1. BCIS Audit Returns Adult Interventional Procedures Jan 2004 to Dec 2004 Peter F Ludman BCIS National Audit Officer On behalf of British Cardiovascular Intervention Society Bristol 2005

2. Audit Domains Structure Appropriateness Process Outcome 2004 data: Ludman

3. Bedford Hospital Darlington Memorial Durham East Surrey Kent and Sussex King George Hospital Ilford King's Mill Centre, Mansfield Lincoln County Hospital Princess Alexandra, Harlow Russells Hall Scunthorpe Solihull Hospital South Tyneside South Warwickshire University Hospital Aintree Wansbeck, Ashington Westmorland General Hosp Wexam Park Whipps Cross Angiography Centres - 2004 19 New Angiography Only centres 2004 2004 data: Ludman

4. North Tyneside (to Freeman Hospital) 1 Stopped 1 Swapped St Albans → fixed lab in Hemel Hempstead Angiography Centres - 2004 2004 data: Ludman 3 Started PCI in 2004 Torbay BUPA Hull Southend TOTAL: 83 Angiography Only Centres (increase of 15 from 2003)

5. PCI Centres - 2004 1.Torbay 2.Southend 3.BUPA Hull 3 Angio only centres now performing PCI in 2004 New PCI centres in 2003 1.Manor Hospital, Oxford 2004 data: Ludman TOTAL: 77 PCI Centres (increase of 4 from 2003)

6. UK Centres - 2004 2004 data: Ludman

7. PCI Centres NHS (1) England 1Battle HospitalReading 2Birmingham City HospitalBirmingham 3Birmingham Heartlands HospitalBirmingham 4Bristol Royal InfirmaryBristol 5Castle Hill HospitalCottingham 6Cheltenham General HospitalCheltenham 7City General HospitalStoke on Trent 8Derriford HospitalPlymouth 9Eastbourne HospitalEastbourne 10Freeman HospitalNewcastle 11Glenfield HospitalLeicester 12Hammersmith HospitalLondon 13Harefield HospitalUxbridge 14Heart HospitalLondon 15James Cook University HospitalMiddlesbrough 16John Radcliffe HospitalOxford 17King Edward VIIWest Sussex 18Kings College HospitalLondon 19Liverpool CTCLiverpool 20London Chest HospitalLondon 21Manchester Royal InfirmaryManchester 22New Cross HospitalWolverhampton 23North Hampshire HospitalBasingstoke 24Northern General HospitalSheffield 25Northwick Park HospitalHarrow 26Nottingham City HospitalNottingham 27Papworth HospitalCambridge 28Queen Elizabeth HospitalBirmingham 29Royal Brompton HospitalLondon 2004 data: Ludman

8. PCI Centres NHS (2) 30Royal Cornwall HospitalTruro 31Royal Devon & ExeterExeter 32Royal Free HospitalLondon 33Royal Sussex County HospitalBrighton 34Sandwell District GeneralWest Bromwich 35Southampton GeneralSouthampton 36Southend 37St Bartholomew's Hospital London 38St George's HospitalLondon 39St Mary's HospitalLondon 40St Peter's HospitalChertsey 41St Thomas' HospitalLondon 42Taunton & SomersetTaunton 43Torbay HospitalTorquay 44Victoria HospitalBlackpool 45Walsgrave HospitalWalsgrave 46Wythenshawe HospitalManchester 47Yorkshire Heart CentreLeeds England (cont) 2004 data: Ludman

9. PCI Centres NHS Scotland 48Aberdeen Royal InfirmaryAberdeen 49Edinburgh Royal InfirmaryEdinburgh 50Glasgow Royal InfirmaryGlasgow 51Glasgow Western InfirmaryGlasgow 52Golden Jubilee National Hospital (formerly HCI)Clydesbank 53Hairmyres HospitalEast Kilbride 54Western General HospitalEdinburgh PCI Centres NHS Wales 55Morriston HospitalSwansea 56University Hospital of WalesCardiff PCI Centres NHS Northern Ireland 57Belfast City HospitalBelfast 58Royal Victoria HospitalBelfast PCI Centres NHS (3) 2004 data: Ludman

