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Zheng WC, Evans N, Dinh D, Bloom JE, Brennan AL, Ball J, Lefkovits J, Shaw JA, Reid CM, Chan W, Stub D. Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2024:S1443-9506(24)00073-8. [PMID: 38565437 DOI: 10.1016/j.hlc.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. METHOD Between 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m2) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)-composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke. RESULTS RT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality. CONCLUSIONS RT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.
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Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Nicole Evans
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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D'Elia N, Vogrin S, Brennan AL, Dinh D, Lefkovits J, Reid CM, Stub D, Bloom J, Haji K, Noaman S, Kaye DM, Cox N, Chan W. Electrocardiographic patterns and clinical outcomes of acute coronary syndrome cardiogenic shock in patients undergoing percutaneous coronary intervention - A propensity score analysis. Cardiovasc Revasc Med 2024:S1553-8389(24)00075-7. [PMID: 38448259 DOI: 10.1016/j.carrev.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To determine the influence of presenting electrocardiographic (ECG) changes on prognosis in acute coronary syndrome cardiogenic shock (ACS-CS) patients undergoing percutaneous coronary angiography (PCI). BACKGROUND The effect of initial ECG changes such as ST-elevation myocardial infarction (STEMI) versus non-STEMI among patients ACS-CS on prognosis remains unclear. METHODS We analysed data from consecutive patients with ACS-CS enrolled in the Victorian Cardiac Outcomes registry between 2014 and 2020. Inverse probability of treatment weighting analysis (IPTW) was used to assess the effect of ECG changes on 30-day mortality. RESULTS Of 1564 patients with ACS-CS who underwent PCI, 161 had non-STEMI and 1403 had STEMI on ECG. The mean age was 66 ± 13 years, and 74 % (1152) were males. Patients with non-STEMI compared to STEMI were older (70 ± 12 vs 65 ± 13 years), had higher rates of diabetes (34 % vs 21 %), prior coronary artery bypass graft surgery (14 % vs 3.3 %), peripheral arterial disease (10.6 % vs 4.1 %, p < 0.01), and lower baseline eGFR (53.8 [37.1, 75.4] vs 65.3 [46.3, 87.8] ml/min/1.73m2), all p ≤ 0.01. Non-STEMI patients were more likely to have a culprit left circumflex artery (29 % vs 20 %) and more often underwent multivessel percutaneous coronary intervention (30 % vs 20 %) but had lower rates of out-of-hospital cardiac arrest (21 % vs 39 %), all p ≤ 0.01. Propensity score analysis with IPTW confirmed that non-STEMI ECG was associated with lower odds for 30-day all-cause mortality (OR 0.47 [0.32, 0.69], p < 0.001), and 30-day major adverse cardiovascular and cerebrovascular events (OR 0.48 [0.33, 0.70]). CONCLUSIONS In patients undergoing PCI, Non-STEMI as compared to STEMI on index ECG was associated with approximately half the relative risk of both 30-day mortality and 30-day MACCE and could be a useful variable to integrate in ACS-CS risk scores.
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Affiliation(s)
- Nicholas D'Elia
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Western Health Department of Cardiology, Victoria, Australia; School Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Jason Bloom
- Baker Heart and Diabetes Institute, Victoria, Australia
| | - Kawa Haji
- Western Health Department of Cardiology, Victoria, Australia
| | - Samer Noaman
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - David M Kaye
- Baker Heart and Diabetes Institute, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia
| | - Nicholas Cox
- Western Health Department of Cardiology, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia
| | - William Chan
- Western Health Department of Cardiology, Victoria, Australia; Baker Heart and Diabetes Institute, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Victoria, Australia; Department of Medicine, Western Health, University of Melbourne, St Albans, Victoria, Australia.
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Zheng WC, Dinh D, Noaman S, Bloom JE, Batchelor RJ, Lefkovits J, Brennan AL, Reid CM, Al-Mukhtar O, Shaw JA, Stub D, Yang Y, French C, Kaye DM, Cox N, Chan W. Effect of Concomitant Cardiac Arrest on Outcomes in Patients With Acute Coronary Syndrome-Related Cardiogenic Shock. Am J Cardiol 2023; 204:104-114. [PMID: 37541146 DOI: 10.1016/j.amjcard.2023.06.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
Patients with acute coronary syndrome (ACS)-related cardiogenic shock (CS) with or without concomitant CA may have disparate prognoses. We compared clinical characteristics and outcomes of patients with CS secondary to ACS with and without cardiac arrest (CA). Between 2014 and 2020, 1,573 patients with ACS-related CS with or without CA who underwent percutaneous coronary intervention enrolled in a multicenter Australian registry were analyzed. Primary outcome was 30-day major adverse cardiovascular and cerebrovascular events (MACCE) (composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularization and stroke). Long-term mortality was obtained through linkage to the National Death Index. Compared with the no-CA group (n = 769, 49%), the CA group (n = 804, 51%) was younger (62 vs 69 years, p <0.001) and had fewer comorbidities. Patients with CA more frequently had ST-elevation myocardial infarction (92% vs 86%), occluded left anterior descending artery (43% vs 33%), and severe preprocedural renal impairment (49% vs 42%) (all p <0.001). CA increased risk of 30-day MACCE by 45% (odds ratio 1.45, 95% confidence interval 1.05 to 2.00, p = 0.024) after adjustment. CA group had higher 30-day MACCE (55% vs 42%, p <0.001) and mortality (52% vs 37%, p <0.001). Three-year survival was lower for CA compared with no-CA patients (43% vs 52%, p <0.001). In Cox regression, CS with CA was associated with a trend toward greater long-term mortality hazard (hazard ratio 1.19, 95% confidence interval 1.00 to 1.41, p = 0.055). In conclusion, concomitant CA among patients with ACS-related CS conferred a particularly heightened short-term risk with a diminishing legacy effect over time for mortality. CS survivors continue to exhibit high sustained long-term mortality hazard regardless of CA status.
