NCVD Percutaneous Coronary Intervention PCI Registry An update

NCVD Percutaneous Coronary Intervention (PCI) Registry An update Dato Dr Rosli Mohd Ali Chairman of NCVD PCI Registry Hilton Kuala Lumpur 17 th April 2009 National Cardiovascular Disease Database (NCVD)

PCI Registry Participating Sites *PH HUSM *QEH (2008) SDMC DSH *KPJSSH SUNMED *SH *IJN *UMMC *HUKM National Cardiovascular Disease Database (NCVD) *SGH *HSAJB * Active sites

Current Activities NCVD-PCI Annual Report 2007 • In the midst of report writing • PCI Report Writing Committee Prof Dr SIM Kui-Hian Prof Dr Wan Azman Wan Ahmad Dr Alan Fong Yean Yip Dato’ Dr Omar Ismail Dr Liew Houng Bang Dr Lu Hou Tee Dr Chee Kok Han Dr Syahidah Syed Tamin Dr Azmee Ghazali National Cardiovascular Disease Database (NCVD)

Current Updates as of 9 th April 2009 (based on unclean data) National Cardiovascular Disease Database (NCVD)

Percutaneous Coronary Intervention (PCI) Registry National Cardiovascular Disease Database (NCVD)

Number of PCI registered (online) by Source Data Providers (SDP) Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Number of PCI registered (online) by Source Data Providers (SDP) Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Patient Demographics Baseline n=8, 236 Age Min, Max mean ± sd 22, 95 yrs 56. 7 ± 10. 06 yrs Age < 40 years 0. 33 % Age > 70 years 0. 55 % Male 81. 99 % Malaysian 92. 67 % Ethnic : Malay 47. 23 % Chinese 24. 66 % Indian 22. 56 % Other Malaysian 0. 33 % Foreigner 4. 93 % Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other Sabahan and Other Sarawakian National Cardiovascular Disease Database (NCVD) For 12 cases, there is no information on ethnicity

Percentage of Ethnic Groups Other Malaysian includes Punjabi, Iban, Kadazan Dusun, Melanau, Bidayuh, Other Sabahan and Other Sarawakian National Cardiovascular Disease Database (NCVD)

Clinical Background & CV Risk Factors Baseline (n=8, 236) Dyslipidaemia 73. 42 % Hypertension 73. 03 % Diabetes 45. 41 % OHA 77. 94 % Insulin 13. 60 % Family History of premature CVD 16. 57 % MI history 38. 19 % Documented CAD 55. 28 % New onset angina (< 2 weeks) 23. 08 % Congestive Heart Failure (> 2 weeks prior) 3. 68 % Chronic Lung Disease 1. 29 % Cerebrovascular disease 1. 51 % Peripheral vascular disease 1. 03 % Chronic renal failure 6. 23 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Previous Revascularization Baseline (n=8, 236) Previous PCI 22. 21 % Previous CABG 4. 02 % Clinical Presentation Baseline (n=8, 236) Acute Coronary Syndrome (n=2, 039) 24. 76 % STEMI 44. 92 % NSTEMI 32. 81 % Unstable Angina 19. 86 % * For 49 cases, the information on ACS stratum are Not Available National Cardiovascular Disease Database (NCVD)