10. England 59BMI Alexandra HospitalCheadle 60BMI Park HospitalArnold 61BMI Priory HospitalEdgbaston 62BUPA Cambridge LeaImpington 63BUPA Hospital BristolRedland Hill 64BUPA Hospital HullAnlaby, Hull 65BUPA Hospital LeedsRoundhay 66BUPA Hospital LeicesterOadby 67BUPA Hospital SouthamptonSouthampton 68Capio Yorkshire ClinicBingley 69Cromwell HospitalLondon 70Harley Street ClinicLondon 71Leeds Nuffield HospitalLeeds 72London Bridge HospitalLondon 73London IndependentLondon 74Manor HospitalHeadington 75St Anthony's HospitalSurrey 76Wellington HospitalLondon Scotland 77Ross Hall HospitalGlasgow PCI Centres - Private 2004 data: Ludman

11. Angiography Only Centres (1) 1Airedale General Hospital 2Altmagelium Hospital 3Arrowe Park Hospital 4Ayr Hospital 5Bedford Hospital NHS Trust 6BMI The Princess Margaret Hospital 7BMI Thornbury Hospital 8Bradford Royal Infirmary 9Broomfield Hospital 10BUPA Hospital, Little Aston 11BUPA Murrayfield Hospital 12Calderdale Royal Hospital 13Conquest Hospital 14County Hospital 15Craigavon Hospital 16Cumberland Infirmary 17Darlington Memorial Hospital 18Derbyshire Royal Infimary 19 Dewsbury and District Hospital 20 Diana Princess of Wales Hospital 21 Doncaster Royal Infirmary 22 Droitcwich Spa Hospital 23 Dudley Group of Hospitals 24 Dumfries & Galloway Royal Infirmary 25 Ealing Hospital 26 East Surrey Hospital 27 Good Hope District General Hospital 28 Goring Hall Hospital 29 Great Western Hospital 30 Harrogate District Hospital 31 Hemel Hempstead General 32 Huddersfield Royal Infimary 33 Inverclyde Royal Hospital 34 Kent and Sussex Hospital 35 King George Hospital 36 Kings Mill Hospital 2004 data: Ludman

12. Angiography Only Centres (2) 37Lincoln County Hospital 38Lister Hospital 39Manor Hospital 40Mayday University Hospital 41Nevill Hall Hospital 42Ninewells Hospital 43Norfolk & Norwich Hospital 44North Middlesex Hospital 45North Staffordshire Nuffield Hospital 41Northampton General Hospital 42Pinderfields General Hospital 43Prince Philip Hospital 44Princess Alexandra Hospital 45Princess of Wales Hospital 46Princess Royal Hospital 47Princess Royal University Hospital 48Queen Elizabeth Hospital 49Queen Elizabeth Hospital 50Queens Medical Centre 51Raigmore Hospital 52Rochdale Infirmary 53Rotherham Hospital 54Royal Bournemouth Hospital 55Royal Gwent Hospital 56Royal Liverpool University Hospital 57Royal Shrewsbury Hospital 58Royal Surrey County Hospital 59Royal United Hospital 60Salisbury District Hospital 61Scunthorpe General Hospital 62Solihull Hospital 63South Tyneside District Hospital 64South Warwickshire NHS Trust 64St James' University Hospital 65St. Mary's Hospital 2004 data: Ludman

13. Angiography Only Centres (3) 66Sunderland Royal Hospital 67University Hospital Aintree 68University Hospital of North Durham 69Wansbeck Hospital 70West Cumberland Hospital 71Westmorland General Hospital 72Wexham Park Hospital 73Whipps Cross University Hospital 74Worcester Royal Hospital 75Worthing Hospital 76Wycombe Hospital 77York District General Hospital 2004 data: Ludman

14. 77 83 PCI centres Angiography only Centres 2004 2004 data: Ludman

15. UK Interventional and Diagnostic centres 2004 No.No cath data No PCI data Caths (% of total) PCIs (% of total) NHS Interventional 5843 Private Interventional 1921 Diagnostic only 8312 TOTAL160 Missing cath data estimated from 2003 figures 2004 data: Ludman

16. PCI Centres not reporting diagnostic numbers for 2004 NHS –Derriford Hospital –St Mary's Hospital, London –St Peter's Hospital, Chertsey –(Belfast City Hospital – very late) Private –BMI Park Hospital, Notts –Harley Street Clinic 2004 data: Ludman

17. Angio only Centres not reporting diagnostic numbers for 2004 –Broomfield Hospital –Diana Princess of Wales Hospital, Grimsby –Dumfries & Galloway RI –Ealing Hospital –Neville Hall Hospital –Queen Elizabeth Hospital, Woolwich –Royal Gwent Hospital –Royal Surrey County Hosp –Salisbury District Hospital –Wycombe Hospital –South Warwickshire NHS Trust –South Tyneside District Hospital 2004 data: Ludman