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Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Riley J Batchelor
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Monash Health, Melbourne, Victoria, Australia
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yang Yang
- Department of Intensive Care, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Craig French
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Department of Intensive Care, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia; Clinical Research Domain, The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
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Lee P, Brennan AL, Stub D, Dinh DT, Lefkovits J, Reid CM, Zomer E, Liew D. Estimating the cost-effectiveness and return on investment of the Victorian Cardiac Outcomes Registry in Australia: a minimum threshold analysis. BMJ Open 2023; 13:e066106. [PMID: 37185178 PMCID: PMC10151970 DOI: 10.1136/bmjopen-2022-066106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES We sought to establish the minimum level of clinical benefit attributable to the Victorian Cardiac Outcomes Registry (VCOR) for the registry to be cost-effective. DESIGN A modelled cost-effectiveness study of VCOR was conducted from the Australian healthcare system and societal perspectives. SETTING Observed deaths and costs attributed to coronary heart disease (CHD) over a 5-year period (2014-2018) were compared with deaths and costs arising from a hypothetical situation which assumed that VCOR did not exist. Data from the Australian Bureau of Statistics and published sources were used to construct a decision analytic life table model to simulate the follow-up of Victorians aged ≥25 years for 5 years, or until death. The assumed contribution of VCOR to the proportional change in CHD mortality trend observed over the study period was varied to quantify the minimum level of clinical benefits required for the registry to be cost-effective. The marginal costs of VCOR operation and years of life saved (YoLS) were estimated. PRIMARY OUTCOME MEASURES The return on investment (ROI) ratio and the incremental cost-effectiveness ratio (ICER). RESULTS The minimum proportional change in CHD mortality attributed to VCOR required for the registry to be considered cost-effective was 0.125%. Assuming this clinical benefit, a net return of $A4.30 for every dollar invested in VCOR was estimated (ROI ratio over 5 years: 4.3 (95% CI 3.6 to 5.0)). The ICER estimated for VCOR was $A49 616 (95% CI $A42 228 to $A59 608) per YoLS. Sensitivity analyses found that the model was sensitive to the time horizon assumed and the extent of registry contribution to CHD mortality trends. CONCLUSIONS VCOR is likely cost-effective and represents a sound investment for the Victorian healthcare system. Our evaluation highlights the value of clinical quality registries in Australia.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiology Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Cardiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Doherty DA, Tong SYC, Reilly J, Shrapnel J, McDonald S, Ahern S, Harris I, Tam CS, Brennan AL, Hodgson C, Wilcox L, Balagurunathan A, Butcher BE, Reid CM. Registry randomised trials: a methodological perspective. BMJ Open 2023; 13:e068057. [PMID: 36858472 PMCID: PMC9980340 DOI: 10.1136/bmjopen-2022-068057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Registry randomised clinical trials (RRCTs) have the potential to provide pragmatic answers to important clinical questions. RRCTs can be embedded into large population-based registries or smaller single site registries to provide timely answers at a reduced cost compared with traditional randomised controlled trials. RRCTs can take a number of forms in addition to the traditional individual-level randomised trial, including parallel group trials, platform or adaptive trials, cluster randomised trials and cluster randomised stepped-wedge trials. From an implementation perspective, initially it is advantageous to embed RRCT into well-established registries as these have typically already overcome any issues with end point validation and adjudication. With advances in data linkage and data quality, RRCTs can play an important role in answering clinical questions in a pragmatic, cost-effective way.
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Affiliation(s)
- Dorota A Doherty
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Biostatistics and Research Design Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Steven Y C Tong
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Menzies School of Health Research, Casuarina, Nothern Territory, Australia
| | - Jennifer Reilly
- Anaesthesiology & Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Shrapnel
- The Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Stephen McDonald
- Central Northern Adelaide Dialysis, The University of Adelaide, Adelaide, South Australia, Australia
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ian Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Charmaine S Tam
- Northern Clinical School, Centre for Translational Data Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Leonie Wilcox
- Australasian Bone Marrow Transplant Recipient Registry, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | | | - Belinda E Butcher
- WriteSource Medical Pty Ltd, Lane Cove, New South Wales, Australia
- University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
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Hamilton GW, Dinh D, Yeoh J, Brennan AL, Fulcher J, Koshy AN, Yudi MB, Reid CM, Hare DL, Freeman M, Stub D, Chan W, Duffy SJ, Ajani A, Raman J, Farouque O, Clark DJ. Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:457-467. [PMID: 36858666 DOI: 10.1016/j.jcin.2022.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft. OBJECTIVES The aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI. METHODS This study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality. RESULTS Overall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non-ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality. CONCLUSIONS Presenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. https://twitter.com/GarryHamilton6
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; School of Population Health, Curtin University, Perth, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - William Chan
- Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Jaishankar Raman
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
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Reid CM, Chih H, Duffy SJ, Brennan AL, Ajani AE, Beltrame J, Tavella R, Yan BP, Dinh D, Chin CT, Do LD, Nguyen QN, Nguyen HTT, Wijaya IP, Yamin M, Rusdi L, Alwi I, Sim KH, Yip Fong AY, Wan Ahmad WA, Yeo KK. Harmonising Individual Patient Level Cardiac Registry Data Across the Asia Pacific Region-A Feasibility Study of In-Hospital Outcomes of STEMI Patients From the Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Network. Heart Lung Circ 2023; 32:166-174. [PMID: 36272954 DOI: 10.1016/j.hlc.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/30/2022] [Accepted: 08/02/2022] [Indexed: 03/04/2023]
Abstract
OBJECTIVE The Asia-Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration was established to inform on percutaneous coronary intervention (PCI) in the Asia-Pacific Region. Our aims were to (i) determine the operational requirements to assemble an international individual patient dataset and validate the processes of governance, data quality and data security, and subsequently (ii) describe the characteristics and outcomes for ST-elevation myocardial infarction (STEMI) patients undergoing PCI in the ASPECT registry. METHODS Seven (7) ASPECT members were approached to provide a harmonised anonymised dataset from their local registry. Patient characteristics were summarised and associations between the characteristics and in-hospital outcomes for STEMI patients were analysed. RESULTS Six (6) participating sites (86%) provided governance approvals for the collation of individual anonymised patient data from 2015 to 2017. Five (5) sites (83%) provided >90% of agreed data elements and 68% of the collated elements had <10% missingness. From the registry (n=12,620), 84% were male. The mean age was 59.2±12.3 years. The Malaysian cohort had a high prevalence of previous myocardial infarction (34%), almost twice that of any other sites (p<0.001). Adverse in-hospital outcomes were the lowest in Hong Kong whilst in-hospital mortality varied from 2.7% in Vietnam to 7.9% in Singapore. CONCLUSIONS Governance approvals for the collation of individual patient anonymised data was achieved with a high level of data alignment. Secure data transfer process and repository were established. Patient characteristics and presentation varied significantly across the Asia-Pacific region with this likely to be a major predictor of variations in the clinical outcomes observed across the region.
