prepared by: action registry-gwtg results: january – december, 2008
TRANSCRIPT
Prepared by:
ACTION Registry-GWTG Results:January – December, 2008
Current Site Distribution
Last updated: 12/31/08
AK(1)
WA(11)
OR(9)
CA(20)
ID(1)
NV(1)
MT(2)
WY(0)
CO(7)
NM(1)
ND(1)
SD(1)
NE (4)
KS(8)
OK(4)
TX(26)
MN(5)
IA(6)
MO(12)
AR(1)
LA(2)
WI(11) MI
(12)
MI
UT(0)
AZ(2)
HI (0)
IL(23)
IN(14)
KY(2)
TN(10)
MS(3)
AL(1)
GA(10)
FL(17)
SC(4)
NC(23)
VA(9)
OH(22)
WV(1)
PA(23)
NY(11)
MD (10)
ME(2)
VT (0)
NH (1)
NJ (4)
MA (3)
CT (3)
DE (0)
RI (0)
DC (0)
Active Sites = 365
Baseline Characteristics - STEMI
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Variable STEMI
(n = 20,998) Mean age ± SD (yrs) 62 ± 14 Female sex 30% Diabetes mellitus 23% Prior MI 20% Prior CHF 5% Prior PCI 20% Prior CABG 7%
Hospital Presentation Characteristics - STEMI
Variable STEMI
(n = 20,998) Qualifying Criteria Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% Hypotension 6% Signs of CHF 12%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
In-Hospital Outcomes - STEMI
Variable STEMI
(n=20,998) Death* 5.8% Re-infarction 1.1% CHF 6.8% Cardiogenic Shock 6.2% Stroke 0.8% RBC Transfusion# 6.4%
* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patientsACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Use of Reperfusion Therapy for STEMI
STEMISTEMIN = 20,998N = 20,998
ReperfusionReperfusionN = 16,374 (78%)N = 16,374 (78%)
No Reperfusion –No Reperfusion –No Contraindication ListedNo Contraindication Listed
N = 1163 (6%)N = 1163 (6%)
Not Eligible for Not Eligible for Reperfusion Therapy Reperfusion Therapy Contraindication Listed Contraindication Listed
N= 3,011 (14%)N= 3,011 (14%)
Primary PCI – 86%*Primary PCI – 86%*Fibrinolytics – 13%*Fibrinolytics – 13%*
Both PCI + Lytics – 1%*Both PCI + Lytics – 1%*
* Among patients receiving reperfusion
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
81%
18%
57%
0%
20%
40%
60%
80%
100%
DTB <= 90 min -Non-Transfer In
DTB <= 90 min -Transfer In
DTN <= 30 min - All
DTB = 1st Door to Balloon for Primary PCIDTN = Door to Needle for Lytics
STEMI – Door to Balloon and Door to Needle Times:
Cumulative 12 Month Data
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
76%80%
84% 87%
0%
20%
40%
60%
80%
100%
Q1 08 Q2 08 Q3 08 Q4 08
STEMI Primary PCI Results -Non-Transfer Patients with DTB 90
mins
73% of the primary PCI patients are not transferred in
14%17%
20% 21%
40%44%
49%
54%
0%
10%
20%
30%
40%
50%
60%
Q1 08 Q2 08 Q3 08 Q4 08
STEMI Primary PCI Results - DTB Benchmarks for Transfer-In Patients
1st Door to Balloon < 90 Minutes
1st Door to Balloon < 120 Minutes
27% of the primary PCI patients are transferred in
STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients
Transfer in DTB Times Non-Transfer in DTB Times
102
130
182
53
70
88
Q1 08
97
123
165
52
67
84
Q2 08
96
120
157
51
66
Q3 08
94
117
150
50
64
79
Q4 08
Tim
e (m
in)
50
220210
60708090
110100
120130140150160170
200
180190
240230
82
403020
250
100
STEMI Acute (< 24 hrs) Medications 98%
95% 95%
73%
88%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Heparin(LMW+UFH)
GP llb-lllaInhibitors
Clopidogrel
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
STEMI Discharge Medications
99% 97%
88%93% 92%
0%
20%
40%
60%
80%
100%
ASA Beta Blocker ACE-I or ARB Statins Clopidogrel
% U
se%
Use
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
STEMI Discharge Interventions
91%95%
82%
97%
0%
20%
40%
60%
80%
100%
ExerciseCounseling
DietaryModification
CardiacRehab
Referral
SmokingCessation
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Variable NSTEMI
(n = 31,774) Mean age ± SD (yrs) 67 ± 14 Female sex 39% Diabetes mellitus 34% Prior MI 28% Prior CHF 16% Prior PCI 24% Prior CABG 19%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Baseline Characteristics - NSTEMI
Hospital Presentation Characteristics -NSTEMI
Variable NSTEMI
