Smoking Status

Never 36.25 %

Stopped (quit > 30 days) 21.45 %

Current (within last 30 days) 32.03 %

Not Available 10.27 %

Status of Aspirin use

Used <7 days 10.47 %

Used >7 days 22.06 %

None 51.96 %

Unknown 15.51 %

Results as of 9th April 2009, n= 10,864


CV Risk Factors

Dyslipidaemia 32.42 %

Hypertension 57.69 %

Diabetes 40.56 %

Family History of premature CVD 11.16 %

MI history 16.68 %

Documented CAD 16.21 %

New onset angina (< 2 weeks) 48.08%

Chronic angina (onset > 2 weeks ago) 11.29%

Chronic Lung Disease 3.26 %

Renal disease 6.40 %

Peripheral vascular disease 0.75 %

Cerebrovascular disease 3.42 %

Heart Failure 6.46 %


Institut Jantung NegaraNational Heart InstituteRisk Factors:

Malaysian NCVD-PCI Registry(IJN)

51%

72%

82%


No episode 14.42 %

1 36.38 %

2 7.52 %

3 2.73 %

4 0.71 %

5 0.38 %

6 0.14 %

7 0.06 %

Number of distinct angina episode within 24hrs

8 0.02 %

9 0.02 %

10 0.07 %

11 0.02 %

12 0.01 %

14 0.03 %

20 0.01 %

NA 37.48 %



Heart Rate 83.5 beats/min

Systolic BP 139.74 mmHg

Diastolic BP 81.12 mmHg

Clinical Examination

Killip classification

I 46.27 %

II 16.37 %

III 3.94 %

IV 3.31 %

Not stated/inadequately described 12.73 %

Not available 17.38 %



ECG abnormalities type

ST-segment elevation ≥ 1mm (0.1mV) in

≥ 2 contiguous limb leads

17.31 %

ST-segment elevation ≥ 2mm (0.2mV) in

≥ 2 contiguous frontal leads or chest leads

31.16 %

ST-segment depression ≥ 0.5mm (0.05mV) in ≥ 2 contiguous leads

24.57 %

T-wave inversion ≥ 1mm (0.1mV) 20.54 %

Bundle branch block (BBB) 4.95 %

Non-specific 5.23 %

None 6.01 %

Not stated / inadequately described 1.86 %


Results as of 9th April 2009


ECG abnormalities location

Inferior leads : II, III, aVF 31.42 %

Anterior leads : V1 to V4 41.96 %

Lateral leads : I, aVL, V5 to V6 30.23 %

True posterior : V1 V2 4.58 %

Right ventricle : ST elevation in lead V4R 3.77 %

None 9.86 %

Not stated / inadequately described 3.89 %




Percentage of Ischaemic status by ACS stratum (n=10,864)

ACS stratum

43.31%

23.7%

26.25%

6.74%

STEMI NSTEMI UA Missing



Percentage according to TIMI Risk Score for STEMI (n= 4,705)


5.95

10.31

19.85

16.54

13.71 13.09

6.95 6.97

3.68

1.91 1.40.15 0.09 0.04

0

5

10

15

20

25

0 1 2 3 4 5 6 7 8 9 10 11 12 13

TIMI Risk Score

Pe

rce

nta

ge

(%

)


Percentage according to TIMI Risk Score for NSTEMI/UA (n=5,427)


11.72

17.36

25.76

23.55

14.09

6.06

1.290.17

0

5

10

15

20

25

30

0 1 2 3 4 5 6 7

TIMI Risk Score

Pe

rce

nta

ge

(%

)


Given at this centre 60.81 %

Given at another centre prior to transfer 12.41 %

Not given - proceeded directly to primary angioplasty 7.25 %

Not given - Missed Thrombolysis 12.48 %

Not given - patient refusal 0.17 %

Not given - Contraindicated 4.21 %

Not Applicable 2.67 %

Fibrinolytic Therapy Status

Baseline (n= 4,705)



Fibrinolytic Drug Used (n=2,861)