18. UK Interventional and Diagnostic centres 2004 No.No cath data No PCI data Caths (% of total) PCIs (% of total) NHS Interventional 5843139,978 (70%) 59,532 (95%) Private Interventional 19219,956 (5%) 3,248 (5%) Diagnostic only 831251,446 (25%) TOTAL160201,38062,780 Missing cath data estimated from 2003 figures if known 2004 data: Ludman

19. Centres Not Reporting PCI numbers for 2004 Southend St Peter's Hospital, Chertsey (Belfast City Hospital – very late) BMI Park Hospital 2004 data: Ludman

20. UK Interventional and Diagnostic centres 2004 No.No cath data No PCI data Caths (% of total) PCIs (% of total) NHS Interventional 5843139,978 (70%) 59,532 (95%) Private Interventional 19219,956 (5%) 3,248 (5%) Diagnostic only 831251,446 (25%) TOTAL160201,38062,780 Missing cath data estimated from 2003 figures if known 2004 data: Ludman

21. PCI per Angiogram ratio 2004 data: Ludman

22. PCI per Angiogram ratio ESC Survey 2003 2004 data: Ludman Cook S for Working Group on Interventional Cardiology (WG 10) of the ESC In Press

23. Total UK PCI Procedures 2004 data: Ludman

24. Rate of increase in PCI numbers pmp 2004 data: Ludman

25. PCI activity to 2004 (UK) 2004 data: Ludman

26. Total PCIs in the UK Countries Total No.s of PCI 2004 data: Ludman

27. Population estimates Mid 2004 Scotland 5.08 m England 50.09 m Wales 2.95 m Rx in Wales: 2.25 m Northern Ireland 1.71 m Welsh Rx in England 0.7 m Total UK: 59.8 m Total Rx in England 50.79 m 2004 data: Ludman

28. PCIs/million UK Countries (2000 to 2004) 2004 data: Ludman

29. PCI vs Isolated CABG Numbers (UK) Data from BCIS and SCTS Registry Note:CABG data for financial yr all PCI v NHS CABG CABG data for 2003 and 2004 from DoH 2004 data: Ludman

30. PCI vs Isolated CABG Ratio (UK) Data from BCIS and SCTS Registry 2004 data: Ludman

31. Euro Heart Survey 3 rd Report Cardiovascular Diseases in Europe 2004 www.escardio.org/knowledge/ehs/slides/

32. Euro Heart Survey 3 rd Report Cardiovascular Diseases in Europe 2004 www.escardio.org/knowledge/ehs/slides/

33. Annual Procedures per cath lab (NHS centres) MeanMedianRange Interventional labs Procedures (pa) per lab 11481093543 to 2304 PCIs (pa) per lab 44940836 to 856 Diagnostic labs Caths (pa) per lab*66954440 to 2786 2004 data: Ludman

34. Number of PCIs performed in NHS Centres (Total Per Annum) 2004 data: Ludman Data from: 57 of 58 centres (2 centres estimated data)

35. Day Case PCI 22 of 77 Units performing day case PCI –Total of 3018 procedures performed (21% increase cf 2003) –4.8% of all PCI procedures (4.6% 2003) 2004 data: Ludman Data from: 64 of 77 centres

36. No. of Interventional Consultants (NHS centres) Note: if work at two NHS centres will be counted twice Includes cardiologists and radiologists 2004 data: Ludman Data from: 57 of 58 centres

37. No. of Interventional Consultants (NHS centres) 2004 data: Ludman Mean 2000 5.5 2001 6.1 2002 6.5 2003 6.7 2004 7.4 2004

38. Mean PCI/consultant 2000125 2001126 2002138 2003139 2004143 No. of PCIs per Consultant (NHS Centres) 2004 data from 56 of 58 centres Note: data from institutional volume divided by No operators per institution 2004 data: Ludman

39. Visiting Interventionists (NHS Centres) 2004 data from 57 of 58 centres 2004 data: Ludman

40. Visiting Interventionists (NHS Centres) 2004 data: Ludman

41. Surgical Cover (NHS Centres) On siteOff site No of centres 57 (74%) 20 (26%) No. of PCI (% of total) 53,390 (85%) 9390 (15%) Mean No. procedures per centre 936.7494.2 Operator volume: PCIs per interventionist * 164.6104.3 2004 data: Ludman