(n = 31,774) Qualifying Criteria ST-segment depression 25% Transient ST-segment elevation 3% Presenting Characteristics Tachycardia 22% Hypotension 3% Signs of CHF 21%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
In-Hospital Outcomes - NSTEMI
* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patients
Variable NSTEMI
(n=32,377) Death* 4.1% Re-infarction 1.0% CHF 7.5% Cardiogenic Shock 2.7% Stroke 0.7% RBC Transfusion# 8.9%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
NSTEMI Acute (< 24 hrs) Medications 97%
92% 92%
47%
60%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Heparin(LMW+UFH)
GP llb-lllaInhibitors
Clopidogrel
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
NSTEMI Acute Medication Overdosing Trends
* Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg)
# Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended)
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
26% 26% 26% 25%
15% 15% 15% 15%
9% 10% 10% 9%
0%
5%
10%
15%
20%
25%
30%
Q1 2008 Q2 2008 Q3 2008 Q4 2008
UFH *LMWH #GP llb-llla
75%
62%
46%39%
11%
0%
20%
40%
60%
80%
100%
Cath Cath < 48 hr PCI PCI < 48 hr CABG
NSTEMI Invasive Cardiac Procedures
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
NSTEMI Revascularization Strategy Trends
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
45% 46% 46%
44% 42% 42%42%
45%
11%11%12%11%
0%
10%
20%
30%
40%
50%
60%
Q1 2008 Q2 2008 Q3 2008 Q4 2008
Medically Managed PCI CABG
NSTEMI Discharge Medications
97% 95%
74%
92%
74%
0%
20%
40%
60%
80%
100%
ASA Beta Blocker ACE-I or ARB Lipid LoweringAgent
Clopidogrel
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
NSTEMI Discharge Clopidogrel Use byRevascularization Strategies
55%
97%
28%
0%
20%
40%
60%
80%
100%
MedicallyManaged
PCI CABG
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
NSTEMI Discharge Interventions
84%91%
72%
95%
0%
20%
40%
60%
80%
100%
ExerciseCounseling
DietaryModification
CardiacRehab
Referral
SmokingCessation
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Variable STEMI
(n=20,998) NSTEMI
(n=31,774) Mean age + SD (yrs) 62 + 14 67 + 14 Female sex 30% 39% Diabetes mellitus 23% 34% Prior MI 20% 28% Prior CHF 5% 16% Prior PCI 20% 24% Prior CABG 7% 19%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Baseline Characteristics –STEMI vs. NSTEMI
Hospital Presentation Characteristics - STEMI vs. NSTEMI
Variable STEMI
(n=20,998) NSTEMI
(n=31,774) Qualifying Criteria ST-Segment Depression 25% Transient ST-Segment Elevation 4% Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% 22% Hypotension 6% 3% Signs of CHF 14% 22%
ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
In-Hospital Outcomes - STEMI vs. NSTEMI
Variable STEMI
(n=20,998) NSTEMI
(n=31,774) Death* 5.8% 4.1% Re-infarction 1.1% 1.0% CHF 6.8% 7.5% Cardiogenic Shock 6.2% 2.7% Stroke 0.8% 0.7% RBC Transfusion# 6.4% 8.9%
* Unadjusted mortality# Transfusion among non-CABG patients* Unadjusted mortality# Transfusion among non-CABG patientsACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Non-CABG Major Bleeding and Transfusion –STEMI vs. NSTEMI
13%12%
15%
10%
0%
5%
10%
15%
20%
Major Bleed Any RBC Transfusion
STEMI NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Acute Medications - STEMI vs NSTEMI 98%
95% 95%
73%
88%
97%92% 92%
47%
60%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Heparin(LMW+UFH)
GP llb-lllaInhibitors
Clopidogrel
STEMI NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Discharge Medications - STEMI vs NSTEMI 99% 97%
88%93% 92%
97% 95%
74%
87%
74%
0%
20%
40%
60%
80%
100%
ASA Beta Blockers ACE-I or ARB Statins Clopidogrel
STEMI NSTEMI ACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008
Discharge Interventions – STEMI vs. NSTEMI
91%95%
82%
97%
84%91%
72%
95%
0%
20%
40%
60%
80%
100%
ExerciseCounseling
DietaryModification
Cardiac RehabReferral
SmokingCessation
STEMI NSTEMIACTION Registry-GWTG DATA: January 1 – December 31, 2008ACTION Registry-GWTG DATA: January 1 – December 31, 2008