Ischemic Heart Disease – Interventional Treatment

Ischemic Heart Disease ? Interventional Treatment

Cardiac Catheterization Laboratory Procedures (N = 10,871)

Cleveland Clinic is a regional and national referral center for percutaneous coronary intervention (PCI). A total of 10,871 cardiac catheterization procedures were done in 2014 to treat patients with simple and complex ischemic heart disease.

The data comparisons below demonstrate outcomes at Cleveland Clinic compared with those at hospitals included in the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) CathPCI Registry? that perform more than 500 PCIs per year. Data are based on a 1-year rolling average; therefore, totals reported here may differ from those reported elsewhere in this book.

Risk Factors Among Patients Undergoing PCI Procedures (N = 1482)

2014 Percent 60 50 40 30 20

Cleveland Clinic Comparable ACC-NCDR hospitals

Complex medical backgrounds can affect outcomes for patients who have PCI procedures. Patients who had PCI procedures at Cleveland Clinic in 2014 had more complex backgrounds in all categories, except advanced age, compared with comparable hospitals.

10

0 Age Acute Care

(> 75 years) Transfer

Prior MI

Prior Heart Failure

Diabetes Prior CABG Severe LV Multivessel Dysfunction Disease

Abbreviations: CABG = coronary artery bypass grafting, LV = left ventricular, MI = myocardial infarction

Source: ACC-NCDR database

Use of Adjunctive Medications Before and After PCI Procedures (N = 1482)

2014 Percent 100

95

90

85

Cleveland Clinic Comparable ACC-NCDR hospitals

One of the ACC-NCDR key performance measures is the use of appropriate adjunctive medications before and after PCI. Cleveland Clinic's administration rates exceed those of comparable hospitals.

80

Aspirin on Admission

Before Procedure

Aspirin

Statins

At Discharge

Thienopyridines

Source: ACC-NCDR database

Sydell and Arnold Miller Family Heart & Vascular Institute

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Ischemic Heart Disease ? Interventional Treatment (continued)

PCI Procedure Complications (N = 1482)

2014 Percent 8

6

Cleveland Clinic Comparable ACC-NCDR hospitals

4

2

0 Composite: Death, Emergency

CABG, Stroke, or Repeat Target

Vessel Revascularization

Stroke

Risk-Adjusted Bleeding Event

In 2014, the rates of major vascular complications and stroke associated with PCI procedures at Cleveland Clinic were better than the rates at comparable hospitals. The rate of risk-adjusted bleeding events was slightly higher. Patients at Cleveland Clinic had greater risk factors than patients at similar hospitals. Cleveland Clinic is continuously striving to achieve the best possible outcomes for patients.

Abbreviation: CABG = coronary artery bypass grafting Source: ACC-NCDR database

PCI Procedure, In-Hospital Mortality (N = 1482)

2014

The rate of in-hospital mortality among patients who had PCI procedures at Cleveland Clinic in 2014 was slightly lower compared with rates at comparable hospitals.

Percent 2.0 1.5 1.0 0.5

0

Risk-Adjusted Mortality

Cleveland Clinic Comparable ACC-NCDR hospitals

Source: ACC-NCDR database

Door-to-Balloon Time (N = 45)a

2014 Minutes 100

The American College of Cardiology/American Heart Association (ACC/AHA) guideline for PCI inflation for patients who come to the emergency

80 62

60

60 60

department with ST-elevated myocardial infarction (STEMI) was recently changed from 90 to 60 minutes. Cleveland Clinic continues to improve

40

Cleveland Clinic

door-to-balloon time to reduce the risk of mortality

Comparable

and morbidity. In 2014, the median time at

20

ACC-NCDR hospitals Cleveland Clinic was 62 minutes.

ACC/AHA goal

0

Source: ACC-NCDR database

aA total of 45 patients treated for myocardial infarction at Cleveland Clinic's emergency department met the ACC-NCDR reporting criteria for a primary diagnosis of STEMI. Among these patients, time to reperfusion was 62 minutes.

