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National Cardiovascular Disease Database (NCVD) NCVD Acute Coronary Syndrome (ACS) Registry An Update Dato’ Dr Azhari Rosman Chairman of NCVD ACS Registry.

Published byDerrick Bess Modified over 9 years ago

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Presentation on theme: "National Cardiovascular Disease Database (NCVD) NCVD Acute Coronary Syndrome (ACS) Registry An Update Dato’ Dr Azhari Rosman Chairman of NCVD ACS Registry."— Presentation transcript:

1 National Cardiovascular Disease Database (NCVD) NCVD Acute Coronary Syndrome (ACS) Registry An Update Dato’ Dr Azhari Rosman Chairman of NCVD ACS Registry Sentral Accord Room, Hilton Kuala Lumpur 19 th April 2009

2 National Cardiovascular Disease Database (NCVD) *SGH *HSAJB *PH HSJ *IJN *UMMC *HKL *HTAR ACS Registry Participating Sites *QEH * Active sites *HI HSNZ *HRPZ II*HTF *HSB *HTJ *HTAA *HM MMC (2009)

3 National Cardiovascular Disease Database (NCVD) 1. Report: NCVD-ACS Registry Annual report year 2006 Downloadable online at http://www.acrm.org.my/ncvd/publications.htm http://www.acrm.org.my/ncvd/publications.htm Current Activities

4 National Cardiovascular Disease Database (NCVD) 2. NCVD-ACS Registry Annual Report year 2007 Currently in the midst of data- cleaning stage Current Activities

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

6 National Cardiovascular Disease Database (NCVD) Acute Coronary Syndrome (ACS) Registry

7 National Cardiovascular Disease Database (NCVD) ACS cases registered online by Source Data Providers (SDP) Results as of 9 th April 2009, n= 10,864 Total SDP = 15 sites

8 National Cardiovascular Disease Database (NCVD) Patient’s Demographics Age Min, Max mean + sd 18.33, 99.52 yrs 59.05 + 11.99 yrs Male75.31 % Ethnic : Malay47.47 % Chinese22.96 % Indians23.25 % Other Malaysian3.88 % Foreigner1.33 % * Other Malaysians include Punjabi, Iban, Kadazan Dusun, Orang Asli, Melanau, Murut, Bajau, Bidayuh ** For 121 cases, there are no information on ethnicity Baseline (n= 10,730) Baseline (n= 10,864)

9 National Cardiovascular Disease Database (NCVD) Smoking Status Never36.25 % Stopped (quit > 30 days)21.45 % Current (within last 30 days)32.03 % Not Available10.27 % Status of Aspirin use Used <7 days10.47 % Used >7 days22.06 % None51.96 % Unknown15.51 % Results as of 9 th April 2009, n= 10,864

10 National Cardiovascular Disease Database (NCVD) CV Risk Factors Dyslipidaemia32.42 % Hypertension57.69 % Diabetes40.56 % Family History of premature CVD11.16 % MI history16.68 % Documented CAD16.21 % New onset angina (< 2 weeks)48.08% Chronic angina (onset > 2 weeks ago)11.29% Chronic Lung Disease3.26 % Renal disease6.40 % Peripheral vascular disease0.75 % Cerebrovascular disease3.42 % Heart Failure6.46 % Results as of 9 th April 2009, n= 10,864

11 Institut Jantung Negara National Heart Institute Risk Factors: Malaysian NCVD-PCI Registry(IJN) 51% 72% 82%

12 National Cardiovascular Disease Database (NCVD) No episode14.42 % 136.38 % 27.52 % 32.73 % 40.71 % 50.38 % 60.14 % 70.06 % Number of distinct angina episode within 24hrs 80.02 % 9 100.07 % 110.02 % 120.01 % 140.03 % 200.01 % NA37.48 % Results as of 9 th April 2009, n= 10,864

13 National Cardiovascular Disease Database (NCVD) Heart Rate83.5 beats/min Systolic BP139.74 mmHg Diastolic BP81.12 mmHg Clinical Examination Killip classification I46.27 % II16.37 % III3.94 % IV3.31 % Not stated/inadequately described12.73 % Not available17.38 % Results as of 9 th April 2009, n= 10,864

14 National Cardiovascular Disease Database (NCVD) ECG abnormalities type ST-segment elevation ≥ 1mm (0.1mV) in ≥ 2 contiguous limb leads 17.31 % ST-segment elevation ≥ 2mm (0.2mV) in ≥ 2 contiguous frontal leads or chest leads 31.16 % ST-segment depression ≥ 0.5mm (0.05mV) in ≥ 2 contiguous leads 24.57 % T-wave inversion ≥ 1mm (0.1mV) 20.54 % Bundle branch block (BBB) 4.95 % Non-specific 5.23 % None 6.01 % Not stated / inadequately described 1.86 % Baseline (n= 10,864) Results as of 9 th April 2009

15 National Cardiovascular Disease Database (NCVD) ECG abnormalities location Inferior leads : II, III, aVF31.42 % Anterior leads : V1 to V441.96 % Lateral leads : I, aVL, V5 to V630.23 % True posterior : V1 V24.58 % Right ventricle : ST elevation in lead V4R3.77 % None9.86 % Not stated / inadequately described3.89 % Baseline (n= 10,864) Results as of 9 th April 2009

