[First annual report of practitioners of interventional cardiology in private practice in Germany. Results of procedures of left heart catheterization and coronary interventions in the year 1996].
The German Society for Cardiac Angiography and Interventions in Private Practice has started a registry of cardiac procedures since 1996 in order to establish a standard for performance. Although quality management for the cath lab makes sense and is also legally required, there is no generally recommended infrastructure for quality assurance existing in Germany at this time. Therefore, the German Society of Cardiologists in Private Practice (BNK) initiated a project in 1994 to develop a computer program for paperless documentation of diagnostic cardiac catheterizations and coronary interventions (PTCA) using a minimal data set. In 1996, 8 private associated groups participated in this project. The (anonymous) analysis of 10,316 diagnostic cardiac catheterizations and 2597 PTCA yielded the following results: In 95% of the patients, diagnostic cardiac catheterization was performed using the femoral and in 5% the brachial/radial approach. The mean volume of administered contrast medium was 164 +/- 138 ml/patient. The mean LV-EF was greater than 50% in 58.4% of the patients and between 30% and 50% in 10.1%. Coronary artery disease was diagnosed in 69.6% of the patients and valvular/congenital heart disease in 8.5%. In 18.4% of the patients undergoing diagnostic cardiac catheterizations no significant heart disease was identified. Mortality in the cath lab as well as the rate of cerebral insults was 0.05%. In 22.9% and 19% of the patients PTCA and cardiac surgery respectively was recommended. In patients undergoing PTCA, stable angina was present in 74.4% and unstable angina in 13.1%. Of the total number of PTCA procedures, 5.8% were performed in the setting of acute myocardial infarction. The PTCA lesion success rate was 96%, the mean diameter stenosis was 81% pre and 6% post-intervention. The mortality rate at 1 month post-PTCA was 0.4%, and myocardial infarction 1.0%. An acute occlusion occurred in 1.3% of the PTCA patients; 0.6% had to be transferred for emergency bypass surgery. None of the cath labs had on-site surgery. In comparison to other registries, our data show some similarities but also some different trends. Thus, our newly developed software proved to be reliable, fast and easy to use. Participating centers receive immediate feedback regarding their position within the whole group.
Silber
S
S
Kardiologische Gemeinschaftspraxis, Klinik Dr. Müller, München. ssilber@med.de
Albrecht
A
A
Göhring
S
S
Kaltenbach
M
M
Kneissl
D
D
Kokott
N
N
Levenson
B
B
Mathey
D
D
Pöhler
E
E
Reifart
N
N
Sauer
G
G
Schofer
J
J
Schwarzbach
F
F
D000790:Angiocardiography / Q000706:statistics & numerical data; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D016279:Atrial Function, Left; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis* / Q000601:surgery; D005194:Family Practice; D005858:Germany; D006801:Humans; D011785:Quality Assurance, Health Care; D012955:Societies, Medical; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis
Erster Jahresbericht niedergelassener Invasivkardiologen in Deutschland. Ergebnisse für diagnostische Linksherzkatheteruntersuchungen und Koronarinterventionen 1996.