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Affiliation(s)
- Christopher M Reid
- School of Population Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
| | - HuiJun Chih
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Stephen J Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Andrew E Ajani
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - John Beltrame
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Rosanna Tavella
- Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Bryan P Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong SAR, China
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Chee Tang Chin
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Loi Doan Do
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Hoai T T Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Ika Prasetya Wijaya
- Cipto Mangunkusumo National General Hospital, Universitas Indonesia Medical School, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Muhammad Yamin
- Cipto Mangunkusumo National General Hospital, Universitas Indonesia Medical School, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Lusiani Rusdi
- Cipto Mangunkusumo National General Hospital, Universitas Indonesia Medical School, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Idrus Alwi
- Cipto Mangunkusumo National General Hospital, Universitas Indonesia Medical School, Jalan Pangeran Diponegoro, Jakarta, Indonesia
| | - Kui Hian Sim
- Sarawak Heart Centre, Sarawak, Malaysia; National Heart Association of Malaysia, Kuala Lumpur, Malaysia
| | - Alan Yean Yip Fong
- Sarawak Heart Centre, Sarawak, Malaysia; National Heart Association of Malaysia, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- National Heart Association of Malaysia, Kuala Lumpur, Malaysia; University of Malaya Medical Centre, Jalan Universiti, Selangor, Malaysia
| | - Khung Keong Yeo
- National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
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8
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Wong MYZ, Yap JJL, Chih HJ, Yan BPY, Fong AYY, Beltrame JF, Wijaya IP, Nguyen HTT, Brennan AL, Reid CM, Yeo KK. Regional differences in percutaneous coronary intervention outcomes in STEMI patients with diabetes: The Asia-Pacific evaluation of cardiovascular therapies (ASPECT) collaboration. Int J Cardiol 2023; 371:84-91. [PMID: 36220505 DOI: 10.1016/j.ijcard.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Diabetes is associated with poorer outcomes and increased complication rates in STEMI patients undergoing percutaneous coronary intervention (PCI). Data are notably lacking in the Asia-Pacific region. We report the overall association of Diabetes with clinical characteristics and outcomes in STEMI patients undergoing PCI across the Asia-Pacific, with a particular focus on regional differences. METHODOLOGY The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration consists of data from various PCI registries across Australia, Hong Kong, Singapore, Malaysia, Indonesia and Vietnam. Clinical characteristics, lesion characteristics, and outcomes were provided for STEMI patients. Key outcomes included 30-day overall mortality and major adverse cardiovascular events (MACE). RESULTS A total of 12,144 STEMI patients (mean(SD) age 59.3(12.3)) were included, of which 3912 (32.2%) had diabetes. Patients with diabetes were likely to have a higher baseline risk profile, poorer clinical presentation, and more complex lesion patterns (all p < 0.05). Across all regions, patients with diabetes had a higher rate of 30-day mortality and MACE (all p < 0.05). After multivariable adjustment, diabetes was significantly associated with both increased 30-day mortality (9.6%vs 5.5%, OR 1.79 [95% CI 1.40-2.30]) and MACE (13.3% vs 8.6%, R 1.73 [1.44-2.08]). The association between diabetes and 30-day MACE varied by region (pinteraction = 0.041), with the association (OR) ranging from 1.34 [1.08-1.67] in Malaysia, to 2.39 [1.66-3.45] in Singapore. CONCLUSIONS Diabetes portends poorer clinical outcomes in STEMI patients undergoing PCI in the Asia-Pacific with regional variations noted. The development of effective preventative measures and interventional strategies targetted at this high-risk group is crucial.
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Affiliation(s)
- Mark Y Z Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan J L Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | - Hui Jun Chih
- School of Population Health, Curtin University, Perth, Australia
| | - Bryan P Y Yan
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - John F Beltrame
- Coronary Angiography Registry Database of South Australia (CARDOSA) registries, Australia
| | - Ika Prasetya Wijaya
- Cardiology Division, Universitas Indonesia, Ciptomangunkusumo General Hospital, Indonesia
| | - Hoai T T Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Viet Nam
| | - Angela L Brennan
- Melbourne Interventional Group, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Christopher M Reid
- School of Population Health, Curtin University, Perth, Australia; Melbourne Interventional Group, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-NUS Medical School, Singapore.