42. Surgical Cover 2004 data: Ludman

43. STEMI

44. Primary PCI for STEMI Do you offer at least some PCI for STEMI? Data from: 55 of 58 centres 2004 data: Ludman

45. Primary PCI Routine Rx for STEMI 2004 data: Ludman Data from: 55 of 58 centres Working Hours Only24/7 Number of Centres

46. Primary PCI Routine Rx for STEMI 2004 data: Ludman Data from: 55 of 58 centres Working Hours Only24/7

47. PCI for STEMI (2004 NHS Hospitals: data from 48 of 58 units) 2004 data: Ludman 5.5% of all PCI activity

48. PCI for STEMI (2004 NHS Hospitals: data from 48 of 58 units) 2004 data: Ludman

49. PCI for All STEMI 2004 data from 48 of 58 centres Total 3447 procedures No data 2004 data: Ludman

50. PCI for All STEMI 2004 data from 48 centres Total 3447 procedures 2004 data: Ludman

51. Primary PCI for STEMI 2004 data from 48 centres Total 1438 procedures No data 2004 data: Ludman

52. Primary PCI for STEMI 2004 data from 48 centres Total 1438 procedures 2004 data: Ludman

53. Primary PCI for STEMI 2004 data: Ludman As Percentage of Each Centre’s PCI Activity

54. Primary PCI – the experience 2004 data: Ludman

55. Primary PCI – the experience UK population 60 million, at 500 pmp = 30,000 procedures pa 2004 data: Ludman

56. 2.3 % 2004 data: Ludman 32 % 1050 pmp1546 pmp UK Activity 2004

57. 2.3 % 2004 data: Ludman 32 % 1050 pmp1546 pmp UK Growth assuming no ↑ in other PCI pmp + 30,000 PPCI

58. 2.3 % 2004 data: Ludman 32 % 1050 pmp1546 pmp UK Growth assuming no ↑ in other PCI pmp

59. Uncertainties 1546 pmp PPCI patients 50% SVD 30% staged PCI later Overall PCI rate increasing Current lysis patients 60% angiography 2004 data: Ludman

60. PCI for Stable v ACS Of Total PCIs performed –44% ACS (excluding STEMI) –50% Elective

61. PCI for Stable v ACS Of Total PCIs performed –44% ACS (excluding STEMI) –50% Elective

62. Audit Domains Structure Appropriateness Process Outcome

63. Stent procedures 2004 data from 60 of 77 centres 2004 data: Ludman

64. Stenting in Different Centres 2004 data: Ludman

65. Drug Eluting Stent cases 2004 data from 69 of 77 centres 2004 data: Ludman NHS and private

66. Drug Eluting Stent cases 2004 data from 53 of 58 centres 2004 data: Ludman NHS only

67. DES use by Centre (NHS) 2004 data: Ludman

68. Drug Eluting Stent cases 2004 data from 53 of 58 centres 2004 data: Ludman

69. PCI for Restenosis (2004 data from 54 of 77 centres) Mean: 20024.9% 20034.3% 20043.6% 2004 data: Ludman

70. Bare Metal and DES use v PCI for Restenosis 2004 data: Ludman

71. PCI in patients with past CABG (Data from 53 of 77 centres) Mean 20028.4% 20036.8% 20046.7% Note: Includes procedures on native vessels and grafts 2004 data: Ludman

72. Use of GP IIb/IIIa blockers 2004 data from 71 of 77 centres Overall mean % use 2004 data: Ludman

73. Abciximab use by Clinical Presentation 2004 data: Ludman

74. Multi-vessel Treatment Excluding Rx of STEMI 2004 data: Ludman

75. Multi-vessel Treatment Excluding Rx of STEMI 2004 data: Ludman

76. Mean (Range) 2004 data: Ludman Multi-vessel Treatment All Clinical Presentations

77. 2004 data: Ludman Multi-vessel Treatment Excluding Rx of STEMI

78. Additional Interventional Coronary Techniques (1) 2004 data from 74 of 77 centres UnitsNo ∆ % cf 2003 * % of all procs Mean**Range Rotablation33338+17%0.54101-54 Atherctmy (DCA) 711-27%0.0171.61-7 TEC22-33%0.00311 Laser361+177%0.1201- 47 Cutting balloon511169-12%1.8231-328 *% of all UK interventional procedures **Mean number in units using the technique 2004 data: Ludman

