The American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository.

Diagnostic cardiac catheterization and percutaneous coronary interventions (PCIs) are critical components of the diagnosis and treatment of patients with coronary artery disease. As the prevalence of heart disease increases in our aging population and increasingly aggressive invasive approaches are developed for the treatment of coronary artery disease, the number of cardiac catheterization procedures performed yearly continues to rise. In the U.S., an estimated 1,194,000 in-patient cardiac catheterizations were performed in 1997 along with nearly 500,000 PCIs (1). Since Andreas Gruentzig performed the first human angioplasty, PCI has rapidly evolved to be a highly successful strategy for achieving myocardial revascularization in patients with coronary artery disease. The PCI mortality rate has decreased in the present era to a fraction of 1%. The number of PCI procedure-related complications leading to myocardial infarction or emergent coronary artery bypass graft surgery has decreased considerably to fewer than 3% each (2). Intracoronary stenting with PCI has taken center stage at the end of the second decade of interventional cardiology. Between 1993 and 1997, stents became commonplace, leading to improved procedural success rates, decreased in-hospital complication rates, and decreased restenosis rates. With the advent of new devices and pharmacological therapies, the risk of adverse outcomes associated with PCI has further decreased. Procedural success rates and complication rates of conventional balloon angioplasty have improved with the introduction of directional coronary atherectomy, rotational atherectomy, extraction atherectomy, and other so-called niche catheter devices. New catheter devices such as filter systems and distal occlusion/aspiration systems are now being introduced. These devices help to minimize periprocedural myocardial infarctions that occur during PCI performed in diseased saphenous vein grafts associated with the release of embolic debris distally in the coronary vasculature. The major drawback of PCI, an unacceptable restenosis rate, is presently being approached with newly developing treatments such as coronary brachytherapy and the use of chemotherapy-eluting stents. For more than 24 years, large-scale registries and databases have been used to accumulate data on PCI and, to a lesser extent, cardiac catheterizations (3). These registries have been used to study patient and procedural characteristics, post-procedure treatments, immediate in-hospital outcomes, and long-term outcomes. Many different analyses of these data have been performed in an effort to improve the quality of care that coronary patients receive. Quality improvements have come about primarily through a greater understanding of the risks and benefits of PCI, both globally for given patient populations and individually for patient procedure risk stratification. This effort has been critical for the original balloon angioplasty procedure and more importantly for the introduction of new devices and the role of PCI in myocardial infarction.