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9
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Wexler NZ, Vogrin S, Brennan AL, Noaman S, Al-Mukhtar O, Haji K, Bloom JE, Dinh DT, Zheng WC, Shaw JA, Duffy SJ, Lefkovits J, Reid CM, Stub D, Kaye DM, Cox N, Chan W. Adverse Impact of Peri-Procedural Stroke in Patients Who Underwent Percutaneous Coronary Intervention. Am J Cardiol 2022; 181:18-24. [PMID: 35999069 DOI: 10.1016/j.amjcard.2022.06.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 11/01/2022]
Abstract
Peri-procedural stroke (PPS) is an important complication in patients who underwent percutaneous coronary intervention (PCI). The extent to which PPS impacts mortality and outcomes remains to be defined. Consecutive patients who underwent PCI enrolled in the Victorian Cardiac Outcomes Registry (2014 to 2018) were categorized into PPS and no PPS groups. The primary outcome was 30-day major adverse cardiovascular events (MACEs) (composite of mortality, myocardial infarction, stent thrombosis, and unplanned revascularization). Of 50,300 patients, PPS occurred in 0.26% patients (n = 133) (71% ischemic, and 29% hemorrhagic etiology). Patients who developed PPS were older (69 vs 66 years) compared with patients with no PPS, and more likely to have pre-existing heart failure (59% vs 29%), chronic kidney disease (33% vs 20%), and previous cerebrovascular disease (13% vs 3.6%), p <0.01. Among those with PPS, there was a higher frequency of presentation with ST-elevation myocardial infarction (49% vs 18%) and out-of-hospital cardiac arrest (14% vs 2.2%), PCI by way of femoral access (59% vs 46%), and adjunctive thrombus aspiration (12% vs 3.6%), all p = <0.001. PPS was associated with incident 30-day MACE (odds ratio [OR] 2.97, 95% confidence intervals [CIs] 1.86 to 4.74, p <0.001) after multivariable adjustment. Utilizing inverse probability of treatment weighting analysis, PPS remained predictive of 30-day MACE (OR 1.91, 95% CI 1.31 to 2.80, p = 0.001) driven by higher 30-day mortality (OR 2.0, 95% CI 1.35 to 2.96, p = 0.001). In conclusion, in this large, multi-center registry, the incidence of PPS was low; however, its clinical sequelae were significant, with a twofold increased risk of 30-day MACE and all-cause death.
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Affiliation(s)
- Noah Z Wexler
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Samer Noaman
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Kawa Haji
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - James A Shaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; The Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Curtain School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
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10
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Cartledge S, Driscoll A, Dinh D, O'Neil A, Thomas E, Brennan AL, Liew D, Lefkovits J, Stub D. Trends and Predictors of Cardiac Rehabilitation Referral Following Percutaneous Coronary Intervention: A Prospective, Multi-Site Study of 41,739 Patients From the Victorian Cardiac Outcomes Registry (2017-2020). Heart Lung Circ 2022; 31:1247-1254. [PMID: 35643797 DOI: 10.1016/j.hlc.2022.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/30/2022] [Accepted: 04/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Following percutaneous coronary intervention (PCI), outpatient cardiac rehabilitation (CR) is essential for secondary prevention. However uptake of CR is suboptimal, despite strong evidence demonstrating benefits. The aim of this study was to identify contemporary trends and predictors of CR referral of PCI patients in Victoria. METHODS A prospective, observational study using data extracted from the Victorian Cardiac Outcomes Registry was undertaken. A total of 41,739 patients were discharged following PCI over the study period (2017-2020) and included for analysis. RESULTS Cardiac rehabilitation referral was 85%, with an increasing trend over time (p<0.001). Multivariable modelling identifying the independent predictors of CR referral included hospitals with high volumes of ST-elevation myocardial infarction patients (STEMI) (OR 4.89, 95% CI 4.41-5.20), STEMI diagnosis (OR 1.90, 95% CI 1.69-2.14), or treatment in a private hospital (OR 1.45, 95% CI 1.33-1.57). Predictors of non-referral included cardiogenic shock (OR 0.54, 95% CI 0.41-0.71), aged over 75 years (OR 0.62, 95% CI 0.57-0.68) and previous PCI (OR 0.66, 95% CI 0.62-0.70). Percutaneous coronary intervention patients with an acute coronary syndrome who were referred to CR were also more likely to be prescribed four or more major preventive pharmacotherapies, compared to those who were not referred (90% vs 82.1%, p<0.001). CONCLUSION Our contemporary multicentre analysis showed generally high CR referral rates which have increased over time. However, more effort is needed to target patients treated in the public sector, low volume STEMI hospitals or with short lengths of stay.
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Affiliation(s)
- Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia.
| | - Andrea Driscoll
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Vic, Australia; Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Adrienne O'Neil
- Food and Mood Centre, IMPACT Institute, Deakin University, Geelong, Vic, Australia
| | - Emma Thomas
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Vic, Australia; Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
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11
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Noaman S, Vogrin S, Dinh D, Lefkovits J, Brennan AL, Reid CM, Walton A, Kaye D, Bloom JE, Stub D, Yang Y, French C, Duffy SJ, Cox N, Chan W. Percutaneous Coronary Intervention Volume and Cardiac Surgery Availability Effect on Acute Coronary Syndrome-Related Cardiogenic Shock. JACC Cardiovasc Interv 2022; 15:876-886. [PMID: 35450687 DOI: 10.1016/j.jcin.2022.01.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/30/2021] [Accepted: 01/11/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study sought to assess the association between cardiac surgery availability and percutaneous coronary intervention (PCI) volume with clinical outcomes of cardiogenic shock (CS) complicating acute coronary syndrome (ACS). BACKGROUND CS remains a grave complication of ACS with high mortality rates despite timely reperfusion and improved heart failure therapies. METHODS The study analyzed data from consecutive patients with CS complicating ACS who underwent PCI and were prospectively enrolled in the VCOR (Victorian Cardiac Outcomes Registry) from 26 hospitals in Victoria. We compared patients treated at cardiac surgical centers (CSCs) versus non-CSCs as well as the annual CS PCI volume (stratified into tiers of <10, 10-25, and >25 cases) for in-hospital major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality. RESULTS Of 1,179 patients with CS, the mean age of patients was 65 years; males comprised 74%, and 22% had diabetes mellitus. Cardiac arrest occurred in 38% of patients, while 90% presented with ST-segment elevation myocardial infarction and 26% received intra-aortic balloon pump support. Overall, in-hospital and long-term mortality were 42% and 51%, respectively. There was no difference among patients treated non-CSCs compared with a CSCs for in-hospital MACCE and mortality (both P > 0.05). Similarly, there was no association between tiers of annual CS PCI volume with in-hospital MACCE and mortality (both P > 0.05). CONCLUSIONS Comparable short- and long-term mortality rates among patients with ACS complicated by CS treated by PCI irrespective of cardiac surgery availability and CS PCI volume support the emergent treatment of these gravely ill patients at their presenting PCI-capable hospital.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Kaye
