Diagnostic coronary angiography and percutaneous coronary intervention practices in New Zealand: The All New Zealand Acute Coronary Syndrome-Quality Improvement CathPCI registry 3-year study (ANZACS-QI 37)

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Highlights

  • The CathPCI registry records all cardiac catheterisation procedures in New Zealand.

  • It is a platform of ANZACS-QI and its methodology and 3-year practice is reported.

  • There were 43,097 diagnostic coronary angiograms, with 15,482 (37%) PCIs.

  • The registry allows quality improvement, research and informs clinical practice.

Abstract

Background

Coronary heart disease remains one of the leading causes of mortality and morbidity in New Zealand (NZ) and globally. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) programme includes the CathPCI registry which records all those referred for diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) in NZ. We present the methods and three-years of data from the ANZACS-QI CathPCI registry.

Methods

The data was extracted from the ANZACS QI CathPCI registry from 01/09/2014 to 24/09/2017. The ANZACS-QI data dictionary defines all the clinical, procedural and outcomes variables collected, and standard statistical analyses were applied.

Results

40,870 patients underwent cardiac catheterisation, with a mean age of 65 years, and males making up 67% of the cohort. Indications included acute coronary syndrome 55%, angina with suspected stable coronary disease 28%, valve surgery workup 8%, planned PCI 3%, heart failure/cardiomyopathy 3%, arrhythmia 1% and other 2%. For those undergoing DCA alone, radial access was used in 85% and two-thirds had at least one major artery with >50% stenosis. PCI was performed in 39% of patients. Drug-eluting stents were used in 97%.

Conclusion

The CathPCI registry records the characteristics and outcomes of all patients undergoing DCA and PCI in NZ hospitals. As part of the ANZACS-QI programme the registry provides an important platform for quality improvement, research and to inform clinical practice.

Introduction

Despite the decline in its incidence over the last four decades worldwide, coronary heart disease (CHD) which includes acute coronary syndromes (ACS) and stable coronary artery disease remains the leading cause of death worldwide particularly in developed countries [[1], [2], [3]]. The three pillars of managing of CHD are risk factor modification, medical therapy and revascularisation [[4], [5], [6], [7], [8], [9]], with specific guidelines for myocardial revascularisation developed [10]. Due to the large body of evidence and guideline recommendations, there has been a global rapid growth in the use of diagnostic coronary angiography (DCA) and percutaneous coronary intervention (PCI) in the management of CHD [[11], [12], [13]].

Randomised clinical trials are the pinnacle of evidence-based medicine. Nonetheless, practice-based research incorporates patients with a greater range of comorbidity and reflects limitations in health care systems. Registries are an important and complementary tool to assess the implementation of evidence-based medicine and outcomes in real-world patients [14,15]. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) CathPCI registry was implemented in all New Zealand (NZ) public hospitals with cardiac catheterisation laboratories in 2013 and an updated dataset was adopted in September 2014 [16]. At least 95% of DCA and PCI procedures performed in NZ have been captured in the registry [17].

The aim of this study is to present the ANZACS-QI Cath PCI registry methodology and use the registry data to describe DCA and PCI practice in a comprehensive contemporary national cohort.

Section snippets

Methods

The methodology of the ANZACS-QI registries programme has been previously reported [16]. In brief, the ANZACS-QI CathPCI registry is part of the ANZACS-QI programme. It utilises a web-based system for systematic collection and entry of data by the secondary cardiac care team at all hospitals in NZ, with a data dictionary for all variable definitions. It aims to capture all patients undergoing DCA and PCI in NZ, and using a unique identifier, the National Health Index (NHI), allows linkage with

Results

During the period of observation, 40,870 patients underwent cardiac catheterisation: 25,011 patients had DCA alone and 15,859 had PCI. Some patients had more than one episode of care within this timeframe. As such, there were 45,169 episodes of care involving DCA alone in 28,138 and PCI in 17,031. Throughout an episode of care, some patients had more than one procedure. In total, there were 46,283 procedures (28,258 DCA alone and 18,025 PCI). The majority of patients had a single procedure

Discussion

As one of the two arms of the ANZACS-QI programme, the CathPCI registry is an online systematic database of all DCA and PCI in NZ hospitals. The CathPCI registry also enables real-time reporting, quality improvement and research activities pertaining to all cardiac catheterisation procedures performed for each centre or nationally. Demographic, past history, indications, procedural findings and intervention data are collected. We present 3-year output of this national cohort. This includes

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  • All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation

    1

    These two authors contributed equally to the manuscript.

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