Cardiology Magazine — Summer 2013
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CathPCI: ACC’s Flagship Registry Leading Registry Innovation

“The future of medicine is increasingly in the hands of those who are effective users of clinical data.”

Bill Weintraub, MD, FACC, the “Grandfather” of the NCDR, et al.1

Established in 1998, the CathPCI Registry® is the oldest registry under the ACC’s NCDR umbrella. Designed to assess the characteristics, treatments and outcomes of cardiac disease patients who receive diagnostic catheterization and/or percutaneous coronary intervention (PCI) procedures, the CathPCI Registry has grown into the largest ongoing contemporary database of PCI procedures2.

From Data to Quality Improvement

The genesis of NCDR and the CathPCI Registry started in 1987 with the formation of a Database Committee under the leadership of Suzanne B. Knoebel, MD, MACC3. The College’s first database was designed and run by a third party software vendor. However, the leaders and visionaries of the Database Committee soon recognized that the greatest asset of the program, the database, needed to be an ACC core competency, and in 1997 the NCDR was born.

“Prior to the launch of NCDR, ACC’s early efforts in creating a national catheterization and PCI database weren’t aligned with our hospitals and clinicians needs,” said Ralph G. Brindis, MD, MPH, MACC, senior medical officer of external affairs for the NCDR, a past president of the ACC, and clinical professor of medicine of the department of medicine and the Philip R. Lee Institute for Health Policy Studies at University of California, San Francisco. “Early visions for the database were approached from a research perspective containing well over 400 data elements, which was not very user-friendly for participating hospitals.”

According to Brindis, members of the Database Committee, including leaders like Bill Weintraub, MD, FACC, Chuck McKay MD, FACC, H. Vernon Anderson, MD, FACC, and Dick Shaw PhD, FACC, agreed that the College needed to think about the registry as a quality improvement tool that could adequately capture data for patients who were receiving diagnostic catheterization and/or PCI, one of the most common cardiac procedures in the U.S.

Brindis notes that at the time, many health care experts were debating if metrics, data collection and outcomes analysis could improve the quality of health care. The big question: could benchmarking hospital performance really lead to better patient care? “The development of the CathPCI Registry was the College’s attempt to answer this question,” he said. “We saw an opportunity to learn from one another and take a look at what was happening in cath labs across the country.”

Since then, the CathPCI Registry has grown from a small cadre of 75 visionary hospitals in its first year to more than 1,620 sites representing nearly 90 percent of cardiac catheterization labs in the U.S. Most recently, the registry has gained international traction with sites in Sao Paulo, Brazil, Riyadh, Saudi Arabia, and Abu Dhabi, United Arab Emirates.

Brindis also credits the success and growth of the registry to external influencers like payers, purchasers, the Centers for Medicare and Medicaid Services (CMS) and other specialty cardiovascular societies. For example, the Society for Cardiovascular Angiography and Interventions became an official CathPCI Registry partner in 2007. In addition, the ACC continues to work closely with The Society of Thoracic Surgeons (STS) to ensure data elements between the CathPCI Registry and the STS National Database are aligned.

“Once health plans and local initiatives converted to using the CathPCI as a platform, people started to take notice,” said Brindis. “And it made sense, since the information being captured at local levels typically was without consistent data definitions. Furthermore, those local facilities’ clinical outcomes were not being risk-adjusted. An important ‘tipping point’ for the CathPCI Registry acceptance was the National Quality Forum’s (NQF) approval and endorsement of the NCDR’s in-hospital risk-adjusted mortality outcomes measure. As the registry continued to grow, it offered an opportunity to truly become the benchmarking national standard for our participating hospitals.”

“If You Can’t Measure It You Can’t Manage It”

Peter Drucker

For 15 years, the CathPCI Registry has provided participants with quality benchmarking data on individual hospital performance compared to the national aggregate. To date, the registry’s vast collection of patient data – more than 14 million patient records from participating hospitals, freestanding laboratories and adult cardiology practices – has been used to measure and quantify quality improvement, in order to best manage cardiovascular care across the country and around the globe.

Specifically, CathPCI Registry data has been used to provide a contemporary view of current practice of invasive cardiology in the U.S., including the availability of on-site cardiac surgery, appropriate use of PCIs, patient population and characteristics, and door-to-balloon (D2B) times for primary PCI patients4. Data have played key roles in helping reduce D2B times; controlling costs associated with preventable procedural complications; limiting hospital readmissions; and more. In addition, data from the registry has been used in more than 100 studies published in medical, peer-reviewed journals, and over 60 are currently in the research and publication process.

Data have also been used to develop performance measures such as the NQF endorsed 30-day PCI mortality measure and PCI Risk Adjusted Metrics for Bleeding and Acute Kidney Injury.