79. Additional Interventional Coronary Techniques (2) 2004 data from 74 of 77 centres UnitsNo ∆ cf 2003 % of all procs MeanRange Thrombectomy31363+12 %0.58121-56 Distal protection46550+ 59 %0.87121-67 Brachytherapy459-50%0.0914.74-21 2004 data: Ludman

80. Other Interventional Techniques 2004 data from 74 of 77 centres UnitsNo ∆ cf 2003 % of all procedures MeanRange PTMR 17- 61%0.0177 Septal ablation 13570 %0.14.41-12 2004 data: Ludman

81. Alcohol Mediated Septal Ablation (HOCM) 2004 data: Ludman Total 57 procedures

82. Other Diagnostic Techniques 2004 data from 74 of 77 centres UnitsNo∆ cf 2003 % of all procedures MeanRange IVUS 38689+ 18%1.1181-167 Press wire 421281+ 30.5%2311-169 Flow wire 6119+ 1387%0.2201-98 2004 data: Ludman

83. Adult non coronary intervention 2004 data from 74 of 77 centres UnitsNo ∆ cf 2003 % of all procedures MeanRange MV plasty 33165 -28% 0.2651-18 AV plasty 922 +29% 0.042.41-5 PV plasty 926 +4% 0.042.91-9 TV plasty 22 NA 11-2 PDA 939 +2.6% 0.064.31-19 ASD 28475 +5.6% 0.8172-74 PFO 28379 +94% 0.6141-86 VSD 1434 +6% 0.052.41-6 2004 data: Ludman

84. Mitral Balloon Valvuloplasty 2004 data: Ludman Total 165

85. Adult great vessel intervention 2004 data from 74 of 77 centres UnitsNo ∆ cf 2003 % of all procedures MeanRange Coarct / Re-coart935-60%0.063.41-9 Carotid429+7%0.047.251-19 Aorta27-41%0.013.51-6 Pulm art832+3%0.0541-9 SVC834-42%0.055.91-17 2004 data: Ludman

86. Other procedures 2004 data from 74 of 77 centres UnitsNo ∆ % cf 2002 % of all procs MeanRange Foreign body removal 1127-4%0.042.41-9 Embolisation927-51%0.032.41-7 Balloon Pericardiotomy 33-78%0.00411 Spinal cord stimulator 328+115%0.0491-20 2004 data: Ludman

87. Radial Artery Access 6457 cases: 10.2% of all PCI 2004 data: Ludman Data from: 68 of 77 centres

88. Femoral artery closure devices 2004 data from 69 of 77 centres Mean: 45% 2004 data: Ludman

89. Audit Domains Structure Appropriateness Process Outcome

90. Data to end of Procedure only 2004 data Battle HospitalReading Birmingham HeartlandsBirmingham City General HospitalStoke Eastbourne HospitalEastbourne Glenfield HospitalLeicester Heart HospitalLondon North HampshireBasingstoke Royal Free HospitalLondon St Bartholomew'sLondon Victoria HospitalBlackpool Wythenshawe HospitalManchester Glasgow Royal InfirmaryGlasgow Golden Jubilee NationalClydesbank Hairmyres HospitalEast Kilbride BMI Alexandra HospitalCheadle BUPA Cambridge LeaImpington BUPA Hull and East Riding Anlaby, Hull BUPA Hospital LeedsRoundhay BUPA LeicesterOadby Capio Yorkshire ClinicBingley Cromwell HospitalLondon Leeds Nuffield HospitalLeeds London IndependentLondon Manor HospitalHeadington St Anthony's HospitalSurrey Wellington HospitalLondon Ross Hall HospitalGlasgow

91. Year Data From Total with mortality data Mortality % Range % 199535/54 11,365 (17,344) 0.690-3.4 199637/53 14,476 (20,511) 0.720-3.2 199741/58 17,577 (22,902) 0.910-10 199844/61 16,946 (24,899) 0.800-9.1 199948/63 20,975 (28,133) 0.610-4 200048/66 24,323 (33,652) 0.640-2.6 200145/64 29,001 (38,992) 0.750-2.8 200253/64 37,437 (44,913) 0.540-1.9 200364/73 49,194 (53,261) 0.530-2.0 200466/78 56,027 (62,780) 0.560-2.2 Mortality - All PCIs To end of PCI or hosp discharge 2004 data: Ludman