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yang Yang
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
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12
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Al-Mukhtar O, Vogrin S, Lampugnani ER, Noaman S, Dinh DT, Brennan AL, Reid C, Lefkovits J, Cox N, Stub D, Chan W. Temporal Changes in Pollen Concentration Predict Short-Term Clinical Outcomes in Acute Coronary Syndromes. J Am Heart Assoc 2022; 11:e023036. [PMID: 35289185 PMCID: PMC9075470 DOI: 10.1161/jaha.121.023036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Atmospheric changes in pollen concentration may affect human health by triggering various allergic processes. We sought to assess if changes in pollen concentrations were associated with different acute coronary syndrome (ACS) subtype presentations and short-term clinical outcomes. Methods and Results We analyzed data in consecutive patients presenting with ACS (unstable angina, non-ST-segment-elevation myocardial infarction, and ST-segment-elevation myocardial infarction) treated with percutaneous coronary intervention between January 2014 and December 2017 and enrolled in the VCOR (Victorian Cardiac Outcomes Registry). Baseline characteristics were compared among patients exposed to different grass and total pollen concentrations. The primary outcome was occurrence of ACS subtypes and 30-day major adverse cardiac and cerebrovascular events (composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularization, or stroke). Of 15 379 patients, 7122 (46.3%) presented with ST-segment-elevation myocardial infarction, 6781 (44.1%) with non-ST-segment-elevation myocardial infarction, and 1476 (9.6%) with unstable angina. The mean age was 62.5 years, with men comprising 76% of patients. No association was observed between daily or seasonal grass and total pollen concentrations with the frequency of ACS subtype presentation. However, grass and total pollen concentrations in the preceding days (2-day average for grass pollen and 7-day average for total pollen) correlated with in-hospital mortality (odds ratio [OR], 2.17 [95% CI, 1.12-4.21]; P=0.021 and OR, 2.78 [95% CI, 1.00-7.74]; P=0.05), respectively, with a trend of 2-day grass pollen for 30-day major adverse cardiac and cerebrovascular events (OR, 1.50 [95% CI, 0.97-2.32]; P=0.066). Conclusions Increased pollen concentrations were not associated with differential ACS subtype presentation but were significantly related to in-hospital mortality following percutaneous coronary intervention, underscoring a potential biologic link between pollen exposure and clinical outcomes.
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Affiliation(s)
- Omar Al-Mukhtar
- Department of Cardiology Western Health Melbourne Victoria Australia
| | - Sara Vogrin
- Department of Medicine Western HealthMelbourne Medical SchoolUniversity of Melbourne Melbourne Victoria Australia
| | - Edwin R Lampugnani
- School of Biosciences The University of Melbourne Melbourne Victoria Australia
| | - Samer Noaman
- Department of Cardiology Western Health Melbourne Victoria Australia.,Department of Cardiology Alfred Health Melbourne Victoria Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Christopher Reid
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,NHMRC Centre of Research Excellence in Cardiovascular Outcomes Improvement Curtin University Perth Western Australia Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia.,Department of Cardiology Royal Melbourne Hospital Melbourne Victoria Australia
| | - Nicholas Cox
- Department of Cardiology Western Health Melbourne Victoria Australia.,Department of Medicine Western HealthMelbourne Medical SchoolUniversity of Melbourne Melbourne Victoria Australia
| | - Dion Stub
- Department of Cardiology Western Health Melbourne Victoria Australia.,Department of Cardiology Alfred Health Melbourne Victoria Australia.,Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - William Chan
- Department of Cardiology Western Health Melbourne Victoria Australia.,Department of Medicine Western HealthMelbourne Medical SchoolUniversity of Melbourne Melbourne Victoria Australia.,Department of Cardiology Alfred Health Melbourne Victoria Australia.,Baker Heart and Diabetes Institute Melbourne Victoria Australia
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13
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Stehli J, Dagan M, Dinh DT, Lefkovits J, Dick R, Oxley S, Brennan AL, Duffy SJ, Zaman S. Differences in outcomes of patients with in-hospital versus out-of-hospital ST-elevation myocardial infarction: a registry analysis. BMJ Open 2022; 12:e052000. [PMID: 35256441 PMCID: PMC8905957 DOI: 10.1136/bmjopen-2021-052000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Patients with ST-elevation myocardial infarction (STEMI) that occur while already in hospital ('in-hospital STEMI') face high mortality. However, data about this patient population are scarce. We sought to investigate differences in reperfusion and outcomes of in-hospital versus out-of-hospital STEMI. DESIGN, SETTING AND PARTICIPANTS Consecutive patients with STEMI all treated with percutaneous coronary intervention (PCI) across 30 centres were prospectively recruited into the Victorian Cardiac Outcomes Registry (2013-2018). PRIMARY AND SECONDARY OUTCOMES Patients with in-hospital STEMI were compared with patients with out-of-hospital STEMI with a primary endpoint of 30-day major adverse cardiovascular events (MACE). Secondary endpoints included ischaemic times, all-cause mortality and major bleeding. RESULTS Of 7493 patients with PCI-treated STEMI, 494 (6.6%) occurred in-hospital. Patients with in-hospital STEMI were older (67.1 vs 62.4 years, p<0.001), more often women (32% vs 19.9%, p<0.001), with more comorbidities. Patients with in-hospital STEMI had higher 30-day MACE (20.4% vs 9.8%, p<0.001), mortality (12.1% vs 6.9%, p<0.001) and major bleeding (4.9% vs 2.3%, p<0.001), than patients with out-of-hospital STEMI. According to guideline criteria, patients with in-hospital STEMI achieved symptom-to-device times of ≤70 min and ≤90 min in 29% and 47%, respectively. Patients with out-of-hospital STEMI achieved door-to-device times of ≤90 min in 71%. Occurrence of STEMI while in hospital independently predicted higher MACE (adjusted OR 1.77, 95% CI 1.33 to 2.36, p<0.001) and 12-month mortality (adjusted OR 1.49, 95% CI 1.08 to 2.07, p<0.001). CONCLUSIONS Patients with in-hospital STEMI experience delays to reperfusion with significantly higher MACE and mortality, compared with patients with out-of-hospital STEMI, after adjustment for confounders. Focused strategies are needed to improve recognition and outcomes in this high-risk and understudied population.