Leading the Registry Innovation

Based on the success of the CathPCI Registry, the ACC has since added six additional registries to the NCDR suite of registries, focusing on various aspects of cardiovascular care such as implantable cardioverter-defibrillator implantation, congenital cardiac care, transcatheter aortic valve replacement and more.

“When NCDR first came on the scene, we could not have envisioned using registries the way we are using them today and the way we hope to use them in the future. What we are doing with CathPCI and the other registries in the NCDR, is proof that the answers for truly assessing safety and effectiveness of cardiovascular procedures and devices are well within us,” said Brindis.

A major milestone for the CathPCI Registry was the recent launch of a physician dashboard for ACC members participating at CathPCI Registry hospitals. This free member benefit includes over 40 physician-level metrics generated from CathPCI Registry data and is available through a secure login on

“The dashboard can be used to support quality improvement, volume tracking and Maintenance of Certification activities,” said Issam D. Moussa, MD, FACC, chair of the CathPCI Registry steering committee, and chair of the division of cardiovascular diseases and professor of medicine at Mayo Clinic College of Medicine in Jacksonville, FL. “The physician reports are refreshed quarterly, and represent real-time feedback. They are also done in aggregate, so if a physician is working at multiple hospitals, information on all patients is in one report.”

In addition to the physician-level dashboard, the overall CathPCI Registry outcomes reports have evolved to incorporate appropriate use criteria (AUC) metrics based on the College’s AUC for Coronary Revascularization. As a result of this integration, hospitals can track the appropriateness of PCIs being performed and benchmark their information with other hospitals in the U.S. Additionally, hospitals are able to identify opportunities to improve the selection of patients who receive PCI by using the “institutional rates of procedural appropriateness” data included in the report.

Further, this July, CathPCI participating hospitals were able to voluntarily report their 30-Day PCI readmission measure results on the CMS Hospital Compare website (see sidebar on page 8). “Unplanned readmissions after a PCI reflects patient comorbidities and the quality of care that hospitals provide to patients before, during, and after the procedure,” said Moussa. “Not all readmissions are preventable, but measuring and reporting readmission rates across hospitals can identify where there is room for improvement.”

The College has also been working with various state departments of health, insurance payers and other industry to promote quality of care and is currently working on legislative policies that include the recommendation of participation in registries to improve patient outcomes.

“An overarching goal of the NCDR is to be the preeminent source of information which can help physicians and hospitals deliver high quality and affordable patient care,” said Moussa. “Through the CathPCI Registry, we’ve seen that opportunities to enhance the quality and value of health care delivery do exist.”

Moving forward, Moussa notes that a new version of the CathPCI Registry is being built to address the changes in AUC and additions of other metrics to the registry. In addition, he highlighs the following goals for the registry:

• Serve as a trusted source for quality measurement and quality reporting

• Improve outcomes and appropriate use of treatments and devices

• Enrich and expand ACC/American Heart Association clinical practice guideline recommendations

• Provide device surveillance and pre/post market studies

• Inform coverage decisions

• Assist with meeting maintenance of certification and other continuing medical education requirements

Both Brindis and Moussa caution that achieving these goals will not be without challenges. “Keeping up with the ever-changing pace of the medical knowledge and providing meaningful and timely feedback to the medical community continues to be the biggest challenge moving forward for the registry,” Moussa said.

However, according to Brindis, it has and continues to be an absolute pleasure to watch the ACC’s flagship registry evolve into what it is today. “It’s hard to believe that it was once rare to implement a quality improvement strategy, and I’m incredibly proud of all of our NCDR volunteers and staff and, in particular, our nation’s hospitals and cardiovascular professionals for positioning the College for continuing to be a leader in this regard,” he said.


1. Weintraub, WS, et al. The American College of Cardiology National Database: Progress and Challenges. J Am Coll Cardiol. 1997;29(2):459-465.

2. Baklanov, DV, et al. The Prevalence and Outcomes of Transradial Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Analysis From the National Cardiovascular Data Registry (2007 to 2011). J Am Coll Cardiol. 2013;61(4):420-426.

3. Brindis, RG, et al. The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): Building a National Clinical Data Repository. J Am Coll Cardiol. 2001;37(8):2240-5.

4. Dehmer, GJ, et al. A Contemporary View of Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention in the United States. J Am Coll Cardiol. 2012;60(20):2017–31.

Watch Video Online

Going Local: What Can NCDR Do For You?

In an interview with CardioSource WorldNews, John Rumsfeld, MD, FACC, chair of the NCDR® Management Board and chief science officer of the NCDR, discusses how the NCDR has grown into seven national programs, and what it can do for hospitals and practices at the local level.

“We’re working very hard for the NCDR to have a direct relevance to clinical practice,” notes Rumsfeld. In addition to collecting data and the rich source of information for research, he notes a focus on a tie to education and quality reporting.