92. Year % Procedure Success % QMI % Re PCI for acute closure % Em. CABG Mortality (%) 1995891.41.90.69 1996901.41.70.72 1997921.21.10.89 1998920.80.70.80 1999900.570.480.61 2000920.60.40.64 2001940.50.40.75 2002 92 (51 of 64) 0.57 (49 of 64) 0.33 (50 of 64) 0.28 (53 of 64) 0.54 (53 of 64) 2003 92 (62 of 73) 0.36 (56 of 73) 0.17 (62 of 73) 0.29 (64 of 73) 0.53 (64 of 73) 2004 93.5 (63 of 78) 0.30 (57 of 78) 0.30 (61 of 78) 0.21 (64 of 78) 0.56 (66 of 78) MACE - All PCIs To end of PCI or hosp discharge 2004 data: Ludman

93. All Procedures: Outcome 2004 data: Ludman

94. Data on HOSPITAL outcome (2004 data 43 of 77 sites) Birmingham City HospitalBirmingham Bristol Royal InfirmaryBristol Castle Hill Hospital (Hull and East Yorkst)Cottingham Cheltenham General HospitalCheltenham Derriford HospitalPlymouth (limited data) Freeman HospitalNewcastle upon Tyne Hammersmith HospitalLondon Harefield HospitalUxbridge James Cook University HospitalMiddlesbrough John Radcliffe HospitalOxford King Edward VIIWest Sussex Kings College HospitalLondon Liverpool Cardiothoracic CentreLiverpool Manchester Royal InfirmaryManchester New Cross HospitalWolverhampton

95. Data on HOSPITAL outcome (2004 data 43 of 77 sites) Northern General HospitalSheffield Northwick Park HospitalHarrow Nottingham City HospitalNottingham Papworth HospitalCambridge Queen Elizabeth HospitalBirmingham Royal Brompton HospitalLondon Royal Cornwall HospitalTruro Royal Devon & Exeter HospitalExeter Royal Sussex County HospitalBrighton, Sussex Sandwell District General HospitalWest Bromwich Southampton General HospitalSouthampton St George's HospitalLondon St Mary's HospitalLondon St Thomas' HospitalLondon Taunton & SomersetTaunton

96. Data on HOSPITAL outcome (2004 data 43 of 77 sites) Some additional centres have provided CCAD data but not form C Torbay HospitalTorquay Walsgrave HospitalWalsgrave Aberdeen Royal InfirmaryAberdeen Edinburgh Royal InfirmaryEdinburgh Glasgow Western InfirmaryGlasgow Western General HospitalEdinburgh Morriston HospitalSwansea University Hospital of WalesCardiff (limited data) Royal Victoria HospitalBelfast BMI Priory HospitalEdgbaston BUPA Hospital SouthamptonSouthampton Harley Street ClinicLondon London Bridge HospitalLondon

97. Data on HOSPITAL outcome (2004 data 35 of 77 sites)

98. Hospital Outcome 2004 Data from 43 centres All Patients 2004 data: Ludman

99. Hospital Outcome 2004 Data from 37 to 40 centres Elective Patients 2004 data: Ludman All Elective Cases – Overall MACE 22,992 0.25% (0-1.3) 0.24% (0-1.7)

100. Hospital Outcome 2004 Data from 34 to 37 centres Does not account for clinical syndrome CABG patients includes Rx of native and grafts Patients with previous bypass grafts Patients treated for restenosis 2004 data: Ludman

101. Hospital Outcome 2004 Data from 28 to 30 centres Patients Rx for acute vessel closure Equivalent to SAT rate 0.32% - likely underestimate 2004 data: Ludman

102. Hospital Outcome 2004 Data from 36 to 38 centres UA and NSTEMI Includes all classified as treated for UA and post MI angina (stable and unstable) 2004 data: Ludman

103. Hospital Outcome 2004 Data from 30 to 32 centres Patients Rx for STEMI 2004 data: Ludman

104. Summary: In Hospital Mortality Risk Stratified by Syndrome (Data from approx 43,000 patients) 2004 data: Ludman

105. In Hospital Mortality by Syndrome (Data from approx 43,000 patients) 2004 data: Ludman

106. Emergency CABG by Syndrome (Data from approx 43,000 patients) 2004 data: Ludman

107. Late Events post Discharge BCIS - CCAD

108. BCIS / CCAD project The Vision Hospital 1 Hospital 2 Hospital 3 Hospital n CCAD Server encryption Internet encryption....