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Outcomes 2014

PCI Procedures -- Total Chronic Occlusion Technical Success With Hybrid Approach

2014

The risks and complexity of PCI procedures for patients with total chronic occlusion are greater than that of standard PCI. Cleveland Clinic physicians are skilled in these procedures and had greater success rates than did physicians at comparable hospitals in 2014.

Percent 100

80 60 40 20

0

Success Rate

Cleveland Clinic Comparable ACC-NCDR hospitals

Source: ACC-NCDR database

PCI Procedures -- Radial Access (N = 492)

2014

In 2014, Cleveland Clinic performed more PCI procedures using radial access than did other comparable hospitals. The use of radial access is associated with reductions in bleeding complications, readmission rates, infection, and recovery time compared with PCI procedures done using a femoral approach.

Percent 50 40 30 20 10

0

Radial Access

Cleveland Clinic Comparable ACC-NCDR hospitals

Source: ACC-NCDR database

Sydell and Arnold Miller Family Heart & Vascular Institute

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OIsuchtceommicesHeart Disease ? Surgical Treatment

Surgical Treatment for Ischemic Heart Disease (N = 1247)

CABG Volume 2014

Cleveland Clinic surgeons performed 1247 coronary artery bypass graft (CABG) procedures in 2014. A total of 652 were in combination with another procedure and 595 were isolated procedures, including reoperations.

Procedure

Isolated CABG + Other

Volume

595 652

CABG Volume, Primary and Reoperations 2014

The majority of CABG procedures at Cleveland Clinic in 2014 were primary operations. A primary operation is the first time a patient has a particular procedure. Reoperations are repeat procedures and are considerably more complex.

100%

15% Reoperations (N = 182)

85% Primary operations (N = 1065)

CABG + Other, In-Hospital Mortality (N = 652) 2014

In-hospital mortality rates among patients who had CABG surgery plus another procedure at Cleveland Clinic in 2014 (primary and reoperations) were lower than expected.

Percent 6

4

4.2

3.5 2

0 CABG + Other

Expected Cleveland Clinic

Source: Data from the UHC Clinical Data Base/Resource ManagerTM used by permission of UHC. All rights reserved.

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Outcomes 2014

Isolated CABG Procedures, In-Hospital Mortality (N = 595)

2014

Cleveland Clinic surgeons performed 595 isolated CABG procedures in 2014. The overall inpatient hospital mortality rate was 1.2% (N = 7), which was lower than the expected rate of 2.0%.

Volume 600

Percent 5

4

Expected Observed

400

3

2

2.0

200

1

1.2

0

0

2014

Source: Data from the UHC Clinical Data Base/Resource ManagerTM used by permission of UHC.

All rights reserved.

Isolated CABG Procedures, In-Hospital Mortality Primary and Reoperation (N = 595)

2014 Many patients who have CABG reoperations at Cleveland Clinic have very complex medical histories, which creates a higher risk of death. Despite these increased risks, the inpatient hospital mortality rates at Cleveland Clinic were 3.5% (N = 2) for reoperations and 0.7% (N = 4) for primary operations. Both rates were lower than expected. Percent

4

3.8

Expected

3

3.5

Cleveland Clinic

2

1

0.9

0

0.7

Primary

Reoperation

Source: Data from the UHC Clinical Data Base/Resource ManagerTM used by permission of UHC. All rights reserved.

STS CABG Quality Ratings

Overall

Approximately 12% - 15% of US hospitals received the STS "3 star" rating for CABG surgery. This denotes the highest category of quality. In the current analysis of national data covering the period from July 1, 2013, through June 30, 2014, the CABG surgery performance at Cleveland Clinic was found to lie in this highest quality tier, thereby earning the STS 3-star rating.

Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 2014

Sydell and Arnold Miller Family Heart & Vascular Institute

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