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Affiliation(s)
- Julia Stehli
- Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Epworth HealthCare, Richmond, Victoria, Australia
| | - Misha Dagan
- Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ron Dick
- Epworth HealthCare, Richmond, Victoria, Australia
| | | | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Stephen J Duffy
- Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah Zaman
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIctoria, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
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14
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Ruseckaite R, Maharaj AD, Dean J, Krysinska K, Ackerman IN, Brennan AL, Busija L, Carter H, Earnest A, Forrest CB, Harris IA, Sansoni J, Ahern S. Preliminary development of recommendations for the inclusion of patient-reported outcome measures in clinical quality registries. BMC Health Serv Res 2022; 22:276. [PMID: 35232454 PMCID: PMC8886855 DOI: 10.1186/s12913-022-07657-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical quality registries (CQRs) monitor compliance against optimal practice and provide feedback to the clinical community and wider stakeholder groups. Despite a number of CQRs having incorporated the patient perspective to support the evaluation of healthcare delivery, no recommendations for inclusion of patient-reported outcome measures (PROMs) in CQRs exist. The aim of this study was to develop a core set of recommendations for PROMs inclusion of in CQRs. METHOD An online two-round Delphi survey was performed among CQR data custodians, quality of life researchers, biostatisticians and clinicians largely recruited in Australia. A list of statements for the recommendations was identified from a literature and survey of the Australian registries conducted in 2019. The statements were grouped into the following domains: rationale, setting, ethics, instrument, administration, data management, statistical methods, and feedback and reporting. Eighteen experts were invited to participate, 11 agreed to undertake the first online survey (round 1). Of these, nine experts completed the online survey for round 2. RESULTS From 117 statements presented to the Delphi panel in round 1, a total of 72 recommendations (55 from round 1 and 17 from round 2) with median importance (MI) ≥ 7 and disagreement index (DI) < 1 were proposed for inclusion into the final draft set and were reviewed by the project team. Recommendations were refined for clarity and to read as stand-alone statements. Ten overlapped conceptually and, therefore, were merged to reduce repetition. The final 62 recommendations were sent for review to the panel members for their feedback, which was incorporated into the final set. CONCLUSION This is the first study to develop preliminary recommendations for PROMs inclusion in CQRs. Recommendations for PROMs implementation are critically important for registries to assure meaningful PROMs data capture, use, interpretation, and reporting to improve health outcomes and healthcare value.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Ashika D Maharaj
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Dean
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karolina Krysinska
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ilana N Ackerman
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, 3004, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Carter
- Australian Stroke Clinical Registry, The Florey Institute of Neuroscience & Mental Health, Melbourne, Victoria, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Sansoni
- Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Liew S, Dinh D, Brennan AL, Clark DJ, Ajani AE, Oqueli E, Duffy S, Reid CM, Freeman M, Katzer A, Hutchison A, Jaworski C, Mok M, Hiew C, Sebastian M. ORSIRO (ULTRATHIN-STRUT, BIODEGRADABLE-POLYMER, SIROLIMUS-ELUTING STENTS) VERSUS THIN-STRUT, DURABLE-POLYMER,EVEROLIMUS-ELUTING STENTS FOR PERCUTANEOUS CORONARY REVASCULARISATION IN THE STEMI POPULATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Wexler N, Vogrin S, Brennan AL, Noaman S, Al-Mukhtar O, Haji K, Dinh D, Zheng W, Duffy S, Lefkovits J, Reid CM, Stub D, Cox N, Chan W. ADVERSE IMPACT OF PERI-PROCEDURAL STROKE AMONG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koshy AN, Dinh DT, Fulcher J, Brennan AL, Murphy AC, Duffy SJ, Reid CM, Ajani AE, Freeman M, Hiew C, Oqueli E, Farouque O, Yudi MB, Clark DJ. Long-term mortality in asymptomatic patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Am Heart J 2022; 244:77-85. [PMID: 34780716 DOI: 10.1016/j.ahj.2021.10.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/27/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Patients with stable ischemic heart disease (SIHD) may present with a variety of symptoms including typical angina, angina equivalents such as dyspnea or no symptoms. We sought to determine whether symptom status affects periprocedural safety and long-term mortality in patients undergoing PCI. METHODS Prospectively enrolled consecutive patients undergoing PCI for SIHD at six hospitals in Australia between 2005 to 2018 as part of the Melbourne Interventional Group registry. Symptom status was recorded at the time of PCI and patients undergoing staged PCI were excluded. RESULTS Overall, 11,730 patients with SIHD were followed up for a median period of 5 years (maximum 14.0 years, interquartile range 2.2-9.0 years) with 1,317 (11.2%) being asymptomatic. Asymptomatic patients were older, and more likely to be male, have triple-vessel disease, with multiple comorbidities including renal failure, diabetes and heart failure (all P < .01). These patients had significantly higher rates of periprocedural complications and major adverse cardiovascular events at 30-days. Long-term mortality was significantly higher in asymptomatic patients (27.2% vs 18.0%, P < .001). On cox regression for long-term mortality, after adjustment for more important clinical variables, asymptomatic status was an independent predictor (Hazard ratio (HR) 1.39 95% CI 1.16-1.66, P < .001). CONCLUSIONS In a real-world cohort of patients undergoing revascularization for SIHD, absence of symptoms was associated with higher rates of periprocedural complications and, after adjustment for more important clinical variables, was an independent predictor of long-term mortality. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Diem T Dinh
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Stephen J Duffy
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- The University of Melbourne, Parkville, Victoria; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria; School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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18
