Mühlberger V, Klein W, Mlczoch J, Probst P
Invasive Interventionelle Kardiologie, Universitätsklinik für Innere Medizin, Innsbruck, Osterreich.
Z Kardiol. 1996 Sep;85(9):647-55.
A complete National Database is the prerequisite for quality control, quality management and improvement. In Austria, we have been reaching for this goal since more than three years. 21 094 diagnostic coronary angiographies (CA) and 4934 PTCAs were performed in all 27 centers (out of which 17 perform PTCA) in Austria during the year 1994. This is a reduction of 3.2% concerning CA and an 8.6% increase in PTCA compared to 1993. 48% of all PTCAs were done during the diagnostic study (CA), multivessel PTCA in 11%, direct PTCA for ongoing infarction in 2.3%. Concerning "new devices", 437 stents (182 during the year 1993) were implanted in 1994; also all 73 cases with rotablator, 105 with intracoronary ultrasound, and 26 directional coronary atherectomies (DCA) are documented. Hospital mortality after PTCA was 0.5% (unchanged from the years 1992 and 1993), emergency bypass surgery rate after PTCA was 1.2% (0.7% during the year 1993), and 1.4% of the patients suffered a myocardial infarction in the cathlab (1.2% during 1993). International comparison shows Austria among the top nations with 2637 CA and 617 PTCA per million inhabitants, corresponding to a ratio of 23% PTCA per 100 CA. Risk adjustment (exercise stress test pre PTCA documented in six cath-labs in 1993, compared to 11 in 1994. Type of stenosis (A, B, C) in five labs in 1993 and in 12 labs in 1994) and outcome control (exercise stress test 3 months after PTCA documented in five cath-labs in 1993, compared to 10 in 1994) are subject to constant improvement of our yearly monitor visits and feedback reaction. Austria is the only nation worldwide to support a complete national database with controlled numbers and parameters since more than 3 years, including yearly monitor visits (Internet address for the 1995 data: http@info.uibk.ac.at/gin/org/i_iik.stu/i_iik+ ++.htm) and feedback reports. We experienced no single negative reaction to our activities, but find them necessary for further quality management targets.
完整的国家数据库是质量控制、质量管理及改进的前提条件。在奥地利，我们为实现这一目标已努力了三年多。1994年，奥地利所有27个中心（其中17个中心进行经皮冠状动脉腔内血管成形术（PTCA））共进行了21094例诊断性冠状动脉造影（CA）和4934例PTCA。与1993年相比，CA减少了3.2%，PTCA增加了8.6%。所有PTCA中有48%是在诊断性研究（CA）期间进行的，11%为多支血管PTCA，2.3%为针对持续性心肌梗死的直接PTCA。关于“新设备”，1994年植入了437个支架（1993年为182个）；同时还记录了所有73例使用旋切器、105例使用冠状动脉内超声以及26例定向冠状动脉斑块旋切术（DCA）的病例。PTCA后的医院死亡率为0.5%（与1992年和1993年持平），PTCA后的急诊搭桥手术率为1.2%（1993年为0.7%），1.4%的患者在导管室发生心肌梗死（1993年为1.2%）。国际比较显示，奥地利以每百万居民2637例CA和617例PTCA位居前列，相当于每100例CA中有23%为PTCA。风险调整（1993年6个导管室记录了PTCA前的运动负荷试验，1994年为11个；1993年5个实验室和1994年12个实验室记录了狭窄类型（A、B、C））以及结果控制（1993年5个导管室记录了PTCA后3个月的运动负荷试验，1994年为10个）在我们每年的监测访问和反馈反应中不断改进。奥地利是全球唯一一个三年多来一直支持拥有可控数量和参数的完整国家数据库的国家，包括年度监测访问（1995年数据的互联网地址：http@info.uibk.ac.at/gin/org/i_iik.stu/i_iik+ ++.htm）和反馈报告。我们的活动没有收到任何负面反应，但我们认为这些活动对于进一步实现质量管理目标是必要的。