Streptokinase 91.68 %

Others 2.31 %

Missing 6.01 %

Door to needle time (mins) 94.36 + 145.24

Cardiac Cathetherization

Yes 19.00 %

No 60.73 %

No - transferred to another centre 2.31 %

Missing 17.95 %




PCI on this admission

Yes (n=1,588) 14.62 %

Yes – for STEMI 42.1 %

No 55.56 %

Not Applicable 12.08 %

Missing 17.75 %

Door to balloon time (mins) 233.77 + 292.63



Pharmacological Therapy

Drug used/given during admission (%)

DrugPre-

admissionDuring

After discharge

ASA 52.26 85.98 69.78

ADP Antagonist 20.50 60.53 47.08

GP Receptor inhibitor 0.52 2.90

Unfrac Heparin 1.29 11.36

LMWH 9.75 50.64

Beta Blocker 24.51 61.73 52.40

ACE Inhibitor 18.87 53.57 45.08

Angiotensin II receptor blocker 4.60 7.35 6.32

Statin 30.03 83.97 69.31



Drug used/given during admission (%)

DrugPre-

admissionDuring

After discharge

Other Lipid Lowering Agent 2.34 5.40 4.41

Diuretics 12.56 28.68 17.04

Calcium Antagonist 9.89 14.28 11.17

Oral Hypoglycaemic Agent 19.40 24.98 25.03

Insulin 6.93 23.38 8.17

Anti-arrhythmic Agent 2.22 6.66 3.55


Pharmacological Therapy


In-hospital Clinical Outcome

Outcome (%)

Discharged 85.65

Transferred 1.98

Died 6.91

NA 5.55

Cause of Death (%)

CVD 74.57

Non-CVD 4.39

Other 2.26

Missing 18.77



In-hospital Clinical Outcome

Final Diagnosis at Discharge (%)

Q Wave MI 35.76

Non-Q Wave MI 19.89

Unstable Angina 24.96

Stable Angina 1.20

Non-cardiac 1.45

Missing 16.74

Bleeding Complication (TIMI Criteria) (%)

Major 0.49

Minor 1.58



Follow up atFollow up at

30days & 1year30days & 1year


Overall Follow Up Management

Type of FU 30days FU 1year FU

Total N % N %Expected visits 9650 7604

FU Done 6493 67.28 3352 44.08Missed FU 3157 32.72 4252 55.92



7604

9650

6493 (67%)

3352 (44%)

0

2000

4000

6000

8000

10000

12000

30days FU 1year FU

Type of Follow Up

Nu

mb

er

of

FU

do

ne

Expected visits FU done

Overall Follow Up done at 30days & 1year


Follow Up done at 30days & 1year by SDP

0 0 0 0 0 0

60

84

1

37

8

54

88

2

94

76

84

93

23

8378

44

25

17

40

78

61

74

49

60

0

10

20

30

40

50

60

70

80

90

10030days FU 1year FU

Per

cen

tag

e o

f F

U d

on

e (%

)

SDP

Total 30days FU = 6,493 (as of 9th April 2009)

Total 1year FU = 3,352 (as of 9th April 2009)


Cardiovascular readmission

ACS STEMI

NSTEMI

UA

Missing

3.89 %14.51 %

14.90 %

53.73 %

16.86 %

Heart Failure 0.49 %

Revascularization 5.15 %

PCI 87.54 %

CABG 9.79 %

Stroke 0.11 %

2.07 %12.86 %

7.14 %

61.43 %

11.43 %

0.53%

3.11%

78.09 %

15.24 %

0.06 %

30days (n= 6,550) 1year (n= 3,374)



Outcome at 30 days & 12 months

85.39 %

3.45 %

8.98 %

0.58 %

1.6 %

Outcome

Alive

Death

Lost to FU

Transferred

Missing

84.53 %

2.31 %

10.58 %

0.18 %

2.4 %

Cause of Death

CVD

Non CVD

Others

Missing

47.44 %

8.97 %

21.79 %

21.80 %

1year (n= 3,374)

1year (n= 78)

30days (n= 6,550)

55.31 %

10.62 %

13.27 %

20.80 %

30days (n= 226)



Thank you

national cardiovascular disease database (ncvd) ncvd acute coronary syndrome (acs) registry an...

Documents