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Lee P, Brennan AL, Stub D, Dinh DT, Lefkovits J, Reid CM, Zomer E, Liew D. Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study. BMJ Open 2021; 11:e053305. [PMID: 34876433 PMCID: PMC8655558 DOI: 10.1136/bmjopen-2021-053305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers. DESIGN A cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective. SETTING A linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR. PRIMARY OUTCOME MEASURES Direct healthcare costs attributed to PCI, estimated using a casemix funding method. RESULTS Key cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors. CONCLUSIONS The overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Curtin University, Perth, Western Australia, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Noaman S, Dinh D, Reid CM, Brennan AL, Clark D, Shaw J, Freeman M, Sebastian M, Oqueli E, Ajani A, Walton A, Bloom J, Biswas S, Stub D, Duffy SJ, Chan W. Comparison of Outcomes of Coronary Artery Disease Treated by Percutaneous Coronary Intervention in 3 Different Age Groups (<45, 46-65, and >65 Years). Am J Cardiol 2021; 152:19-26. [PMID: 34147208 DOI: 10.1016/j.amjcard.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022]
Abstract
There is paucity of data examining long-term outcomes of premature coronary artery disease (CAD). We aimed to investigate the short- and long-term clinical outcomes of patients with premature CAD treated by percutaneous coronary intervention (PCI) compared to older cohorts. We analyzed data from 27,869 patients who underwent PCI from 2005-2017 enrolled in a multicenter PCI registry. Patients were divided into three age groups: young group (≤ 45 years), middle-age group (46-65 years) and older group (>65 years). There were higher rates of current smokers in the young (n = 1,711) compared to the middle-age (n = 12,830) and older groups (n = 13,328) (54.2% vs 34.6% vs 11%) and the young presented more frequently with acute coronary syndrome (ACS) (78% vs 66% vs 62%), all p <0.05. There were also greater rates of cardiogenic shock (CS), out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) in the young, all p <0.05. The young cohort with STEMI had higher rates of in-hospital, 30-day death, and long-term mortality (3.8% vs 0.2%, 4.3% vs 0.2% and 8.6% vs 3.1%, all p <0.05, respectively) compared to the non-STEMI subgroup. There was a stepwise increase in long-term mortality from the young, to middle-age, to the older group (6.1% vs 9.9% vs 26.8%, p <0.001). Younger age was an independent predictor of lower long-term mortality (HR 0.66, 95% CI 0.52-0.84, p = 0.001). In conclusion, younger patients presenting with STEMI had worse prognosis compared to those presenting with non-STEMI. Despite higher risk presentations among young patients, their overall prognosis was favorable compared to older age groups.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Alfred Health, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Victoria, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Geelong University Hospital, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Andrew Ajani
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash University, Victoria, Australia.
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20
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Biswas S, Dinh D, Lucas M, Duffy SJ, Brennan AL, Liew D, Cox N, Nadurata V, Reid CM, Lefkovits J, Stub D. Incidence and Predictors of Unplanned Hospital Readmission after Percutaneous Coronary Intervention. J Clin Med 2020; 9:jcm9103242. [PMID: 33050476 PMCID: PMC7600497 DOI: 10.3390/jcm9103242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/25/2020] [Accepted: 10/03/2020] [Indexed: 11/24/2022] Open
Abstract
Unplanned readmissions to hospital after percutaneous coronary intervention (PCI) pose a significant burden to the healthcare system and are potentially preventable. In this study, we sought to determine the incidence of, and risk factors for, unplanned hospital readmissions within 30 days following PCI. We prospectively collected data on 28,488 patients undergoing PCI between 2013 and 2019, who were enrolled in the state-wide multi-centre Victorian Cardiac Outcomes Registry. Patients’ data were then linked to data from the Victorian Department of Health administrative database that records statewide hospital admissions. Disease diagnosis codes were used to identify cause of readmission. Patients who had an unplanned readmission were further divided into those who had a cardiac vs. non-cardiac cause for readmission. Overall, 3059 patients (10.7%) had an unplanned hospital readmission within 30 days of PCI, of which 1848 patients (60.4%) were readmitted for primarily cardiac diagnoses. Independent predictors of both 30-day unplanned cardiac and non-cardiac readmissions post-PCI were female sex, having ≥1 admission in the 12 months prior to PCI, acute coronary syndrome presentation, having any in-hospital complication and being discharged on an oral anticoagulant (all p < 0.05). A stepwise increase in readmission risk was observed with increasing number of admissions from 1 to ≥4 admissions in the 12 months prior to PCI. In conclusion, a substantial proportion of patients undergoing PCI have unexpected readmissions to hospital in the 30 days following PCI. Targeted strategies for patients with risk factors for readmission may be useful to reduce this significant burden to the healthcare system.
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Affiliation(s)
- Sinjini Biswas
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- Department of Cardiology, The Alfred Hospital, Melbourne 3004, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
| | - Mark Lucas
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
| | - Stephen J. Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- Department of Cardiology, The Alfred Hospital, Melbourne 3004, Australia
| | - Angela L. Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- Department of General Medicine, The Alfred Hospital, Melbourne 3004, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Melbourne 3021, Australia;
- Department of Medicine—Western Health, The University of Melbourne, Melbourne 3021, Australia
| | | | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- School of Public Health, Curtin University, Perth 6102, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- Department of Cardiology, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia; (S.B.); (D.D.); (M.L.); (S.J.D.); (A.L.B.); (D.L); (C.M.R.); (J.L.)
