Nearly 20 years ago, the American College of Cardiology (ACC) created the National Cardiovascular Data Registry (NCDR) to measure and improve cardiovascular care. Today, the NCDR contains 10 registries encompassing a variety of cardiovascular areas, including eight registries for in-patient settings and two for outpatient settings.
In 1998, the ACC launched the first NCDR initiative known as the CathPCI registry. Since then, CathPCI has tracked more than 17.1 million PCIs and coronary angiography procedures in the U.S.
Recently, the ACC released updated data from CathPCI, which showed that more than 90 percent of PCI-capable hospitals in the U.S. used the registry. Of those sites, 70 percent submit data for all diagnostic catheterization and PCI procedures.
In 2014, the CathPCI registry included data on 667,424 patients who underwent PCI at 1,612 hospitals. The mean age of the patients was 64.6 years old, while 86.5 percent were white, 30.4 percent had a prior MI, 41.2 percent had a prior PCI and 17.8 percent had a prior CABG. Of the hospitals, 87 percent were private or community hospitals and 81 percent were in urban or suburban locations.
For patients who were not transferred for the procedure, the median time to PCI was 59 minutes, which was below the guideline-recommended threshold of 90 minutes. In all, 93.5 percent of patients received PCI within 90 minutes.
For patients who transferred for the procedure, the median time to primary PCI was 105 minutes. In all, 32.3 percent of the transferred patients were treated within 90 minutes of presentation.
The report found that the median time to primary PCI for patients with STEMI was stable between 2011 and 2014. It also found that 93.5 percent of patients undergoing PCI in 2014 received aspirin, P2Y12 inhibitors and statins at hospital discharge, up from 89.1 percent in 2011.
In addition, 98.3 percent of the 563,448 PCIs performed for acute coronary syndromes in 2014 were deemed appropriate. Of the patients without acute coronary syndromes, 53.5 percent of the PCIs were deemed appropriate, 32.6 percent were deemed as possibly being appropriate and 13.9 percent were deemed as rarely appropriate.
Further, 25.2 percent of procedures in 2014 were performed by the radial approach, up from 10.9 percent in 2011. Meanwhile, 2.4 percent of PCIs in 2014 involved the use of mechanical ventricular support during hospitalization.
The authors released data on complications following PCI, as well. The unadjusted rates of acute kidney injury were 2.3 percent in 2011 and 2.6 percent in 2014, while 1.9 percent and 1.4 percent of patients, respectively, had blood transfusions. In 2014, post-procedural strokes occurred in 0.2 percent of procedures, emergency CABG was performed after 0.2 percent of procedures and vascular access site injury occurred in 1.3 percent of procedures.
The ACC’s report also provided updated data from the ACTION-GWTG registry for acute MI, the ICD registry for implantable cardioverter defibrillators and cardiac resynchronization therapy and the IMPACT registry for catheterization procedures for congenital heart disease.
“As this report demonstrates, NCDR programs provide unique opportunities to advance the understanding of the clinical characteristics, care, and outcomes of patients with cardiovascular disease in the US, and more recently, internationally,” the researchers wrote. “These programs collect data for a broad range of patients undergoing cardiovascular procedures or in the outpatient setting in geographically and structurally diverse care settings characterizing the clinical characteristics of patients with high impact cardiovascular conditions and undergoing common cardiovascular procedures, the extent of use of evidence-based cardiovascular therapies and patient outcomes.”