16 National Cardiovascular Disease Database (NCVD) Percentage of Ischaemic status by ACS stratum (n=10,864) Results as of 9 th April 2009, n= 10,864

17 National Cardiovascular Disease Database (NCVD) Percentage according to TIMI Risk Score for STEMI (n= 4,705) Results as of 9 th April 2009, n= 10,864

18 National Cardiovascular Disease Database (NCVD) Percentage according to TIMI Risk Score for NSTEMI/UA (n=5,427) Results as of 9 th April 2009, n= 10,864

19 National Cardiovascular Disease Database (NCVD) Given at this centre 60.81 % Given at another centre prior to transfer 12.41 % Not given - proceeded directly to primary angioplasty 7.25 % Not given - Missed Thrombolysis 12.48 % Not given - patient refusal 0.17 % Not given - Contraindicated 4.21 % Not Applicable 2.67 % Fibrinolytic Therapy Status Baseline (n= 4,705) Results as of 9 th April 2009, n= 10,864

20 National Cardiovascular Disease Database (NCVD) Fibrinolytic Drug Used (n=2,861) Streptokinase91.68 % Others2.31 % Missing6.01 % Door to needle time (mins)94.36 + 145.24 Cardiac Cathetherization Yes19.00 % No60.73 % No - transferred to another centre2.31 % Missing17.95 % Baseline (n= 10,864) Results as of 9 th April 2009

21 National Cardiovascular Disease Database (NCVD) PCI on this admission Yes (n=1,588)14.62 % Yes – for STEMI42.1 % No55.56 % Not Applicable12.08 % Missing17.75 % Door to balloon time (mins)233.77 + 292.63 Results as of 9 th April 2009, n= 10,864

22 National Cardiovascular Disease Database (NCVD) Pharmacological Therapy Drug used/given during admission (%) Drug Pre- admission During After discharge ASA52.2685.9869.78 ADP Antagonist20.5060.5347.08 GP Receptor inhibitor0.522.90 Unfrac Heparin1.2911.36 LMWH9.7550.64 Beta Blocker24.5161.7352.40 ACE Inhibitor18.8753.5745.08 Angiotensin II receptor blocker4.607.356.32 Statin30.0383.9769.31 Results as of 9 th April 2009, n= 10,864

23 National Cardiovascular Disease Database (NCVD) Drug used/given during admission (%) Drug Pre- admission During After discharge Other Lipid Lowering Agent2.345.404.41 Diuretics12.5628.6817.04 Calcium Antagonist9.8914.2811.17 Oral Hypoglycaemic Agent19.4024.9825.03 Insulin6.9323.388.17 Anti-arrhythmic Agent2.226.663.55 Results as of 9 th April 2009, n= 10,864 Pharmacological Therapy

24 National Cardiovascular Disease Database (NCVD) In-hospital Clinical Outcome Outcome (%) Discharged85.65 Transferred1.98 Died6.91 NA5.55 Cause of Death (%) CVD74.57 Non-CVD4.39 Other2.26 Missing18.77 Results as of 9 th April 2009, n= 10,864

25 National Cardiovascular Disease Database (NCVD) In-hospital Clinical Outcome Final Diagnosis at Discharge (%) Q Wave MI35.76 Non-Q Wave MI19.89 Unstable Angina24.96 Stable Angina1.20 Non-cardiac1.45 Missing 16.74 Bleeding Complication (TIMI Criteria) (%) Major0.49 Minor1.58 Results as of 9 th April 2009, n= 10,864

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

27 National Cardiovascular Disease Database (NCVD) Overall Follow Up Management Type of FU30days FU1year FU TotalN%N% Expected visits96507604 FU Done649367.28335244.08 Missed FU315732.72425255.92 Results as of 9 th April 2009

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

29 National Cardiovascular Disease Database (NCVD) Follow Up done at 30days & 1year by SDP Percentage of FU done (%) SDP Total 30days FU = 6,493 (as of 9 th April 2009) Total 1year FU = 3,352 (as of 9 th April 2009)

30 National Cardiovascular Disease Database (NCVD) Cardiovascular readmission ACS STEMI NSTEMI UA Missing 3.89 % 14.51 % 14.90 % 53.73 % 16.86 % Heart Failure0.49 % Revascularization5.15 % PCI87.54 % CABG9.79 % Stroke0.11 % 2.07 % 12.86 % 7.14 % 61.43 % 11.43 % 0.53% 3.11% 78.09 % 15.24 % 0.06 % 30days (n= 6,550)1year (n= 3,374) Results as of 9 th April 2009, n= 10,864

31 National Cardiovascular Disease Database (NCVD) Outcome at 30 days & 12 months 85.39 % 3.45 % 8.98 % 0.58 % 1.6 % Outcome Alive Death Lost to FU Transferred Missing 84.53 % 2.31 % 10.58 % 0.18 % 2.4 % Cause of Death CVD Non CVD Others Missing 47.44 % 8.97 % 21.79 % 21.80 % 1year (n= 3,374) 1year (n= 78) 30days (n= 6,550) 55.31 % 10.62 % 13.27 % 20.80 % 30days (n= 226) Results as of 9 th April 2009, n= 10,864

32 National Cardiovascular Disease Database (NCVD) Thank you

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