NIC Registry Proforma-2010
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Transcript of NIC Registry Proforma-2010
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NATIONAL INTERVENTIONAL C,OUNCILCARDIOLOGICAL SOCIETY OF INDIA
REGISTRY PERFORMAfor
Coronary, Non-Coronary & Peripheral InterventionsPeriod
from JAN 2010 to Dee 2010.
From:On behalf of Nationallnterventional CounciloJVS Technologies Pvt. Ltd.
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Chairman - Nationallnterventional CouncilDr. H. M. MardikarDirector, Spandan Heart Institute & Research CenterDhantoli, Nagpur - 12Tel: 0712 - 2443333, 6453333, Mobile: 09823082609Email: [email protected]
ConvenorsCoronary InterventionDr. P. P.MohananDirector, West Fort Hitech HospitalThrissur
Peripheral InterventionDr. N. N. KhannaIndraprastha Apollo HospitalNew Delhi
Congenital Heart DiseaseDr. Bharat V. DalviNanavati Hospital,Mumbai
Non Coronary InterventionDr. Prasanna NyayadhishKEM HospitalMumbai
Rheumatic Heart DiseaseDr. Satyanarayan Routray
8CB Medical College,Cuttack
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NIC RegistryPERFORMA FOR THE YEAR 2010 (JAN - DEC)Name of HospitalAddress
Contact No(s)Form Filled byDateName of Interventional Cardiolo1.2. 4.
Total number of PCls durinGenderAge Group
Procedure approach
Vessels treated
Vessels Distribution
Stent DetailsName & No. of DES1.2.3.
TotalTotal No. of Drug EI
Name &No(S)14.No(s) 5.No(s) 6.
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II B/IIIA BlockerABCIXIMAB (REOPRO)
. No(s)No(s)No(s) No(s)No(s)1. IIB/IIIA BLOCKER No(s)No(s)No(s)TED
No(s)No(s)MaleNo(s)No(s)
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NIC Registry Section BNon -Coronary InterventionsloplastyMean ageBalloon used - Accura/ Inoue/ Double balloon/Jomiva/others( specify)Average balloon sizeComplicationsMR requiring MVR (Percentage) Aortic ValvuloplastyMean ageBalloon usedAverage balloon sizeComplicationsAR (More than moderate) Pulmonary ValvuloplastyMean ageBalloon usedAverage balloon sizeComplications Tricuspid ValvuloplastyMean ageBalloon usedAverage balloon sizeComplications Aortic Procedures
Mean AgeNumberLocationl / standalone) Devices usedBalloon
Mean AgeNumberge balloon sizeII II II
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NIC Registry Section CPeripheralInterventions NumberComplicationsealNumberComplicationsNumberDistal protection use(%)RenalNumberComplicationslosureNumber- succeeded) TEE useAverage device size Complications
MI VSD also separately)Mean AgeNumber/ succeeded) TEE useComplications/CoilNumberAverage device sizelosure Multiple coilsPercentage successOther shunts(AP window/ CAVF/RSOV)al Number IDevice used Nos.Nos.Nos.r'Nos., {Nos. Nos.
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Instructions~ Please fill all form with complete and accurate Gala 0; proceduresperformed during 1st January, 2010 to 31 st Decemberj 2
~ For any assistance in filling up the forms, call Mr. Saket Singhi on+91 9825528002. Or email [email protected].~ Please send your completed forms to below address by post or email:Scanned copy.Post:
E-mail:
JVS Technologies Pvt. Ltd.B-101, Nirman Complex,Opp. Havmor, Navrangpura,Ahmedabad - 380009 (Gujarat)Phone: 079-30023120saket@ jvsgroup.com
~ If you have any questions, please contact Dr. P.P.Mohanan on+91 9846076006.~ Please note your completed forms must reach us by
25th March, 2011 in order to include them in the registry.
