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Leung J, Pender P, French J, Leung D, Mussap C, Asrress K, Taylor D, Naguib BT, Kaddapu K, Gibbs O, Kachwalla H, Nguyen P, Hopkins A, Lo S. Initial Experience with Intravascular Lithotripsy with Shockwave Balloon for Calcified Coronary Lesions During Percutaneous Coronary Intervention (PCI). Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Brachial Artery Flow-Mediated Vasodilation is Related to the Coronary Index of Microcirculatory Resistance in Non-ST Elevation Acute Coronary Syndrome. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Femia G, Ramachandran J, Poon J, Hopkins A, Mussap C, Rajaratnam R, French J, Leung D, Lo S, Juergens C. The Impact of COVID-19 on ST Elevation Myocardial Infarction. Heart Lung Circ 2021. [PMCID: PMC8324111 DOI: 10.1016/j.hlc.2021.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szafron V, Pereira M, Vogel T, Leung D, Forbes-Satter L. M412 A BALANCING ACT: TREATMENT OF COVID-19 AND CYTOMEGALOVIRUS IN A PATIENT WITH PRIMARY IMMUNODEFICIENCY. Ann Allergy Asthma Immunol 2020. [PMCID: PMC7661922 DOI: 10.1016/j.anai.2020.08.359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kim M, Sun Y, Aryal M, Parmar H, Piert M, Rosen B, Mayo C, Balter J, Schipper M, Gabel N, Briceño E, You D, Heth J, Al-Holou W, Umemura Y, Leung D, Junck L, Wahl D, Lawrence T, Cao Y. A Phase II Study of Dose-Intensified Chemoradiation Using Biologically-Based Target Volume Definition in Patients with Newly Diagnosed Glioblastoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nakatsuji T, Hata T, Tong L, Cheng J, Shafiq F, Butcher A, Spergel A, Johnson K, Jepson B, Calatroni A, Taylor P, Leung D, Gallo R. 860 Microbiome therapy of atopic dermatitis by application of rationally selected human commensal skin bacteria. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Graif A, Scott A, Zimmermann T, Kimbiris G, Grilli C, Putnam S, Paik H, Nwosu U, Leung D. 4:12 PM Abstract No. 263 Temporal analysis of heart rate during catheter-directed thrombolysis for acute pulmonary embolism. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Graif A, Kornblum J, McNinch J, Putnam S, Paik H, Grilli C, Kimbiris G, Agriantonis D, Leung D. 3:09 PM Abstract No. 256 Comparison of endovascular and noninvasive therapies in acute pulmonary embolism: a PERT experience. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. 805 Clopidogrel Versus Ticagrelor on Coronary Microvascular and Peripheral Endothelial Function After Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS): Results of a Randomised Trial. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nayyar D, Leung D, Aty W, Premawardhana U, Kadappu K. 422 Transoesophageal Echocardiography in Diagnosing Acute Aortic Dissection not Evident on CT Aortogram. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. P2708Clopidogrel versus ticagrelor on coronary microvascular and peripheral endothelial function after non-ST elevation acute coronary syndrome: a randomised trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ticagrelor has been shown to reduce microvascular injury and improve peripheral endothelial function compared to clopidogrel in ST-elevation myocardial infarction and stable patients. However, comparable data is lacking in non-ST elevation acute coronary syndromes (NSTE-ACS).
Purpose
To investigate the effects of clopidogrel versus ticagrelor on coronary microvascular function and peripheral endothelial function in NSTE-ACS patients.
Methods
Patients hospitalised for NSTE-ACS were prospectively randomised 1:1 to clopidogrel (300mg loading then 75mg daily) or ticagrelor (180mg loading then 90mg twice-daily). Coronary microvascular function was assessed with index of microcirculatory resistance (IMR) in the infarct related artery (IRA) and non-IRA before and after percutaneous coronary intervention (PCI) using a standard pressure-temperature coronary wire. Peripheral endothelial function was assessed with flow-mediated vasodilation (FMD) of the brachial artery, performed on admission prior to antiplatelet loading and again before discharge, using a pneumatic cuff and 10MHz linear ultrasound transducer.
