ACC releases updated findings from four cardiovascular registries

The American College of Cardiology (ACC) recently released detailed data from four registries that are part of the National Cardiovascular Data Registries (NCDR).

Lead researcher Frederick A. Masoudi, MD, MSPH, of the University of Colorado Anschutz Medical Campus, and colleagues published their results online in the Journal of the American College of Cardiology on Dec. 23.

The NCDR includes 10 registries, of which eight are hospital-based and two are outpatient programs for the ambulatory care setting.

This report focused on the CathPCI registry for coronary angiography and PCIs, 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.

The CathPCI registry was the first NCDR program and was launched n 1998. Through 2014, the registry had captured information on more than 17.6 million coronary angiography and PCI procedures performed in the U.S.

In 2014, CathPCI was used in more than 90 percent of PCI-capable hospitals in the U.S. Of the hospitals that used the registry, 70 percent submitted data for all diagnostic catheterization and PCI procedures.

In 2014, the registry included 667,424 patients who underwent PCI at 1,612 hospitals. The mean age was 64.6 years old, and 86.5 percent of patients were white. The authors mentioned that 35.3 percent of PCIs were performed for elective indications and 64.7 percent were performed for non-elective indications.

Of the patients, 30.4 percent had prior MI, 41.2 percent had prior PCI and 17.8 percent had prior CABG. Of the hospitals, 87 percent were private or community hospitals and in urban or suburban locations.

For patients who were not transferred for PCI, the median time to primary PCI was 59 minutes, which was below the guideline-recommend threshold of 90 minutes. In all, 93.5 percent of patients received PCI within the 90-minute threshold. For transferred patients, the median time to primary PCI was 105 minutes, while 32.3 percent were treated within 90 minutes.

In 2014, 93.5 percent of patients undergoing PCI received aspirin, P2Y12 inhibitors and statins if they met eligibility for treatment at hospital discharge, an increase from 89.1 percent in 2011.

Between 2011 and 2014, the use of femoral access PCIs decreased from 88.8 percent to 74.5 percent, while the use of radial access PCIs increased from 10.9 percent to 25.2 percent.

Meanwhile, the NCDR created the ICD registry in 2006 shortly after the Centers for Medicare and Medicaid Services expanded coverage for ICDs. Through 2014, the registry included data on more than 1.3 million records.

In 2014, the ICD registry included data on 158,649 patients from 1,715 hospitals. Of the patients, 120,228 received a device for primary prevention and 38,421 received a device for secondary prevention. The mean age was 67.1 years old, while 82.9 percent of patients were white.

In 2014, 25 percent of procedures involved a single chamber device, 32 percent involved dual chamber devices and 43 percent involved a cardiac resynchronization therapy with an ICD. In 2011, the rates were 19 percent, 37 percent and 44 percent, respectively.

In addition, the NCDR created the ACTION-GWTG registry in 2008. Through the end of 2014, the registry included data on more than 800,000 patients.

In 2014, the program collected data from 907 hospitals on 182,903 patients with acute MI, of whom 71,368 had ST-segment elevation MI (STEMI) and 111,535 had non-ST-segment elevation acute coronary syndromes. The mean age was 64.6 years old, while 34.4 percent of patients were women and 84.3 percent were white.

The ACC said in a news release there was room for improvement in defect-free care (78.4 percent), P2Y12 inhibitor use in eligible patients (56.7 percent) and use of aldosterone antagonists in patients with left ventricular systolic dysfunction and diabetes or heart failure (12.8 percent).

The rates of death were 6.4 percent for STEMI patients and 3.4 percent for NSTEMI patients. The rates of cardiogenic shock were 4.4 percent and 1.6 percent, respectively, while the bleeding rates were 8.5 percent and 5.5 percent, respectively.

Further, the NCDR launched the IMPACT registry in 2010. Through the end of 2014, the registry included data on more than 54,600 records.

In 2014, the registry collected data from 76 hospitals on procedures for 20,169 patients, of whom 46.4 percent were female and 71.2 percent were white. The authors mentioned that closures of atrial septal defects and patent ductus arteriosus exceeded 94 percent, while the rates of success were 84.3 percent for pulmonary valvuloplasty, 87.4 percent for aortic coarctation stenting and 55.1 percent for aortic coarctation balloon angioplasty.

Further, device embolization during atrial septal defect occurred in 1.2 percent of patients, patent ductus arteriosus occurred in 1.1 percent of patients, while 10.6 percent of patients had increases in aortic regurgitation after balloon valvuloplasty.

“The data in this report provide unique perspectives into the care and outcomes of cardiovascular care in the US that are not available elsewhere,” the researchers wrote. “NCDR programs, through the contributions of the participating hospitals and practices, generate the benchmarks for local, regional, and national quality improvement and support health services research that informs practice and health policy. This report illustrates the strength of national quality programs using standardized data to advance the effectiveness and safety of patients with cardiovascular disease nationwide.”