109. BCIS / CCAD project The Vision Hospital 1 Hospital 2 Hospital 3 Hospital n CCAD Server encryption Internet encryption.... Hospital 1 v All Others Hospital 2 v All Others

110. BCIS / CCAD project The Vision CCAD Server ONS tracking Crosslink (NHS No.) BCIS SCTS MINAP EP / ICD Pacing Patient outcome Advanced Analysis Risk stratified Appropriateness Process Outcome Device monitoring etc. Publication strategy

111. Downloading to CCAD September 2005 Birmingham Heartlands Hospital Freeman Hospital Glenfield Hospital James Cook University Hospital John Radcliffe Hospital, Oxford King Edward VII, Midhurst Kings College Hospital London Chest Hospital Queen Elizabeth Hospital, B’ham Royal Devon & Exeter Hospital Southend Hospital St Bartholomew's Hospital St Peter's Hospital Torbay Hospital Yorkshire Heart Centre Bradford Royal infirmary Royal Bournemouth Hemel Hempstead University Hospital Wales Harley Street clinic London Bridge Hospital 21 Centres

112. North Hampshire Hospital St Thomas' Hospital Victoria Hospital Walsgrave Hospital Wythenshawe Hospital Harefield Hospital (imminent) Bristol Royal Infirmary Some Data to CCAD September 2005 Total 28 Centres

113. Birmingham City Hospital Castle Hill / Royal Hull Hospital Cheltenham General Hospital City General Hospital Derriford Hospital Eastbourne Hospital Hammersmith Hospital Heart Hospital (UCLH) Liverpool CTC Manchester Royal New Cross Hospital Northern General Hospital Northwick Park Hospital Nottingham City Hospital Papworth Hospital Royal Berkshire and Battle Royal Brompton Hospital Royal Cornwall Hospital Royal Free Hospital Royal Sussex County Sandwell District General Southampton General St George's Hospital St Mary's Hospital Taunton & Somerset Morriston NO Data to CCAD September 2005 26 Centres

114. Monthly CCAD data Jan 2004 to Sept 2005

115. Total Data in CCAD to Sept 2005

116. Tracking via CCAD Data completeness NHS numbers –National Average 63% –MINAP 87% –SCTS83% 24,073 PCI Procedures 15,250 Successful ONS tracking

117. Length of follow-up (tracking performed July 2005) Median = 362 days CCAD

118. Survival after Any PCI (tracking performed July 2005) In Hospital †:0.61% Subsequent †:3.0% Approx 1.7% pa

119. Survival after Elective PCI (tracking performed July 2005) 2005 CCAD Approx 1 % pa

120. urgent emergency salvage Survival after PCI for UA / NSTEMI by Procedure Urgency CCAD (tracking performed July 2005)

121. No shock shock Survival after PCI All Shock (tracking performed July 2005) CCAD

122. Non-STEMI STEMI p<0.0001 Survival after PCI for ACS STEMI v NSTEMI / UA Shock excluded (tracking performed July 2005) CCAD

123. Non-STEMI STEMI p<0.0001 Survival after PCI for ACS STEMI v NSTEMI / UA Shock excluded (tracking performed July 2005) CCAD

124. Non-STEMI STEMI Shock Survival after PCI for ACS STEMI v NSTEMI / UA v Shock (tracking performed July 2005) CCAD

125. Admission with ACS after PCI (any PCI indication) Patients with an exit diagnosis of ACS(tracking performed July 2005) CCAD

126. Non-STEMI STEMI Shock p=n.s. Patients with an exit diagnosis of ACS(tracking performed July 2005) Re-admission with ACS after PCI STEMI v NSTEMI v Shock CCAD

127. Events: death, ACS admission, redo PCI, cardiac surgery Event free survival after PCI All Cases (tracking performed July 2005) CCAD 87% 1 yr 83% 2 yr

128. Events: death, ACS admission, redo PCI, cardiac surgery ACS: non-STEMI ACS: STEMI Shock Stable Event free survival after PCI (tracking performed July 2005) CCAD

129. Summary 77 PCI centres in UK 1050 PCI pmp in UK Cath : PCI = 31.3% PCI : CABG = 2.5 : 1 MACE –Stable syndromes mortality 0.24%, CABG 0.25% –UA / NSTEMI Mortality 0.75%, CABG 0.21% BCIS – CCAD –A new dawn