He argues that physicians should use their own clinical data as the way their quality is judged, and encourages physicians to sit down with the performance quality improvement managers in their hospitals to review their reports in order to improve outcomes.

Hospitals Nationwide Begin Reporting PCI Readmission Measure Results

As of July 18, more than 300 hospitals participating in the CathPCI Registry® began voluntarily reporting their 30-day all-cause risk-standardized readmission rates following percutaneous coronary intervention (PCI) on the Centers for Medicare and Medicaid Services’ (CMS) Hospital Compare website.

“By publicly reporting, hospitals are pioneering efforts to engage patients in understanding the quality of cardiovascular care being provided in their local communities,” said ACC President John Gordon Harold, MD, MACC, who noted that from Jan. 1, 2010 to Nov. 30, 2011, the overall NCDR CathPCI Registry readmission rate was 11.9 percent.

This voluntary public reporting pilot program is the result of a partnership between the ACC, Yale New Haven Health Services Corporation - Center for Outcomes Research and Evaluation (YNHHSC-CORE), and CMS. The initiative was launched in early 2013 after ACC, YNHHSC-CORE, and CMS collaborated to develop the PCI readmission measure, obtain National Quality Forum endorsement, and determine a path forward for voluntary public reporting. The measure uses methodology that is consistent with other CMS measures currently reported on Hospital Compare for acute myocardial infarction, heart failure, and pneumonia. The PCI readmission measure is unique, however, in that it uses clinical registry data to assess the health of each hospital’s patient population for risk adjustment.

“The PCI voluntary public reporting pilot leverages the existing infrastructure of the ACC’s registries to provide additional quality information to the public,” said Gregory J. Dehmer, MD, FACC, chair of the ACC Public Reporting Advisory Group. “It is aligned with the ACC public reporting principles, which emphasize quality improvement based upon rigorous data, requires reporting that is scientifically valid, includes physician participation, uses standardized data elements, and implements a formal review process.”

Patient-focused information on the measure is available at

STS/ACC TVT Registry Continues to Break New Ground With Launch of IDE Study

The ACC and The Society of Thoracic Surgeons (STS) have come a long way since the launch of the STS/ACC TVT Registry™ more than a year ago. In fact, the two organizations’ efforts to shape the future of this transformational new therapy received another boost this summer with the official launch of an investigational device exemption (IDE) study to assess alternative access approaches for transcatheter aortic valve replacement (TAVR).

The IDE – the first for both the ACC and STS – was granted by the Food and Drug Administration (FDA) this past February. Both organizations worked closely with the FDA, the Centers for Medicare and Medicaid Services (CMS) and Edwards Lifesciences to develop the trial, which will be tracked using the STS/ACC TVT Registry.

“The goal behind the study is to expand the field and extend the benefits of TAVR to broader patient groups,” said former ACC President David Holmes, Jr., MD, MACC. “This should be a model for specialty societies, industry and federal regulators aligning efforts to ensure appropriate patient access to a new technology in a cost-effective and evidence-based way.”

Currently, only the transfemoral approach to TAVR using the Edwards SAPIEN valve and in some cases the transapical approach, have been approved in the U.S. However, an estimated one out of four patients are not eligible for this approach due to inadequate vessel size, vessel disease and/or other anatomical considerations. As part of the IDE study, patients not eligible for aortic valve surgery will receive TAVR through transapical, transaortic, and other non transfemoral approaches. These data will be compared to those of patients in the original PARTNER Cohort A trial who received TAVR through the transapical approach.

At the time the study was approved, Michael Mack, MD, FACC, past president of STS and ACC Board of Trustees member, noted that the goal of the study is controlled off-label use of an approved device. “Specifically, we hope to gain complete and accurate information regarding off-label use that may ultimately lead to label expansion,” he said.

The study represents the next step in the collaboration among professional societies, CMS, the FDA, and medical device manufacturers that resulted in the STS/ACC TVT Registry. According to Mack, the process required all parties to be flexible and innovative while navigating uncharted waters. “This is an iterative process that we hope will allow the safe and timely introduction of new medical device technology to our patients,” he said.

Moving forward, the STS and ACC are working to gain FDA approval to perform two additional studies examining the role of alternative approaches in high-risk patients who are eligible for surgery and valve-in-valve TAVR procedures, respectively. In addition, Holmes notes that collaborations with other international registries have also been initiated.

“We have learned much about TAVR since its approval a little more than a year ago,” said Holmes. “The beauty of the STS/ACC TVT Registry is that we can continue to gain a truly complete picture of the risks and benefits of different approaches to TAVR. Having the data in one place means we can conduct further data analysis for outcome assessment, fulfill regulatory mandates, and potentially identify and implement additional new proposals and protocols to make TAVR accessible to more patients.”

For more information about TAVR, visit the ACC’s TAVR Resource Center at