Results
A total of 40 patients were included for analysis (Figure 1). Median age was 53.5 (IQR 49.0–61.5) years, 35 (87.5%) were male, 11 (27.5%) had diabetes, 19 (47.5%) were smokers. Median peak troponin T was 527 (175–1006.5) ng/L, median GRACE score 91.5 (78.3–103.3) and median SYNTAX score 13 (6–20). Baseline characteristics were similar between both groups. There was no significant difference in the median baseline IMR between the 2 groups in both the IRA (clopidogrel 14.4 [IQR 12.2–18.6] vs ticagrelor 20.8 [11.3–27.4], p=0.22) and non-IRA (14.0 [11.0–22.0] vs 14.0 [10.0–29.5] respectively, p=0.74). 28 patients underwent PCI to the IRA (12 clopidogrel, 16 ticagrelor). There was no significant difference in the median post-PCI IMR between the 2 groups (19.5 [14.5–24.5] vs 29.0 [19.0–35.6] respectively, p=0.11). However, there was significant worsening of post-PCI compared with pre-PCI IMR (19.5 vs 15.0, p=0.049) in the clopidogrel group but not in the ticagrelor group (29.0 vs 25.4, p=0.47). FMD was performed in 23 patients (9 clopidogrel, 14 ticagrelor). Admission median %FMD (change in post-stimulus diameter as a percentage of the baseline diameter) was similar between the 2 groups (13.2% [10.1–17.6] vs 12.2% [10.2–15.8] respectively, p=0.41). There was a trend towards higher median pre-discharge %FMD in the ticagrelor group (12.8% [12.2–18.0]) compared to the clopidogrel group (10.4% [9.5–11.2], p=0.09). There was a trend towards lower pre-discharge %FMD compared to admission in the clopidogrel group (10.4% vs 13.2%, p=0.05) but not the ticagrelor group (12.8% vs 12.2%, p=0.43).
Figure 1
Conclusions
In our NSTE-ACS patients undergoing PCI, ticagrelor resulted in less disruption of coronary microvascular function and may also have beneficial effects on peripheral endothelial function compared to clopidogrel.
Acknowledgement/Funding
Dr. James Xu is funded by a post-graduate scholarship from the Australian Government Research Training Program (RTP)
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Vance A, Chohan O, Chedrawy C, Graif A, McKenna G, Garcia M, Kimbiris G, Grilli C, Leung D. 03:18 PM Abstract No. 95 May-Thurner and beyond: subclassification of iliac vein compression related to overlying arterial vasculature. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Xu J, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Intravascular Ultrasound (IVUS) Analysis of Intensive Plaque Modification with Rotational Atherectomy with or without Adjunctive Cutting Balloon for Extremely Calcified Coronary Lesions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Kee A, Rajaratnam R, Leung D, French J, Juergens C. Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) - A Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pender P, Faour A, Gibbs O, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Use of Mechanical Cardiac Support (MCS) for ST-elevated Myocardial Infarction with Cardiogenic Shock(STEMI-CS) in a Non-transplant Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huynh Q, Negishi K, De Pasquale C, Hare J, Leung D, Stanton T, Marwick T. Cognitive Domains and Post-Discharge Outcomes in Hospitalised Patients With Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Clopidogrel Versus Ticagrelor on Coronary Microvascular Function After Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Randomised Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Assad J, Pender P, Faour A, Leung D, Rajaratnam R, Mussap C, Juergens C, Lo S. Pericardiocentesis for Pericardial Effusion – a Single Centre Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pender P, Gibbs O, Faour A, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Mechanical Circulatory Support for Semi – elective PCI in High-risk Patients with Extracorporeal Membranous Oxygenation (ECMO) Compared to Impella Heart Pump Device. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Leung D, Wong G. AWARENESS AND ANXIETY IN HELP-SEEKERS FOR DEMENTIA ASSESSMENT SERVICE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leung D, Cheung P, Cheuk M, Dorsch M, Jones A. P1489Sustained long term benefits after alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: a single centre experience. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chedrawy C, Graif A, Leung D, Agriantonis D, Nwosu U, Vance A, Kimbiris G, Garcia M, Putnam S, Lie K, Grilli C. 3:18 PM Abstract No. 353 Nitinol self-expanding stents for the treatment of chronic iliofemoral veno-occlusive disease. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Graif A, Chedrawy C, Vance A, Kimbiris G, Grilli C, Agriantonis D, Leung D. 3:18 PM Abstract No. 223 Catheter-directed thrombolysis for acute pulmonary embolism in 132 patients: a single-center experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vance A, Graif A, Grilli C, Nwosu U, Liao M, Agriantonis D, Kimbiris G, Garcia M, Leung D. Abstract No. 639 Outcome of iliocaval stent-assisted reconstruction in patients with chronic obstruction of the inferior vena cava. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Tran J, Ng A, Chan O, Leung D, Leung M. The Long-Term Prognostic Values of Left Ventricular Function and Dyssynchrony After a Non-ST Elevation Myocardial Infarction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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