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[Quality assurance in invasive cardiology: Switzerland]
Insights
Coronary catheterization procedures in Switzerland increased significantly, with notable reductions in associated heart attacks and emergency bypass surgeries. Data suggests university centers may treat more complex cases, potentially impacting complication rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health Surveillance
Context:
- Annual collection and analysis of mortality and morbidity data for coronary catheterization in Switzerland since 1985.
- Inclusion of data from all interventional centers, including university, private, and public non-academic hospitals.
Purpose:
- To analyze trends in diagnostic coronary catheterizations and percutaneous transluminal coronary angioplasty (PTCA).
- To evaluate the incidence of procedure-related complications, including myocardial infarction, emergency coronary artery bypass grafting (CABG), and in-hospital deaths.
- To compare complication rates between university and non-university centers.
Summary:
- A marked increase in diagnostic catheterizations and PTCAs was observed between 1989 and 1994.
- Procedure-related myocardial infarction and emergency CABG rates in PTCA patients decreased significantly over a 5-year period.
- The incidence of myocardial infarction post-PTCA slightly increased, while overall in-hospital death rates also evolved.
Impact:
- Findings suggest improvements in PTCA outcomes, with reduced major complications.
- Higher complication rates in university centers may reflect patient population complexity rather than treatment quality.
- Data likely underestimates true complication rates due to reporting influences; future surveys may consider anonymous data and audits.
Abstract:
In Switzerland, since 1985 mortality and morbidity data concerning either diagnostic and therapeutical coronary catheterization have been annually collected and analyzed. All interventional centres of the country (1994: 5 universities, 9 private and 3 public non academic hospitals) delivered their respective data. While there was a marked increase in diagnostic catheterizations (1989: 11'197, 1994: 20'603) and PTCAs (1989: 1'976, 1994: 5'590), the incidence of procedure related myocardial infarctions, emergency coronary artery bypass graftings (CABG) and in-hospital deaths evolved as shown in table 1 (results separated for university and non-university centres). Procedure related myocardial infarction and emergency CABG rates in patients undergoing PTCA have dropped from 2.1% to 0.9% and 3.1% to 1%, respectively, within 5 years. In the same period of time, the incidence of myocardial infarction after PTCA slightly increased from 0.7% to 0.9%. The higher rates of infarction and death in university hospitals do not necessarily mean poor quality of treatment but may reflect a more complex patient population in these centres. Furthermore, as declaring complications tends to be influenced by the concern of a negative impact on referrals, our data probably underestimate the true complications rates. For future surveys we consider anonymous data presentation and per-sonal audits at the individual centres.