[Quality assurance in the clinic--an example of interventional cardiology]

Beginning in October 1992, all PTCAs from more than 70 German hospitals were gathered in a central registry of the Working Group of the Leading Hospital Physicians in Cardiology in an intention to treat analysis. Each centre was visited twice a year and the local records were compared with the procedures entered into the registry to ensure completeness of the data. In selected patients, a quality control was performed by expert rating regarding the technical performance and the indication for the intervention. Additional registries about primary PTCA in patients with acute myocardial infarction and stent implantations were initiated in 1994 and 1995. Completeness of the registries was more than 98% and more than 150,000 PTCA procedures, more than 5,000 PTCAs in acute myocardial infarction and more than 35,000 stent implantations were entered into the specific registries until April 1998. These data demonstrate that a complete registration and monitoring of procedural outcome is feasible even in high volume procedures such as PTCA. A still unresolved problem is the determination of the appropriateness of the indication for an intervention. However, this part of quality control is very important in interventional cardiology and therefore methods to assess the quality of indications have to be elaborated.