PCI status Baseline (n=8, 236) Elective (n = 7, 439) 90. 32 % Staged PCI Cath-PCI in same setting (adhoc) 22. 06 % 84. 12 % Urgent (NSTEMI/UA) 4. 66 % Rescue 2. 09 % Primary 2. 48 % Missing 0. 45 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Adjunctive Pharmacotheraphy PCI Baseline (n=8, 236) Thrombolytics 5. 45 % IIb/ IIIa Blockade 6. 47% Heparin 85. 31 % LMWH 4. 83% Ticlopidine 3. 36 % Bivalirudin 0. 29 % Aspirin 96. 26 % Clopidogrel 97. 69 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Antiplatelets strategy during PCI Baseline (n=8, 236) ASPIRIN 96. 26 % Prior 92. 71% After 0. 85 % During 1. 08 % Clopidogrel loading (if prior) n = 7, 408 Hours First / load dose 97. 69 % Prior 92. 07% After 2. 71 % During 2. 24 % <6 hr 6 -24 hr >24 -72 hr >72 hr 17. 40 % 29. 02 % 10. 14 % 35. 80 % 75 mg 300 mg 600 mg >1200 mg 36. 60 % 51. 32 % 5. 45 % 0. 01 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Percutaneous entry Baseline (n=8, 236) Brachial 0. 98 % Radial 35. 10 % Femoral 57. 81 % Multiple site 1. 49 % Missing 4. 58 % Extent of coronary disease Baseline (n=8, 236) Single vessel disease 44. 50 % Multiple vessel disease 54. 43 % Graft 1. 18 % Left Main 0. 80 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Lesion characteristics Baseline (n=11, 508) De novo 91. 28 % Acute stent thrombosis 0. 50 % Acute Subacute Late 35. 09 % 21. 05% 26. 32 % Restenosis (no prior stent) 0. 23 % In stent restenosis 4. 52% Missing 3. 47 % AHA-ACC Lesion Morphology Type A 11. 76 % B 1 25. 14 % B 2 19. 38% C 39. 45 % Missing 4. 28 % National Cardiovascular Disease Database (NCVD) Total Lesion= 11, 508 as of 9 th April 2008

Graft PCI Location in Graft (n = 167) Ostial 9. 58 % Mid 20. 96 % Distal 11. 98 % Anastomosis 7. 78 % Proximal 28. 14 % For 36 cases, the information on Location in Graft PCI is Not Available Total Lesion= 11, 508 as of 9 th April 2008 National Cardiovascular Disease Database (NCVD)

Native vessel PCI Location description Ostial 6. 33 % Bifurcation 7. 69 % CTO < 3 mo 3. 02 % CTO > 3 mo 7. 10 % Thrombus 3. 21 % Not Applicable 70. 20 % Pre-PCI stenosis %, Post-PCI stenosis %, 84. 52 + 12. 08 3. 94 + 17. 08 TIMI flow 0 11. 44 % 0 1. 77 % 1 4. 13 % 1 0. 37 % 2 15. 53 % 2 1. 10 % 3 63. 21 % 3 90. 98 % Total Lesion= 11, 508 as of 9 th April 2008 National Cardiovascular Disease Database (NCVD)

Procedural Characteristics Max balloon size (mm) 3. 06 + 0. 58 Max stent/balloon deploy pressure (atm) 15. 77 + 3. 81 Direct stenting Stent type 18. 67 % Baseline (n=11, 508) DES 56. 67 % BMS 40. 58 % Bio-absorbable stent 0. 03 % Antibody coated 2. 30 % Other stent 0. 41 % Stent length (mm) 22. 52 + 7. 32 Stent diameter (mm) 2. 99 + 0. 46 Total Lesion= 11, 508 as of 9 th April 2008 National Cardiovascular Disease Database (NCVD)

Percentage of stent by total number of stent used (n = 11, 508) Other stents refer to stents other than listed in the Reference Stent List Total Stent, n =11, 508 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Procedural Characteristics Baseline (n=11, 508) Intracoronary devices used (total no of lesions treated) Unsuccessful 2. 58 % Balloon only (POBA) 7. 69 % BMS 38. 40 % Drug eluting balloon 2. 67% Distal embolic protection (n = 15) Filter 0. 47 % 96. 30% Cutting balloon 2. 20 % DES 46. 23 % Flowire 0. 01 % IVUS 3. 86 % Rotablator 0. 85 % Others (eg. Thromboaspiration) 3. 53 % Closure device 5. 12 % National Cardiovascular Disease Database (NCVD)

Target Vessel Complications Baseline (n = 11, 508) Acute closure 0. 38 % Dissection 4. 20 % Perforation 0. 29 % No Reflow (n = 149) 1. 29 % Transient 63. 76 % Persistent 22. 82 % Missing 13. 42 % Successful lesion 93. 19 % National Cardiovascular Disease Database (NCVD)

