Interventional cardiology

Real time national PCI registry impacts clinical practice

A national real-time PCI patient registry has directly influenced the prescribing of evidence-based therapies, an audit shows.

The Genesis Cardiovascular Outcomes Registry (GCOR-PCI) – set up by Genesis HeartCare, an organisation that identifies as ‘Australia’s largest collaborative venture of cardiologists’ – reports in real time the patient’s clinical characteristics, management, in-hospital and long-term outcomes and compliance with secondary prevention therapies of patients undergoing PCI in private hospitals.

So far the registry, which was established in 2009, includes data on over 6,000 patients who underwent 7167 coronary interventions at 10 private hospitals across the country.

Interventional cardiologist at Royal Melbourne Hospital David Eccleston, who is a member of the registry’s steering committee said that while similar registries have been well established in the US and Europe, said GCOR is the first national PCI Registry in Australia to establish a unified systematic approach to PCI data collection.

He added that this was despite increasing PCI volumes, health care expenditure and repeated calls for a national registry.

Writing in a paper published earlier this week, he said early data identified specific practice patterns associated with lower rates of statin therapy post-PCI.

The registry, which operates in real time, is able to send that information back to participating cardiologist and hospitals that are then able to adjust practice and, ultimately, improve long-term outcomes for patients.

“Between the first and latest year of data collection there was significant improvement in the rates of statin therapy at discharge (92.1 vs. 94.4% p<0.03) and 12 months post-PCI (87.0 vs. 92.2% p<0.001) and of antiplatelet therapy at 12 months (90.7 vs. 94.3% p<0.001).”

According to registry data, the indication for PCI was ACS in 38.2% of procedures performed, of which 18.0% were ST-segment elevation MI (STEMI) and 20.2% were non-STEMI.

Most lesions were de novo lesions (94.6%), and a significant proportion were complex lesions (48.5% type B2/ C). The mean stent length was 16.6 mm (SD, 5.3 mm) and the mean stent diameter was 2.9 mm (SD, 0.5 mm).

Registry data also revealed very high procedural success rates, low in-hospital complication rates and low long-term cardiovascular event rates with PCI for either acute coronary syndrome (ACS) or stable coronary artery disease (CAD).

But there was ‘incomplete provision of evidence-based therapies’ with wide regional variation, Professor Eccleston noted.

He said feedback like this was critical to improving practice.

“Clinical data describing treatment effectiveness has already demonstrated the potential to improve processes of care and therefore patient outcomes nationally … A long-term national PCI database such as GCOR will provide quality assurance and benchmarking against international standards for interventional cardiology procedures in Australia.”

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