Procedural Complications Baseline (n=8, 236 Periprocedural MI 0. 44 % Emergency Reintervention (n = 20) 0. 24 % Stent thrombosis Dissection Perforation Others 50. 00 % 35. 00 % 70. 00 % 30. 00 % Bail-out CABG 0. 04 % Cardiogenic shock 0. 53 % Arrhythmia (VT/VF/Brady) 0. 61 % TIA/Stroke 0. 05 % Tamponade 0. 05 % Contrast reaction 0. 06 % New onset/ worsened HF 0. 11 % New renal impairment 0. 16 % National Cardiovascular Disease Database (NCVD) Total PCI = 8, 236 as of 9 th April 2009

Vascular Complications Bleeding Yes (n = 28) Minor Major Minimal NA No 0. 74 % 13. 11 % 8. 20% 68. 85 % 6. 56 % 97. 29 % * For 162 cases, the information on Bleeding complication are Missing National Cardiovascular Disease Database (NCVD)

In-hospital Outcome Baseline (n= 8, 236) Outcome Alive 98. 14% Death 1. 03 % Transferred 0. 04 % Missing 0. 79 % Cause of death Cardiac 88. 24 % Vascular 4. 71 % Renal 1. 18 % Pulmonary 1. 18 % Missing 2. 35 % Location In lab 5. 88 % Out of Lab 90. 59 % National Cardiovascular Disease Database (NCVD) Total PCI = 8, 236 as of 9 th April 2009

Medications at discharge Baseline (n=8, 236) Aspirin 92. 20 % Clopidogrel 93. 14 % Ticlopidine 5. 62 % Statin 90. 18 % Beta blocker 71. 01 % ACE inhibitor 53. 64 % ARB 13. 65 % Warfarin 1. 10 % Others 68. 71 % Total PCI = 8, 236 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Follow up at 30 days & 1 year National Cardiovascular Disease Database (NCVD)

Overall Follow Up Management Total 30 days FU 6 months FU 12 months FU (+7 days) (+14 days) (+30 days) N % N % Expected visits 6181 100 4892 100 3403 100 Visit done 2337 38 786 16 427 13 Missed FU 3844 62 4106 84 2976 87 Results as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Overall Follow Up done at 30 days & 1 year National Cardiovascular Disease Database (NCVD)

Follow Up done at 30 days & 1 year by SDP Total 30 days FU = 3, 470 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD) Total 6 months FU =1, 700 as of 9 th April 2009

Percentage of 30 days Follow Up completed by Source Data Providers (SDP) Total 30 days FU completed = 3, 470 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Percentage of 6 months Follow Up completed by Source Data Providers (SDP) Total 6 months FU completed = 1, 700 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

Outcome at 30 days FU & 6 months FU Outcome 30 days FU 6 mths FU Alive 98. 14 % 96. 54 % 96. 06 % Death 1. 03 % 0. 69 % 0. 41 % 0. 06 % - 2. 71 % 3. 47 % 0. 78 % - - Transferred Lost to FU Missing 1. 04 % Total 30 days FU = 3, 470 as of 9 th April 2009 Total 6 months FU =1, 700 as of 9 th April 2009 National Cardiovascular Disease Database (NCVD)

At 30 days and 6 months 30 days FU 6 months FU (n = 244) (n = 114) Readmission 7. 03 % 6. 71 % CHF 1. 64 % 2. 63 % Recurrent Angina 11. 07 % 7. 89 % PCI – planned 56. 97 % 42. 11 % PCI – unplanned 2. 87 % 6. 14 % AMI 1. 64 % 4. 39 % CABG 0. 82 % 2. 63 % Others 14. 75 % 27. 19 % Missing 9. 84 % 4. 39 % Duration National Cardiovascular Disease Database (NCVD) Total 30 days FU = 3, 470 as of 9 th April 2009 Total 6 months FU =1, 700 as of 9 th April 2009

Readmission Reason at 30 days FU & 6 months FU National Cardiovascular Disease Database (NCVD) Total PCI = 8, 236 as of 9 th April 2009

THANK YOU National Cardiovascular Disease Database (NCVD)