- Department of Cardiology, The Alfred Hospital, Melbourne 3004, Australia
- Department of Cardiology, Western Health, Melbourne 3021, Australia;
- Baker IDI Heart and Diabetes Institute, Melbourne 3004, Australia
- Correspondence: ; Tel.: +61-3-9076-3263
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21
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Noaman S, O'Brien J, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Sharma A, Chan W, Clark D, Stub D, Biswas S, Freeman M, Ajani A, Yip T, Duffy SJ, Oqueli E. Clinical outcomes following ST-elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 96:E406-E415. [PMID: 32087042 DOI: 10.1002/ccd.28802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) secondary to stent thrombosis (ST) compared to those presenting with STEMI secondary to a de novo culprit lesion and treated by percutaneous coronary intervention (PCI). BACKGROUND ST is an infrequent but serious complication of PCI with substantial associated morbidity and mortality, however with limited data. METHODS We studied consecutive patients who underwent PCI for STEMI from 2005 to 2013 enrolled prospectively in the Melbourne Interventional Group registry. Patients were divided into two groups: the ST group comprised patients where the STEMI was due to ST and the de novo group formed the remainder of the STEMI cohort and all patients were treated by PCI. The primary endpoint was 30-day all-cause mortality. RESULTS Compared to the de novo group (n = 3,835), the ST group (n = 128; 3.2% of STEMI) had higher rates of diabetes, hypertension and dyslipidemia, established cardiovascular diseases, myocardial infarction, and peripheral vascular disease, all p < .01. Within the ST group, very-late ST was the most common form of ST, followed by late and early ST (64, 19, and 17%, respectively). There was no significant difference in the primary outcome between the ST group and the de novo group (4.7 vs. 7.1%, p = .29). On multivariate analysis, ST was not an independent predictor of 30-day mortality (odds ratio: 0.62, 95% confidence interval: 0.07-1.09, p = .068). CONCLUSION The short-term prognosis of patients with STEMI secondary to ST who were treated by PCI was comparable to that of patients with STEMI due to de novo lesions.
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Affiliation(s)
- Samer Noaman
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Jessica O'Brien
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anand Sharma
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - William Chan
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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22
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Murali S, Vogrin S, Noaman S, Dinh DT, Brennan AL, Lefkovits J, Reid CM, Cox N, Chan W. Bleeding Severity in Percutaneous Coronary Intervention (PCI) and Its Impact on Short-Term Clinical Outcomes. J Clin Med 2020; 9:jcm9051426. [PMID: 32403442 PMCID: PMC7291133 DOI: 10.3390/jcm9051426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 11/27/2022] Open
Abstract
Bleeding severity in patients undergoing percutaneous coronary intervention (PCI), defined by the Bleeding Academic Research Consortium (BARC), portends adverse prognosis. We analysed data from 37,866 Australian patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR), and investigated the association between increasing BARC severity and in-hospital and 30-day major adverse cardiac and cerebrovascular events (MACCE) (a composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, or stroke). Independent predictors associated with major bleeding (BARC groups 3&5), and MACCE were also assessed. There was a stepwise increase in in-hospital and 30-day MACCE with greater severity of bleeding. Independent predictors of bleeding included female sex (Odds Ratio (OR) 1.34), age (OR 1.02), fibrinolytic therapy (OR 1.77), femoral access (OR 1.51), and ticagrelor (OR 1.42), all significant at the p < 0.001 level. Following adjustment of clinically important variables, BARC 3&5 bleeds (OR 4.37) were still predictive of cumulative in-hospital and 30-day MACCE. In conclusion, major bleeding is an uncommon but potentially fatal PCI complication and was independently associated with greater MACCE rates. Efforts to mitigate the occurrence of bleeding, including radial access and judicious use of potent antiplatelet therapies, may ameliorate the risk of short-term adverse clinical outcomes.
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Affiliation(s)
- Shashank Murali
- Department of Medicine, University of Melbourne, Melbourne 3010, Victoria, Australia; (S.M.); (S.N.)
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Melbourne 3010, Victoria, Australia;
| | - Samer Noaman
- Department of Medicine, University of Melbourne, Melbourne 3010, Victoria, Australia; (S.M.); (S.N.)
- Department of Cardiology, Western Health, St Albans 3021, Victoria, Australia;
- Department of Cardiology, Alfred Health, Melbourne 3004, Victoria, Australia
| | - Diem T. Dinh
- School of Public Health & Preventive Medicine, Monash University, Melbourne 3004, Victoria, Australia; (D.T.D.); (A.L.B.); (J.L.); (C.M.R.)
| | - Angela L. Brennan
- School of Public Health & Preventive Medicine, Monash University, Melbourne 3004, Victoria, Australia; (D.T.D.); (A.L.B.); (J.L.); (C.M.R.)
| | - Jeffrey Lefkovits
- School of Public Health & Preventive Medicine, Monash University, Melbourne 3004, Victoria, Australia; (D.T.D.); (A.L.B.); (J.L.); (C.M.R.)
| | - Christopher M. Reid
- School of Public Health & Preventive Medicine, Monash University, Melbourne 3004, Victoria, Australia; (D.T.D.); (A.L.B.); (J.L.); (C.M.R.)
- School of Public Health, Curtin University, Perth 6102, Western Australia, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, St Albans 3021, Victoria, Australia;
| | - William Chan
- Department of Medicine, University of Melbourne, Melbourne 3010, Victoria, Australia; (S.M.); (S.N.)
- Department of Cardiology, Western Health, St Albans 3021, Victoria, Australia;
- Department of Cardiology, Alfred Health, Melbourne 3004, Victoria, Australia
- Correspondence: ; Tel.: +61-(03)-8345-1333
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23
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Dawson LP, Cole JA, Lancefield TF, Ajani AE, Andrianopoulos N, Thrift AG, Clark DJ, Brennan AL, Freeman M, O'Brien J, Sebastian M, Chan W, Shaw JA, Dinh D, Reid CM, Duffy SJ. Incidence and risk factors for stroke following percutaneous coronary intervention. Int J Stroke 2020; 15:909-922. [PMID: 32248767 DOI: 10.1177/1747493020912607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. AIMS This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. METHODS Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke. RESULTS Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old. CONCLUSIONS Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Justin A Cole
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Jessica O'Brien
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Martin Sebastian
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Perth, Australia
| | - Stephen J Duffy
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Ariyaratne TV, Ademi Z, Ofori-Asenso R, Huq MM, Duffy SJ, Yan BP, Ajani AE, Clark DJ, Billah B, Brennan AL, New G, Andrianopoulos N, Reid CM. The cost-effectiveness of guideline-driven use of drug-eluting stents: propensity-score matched analysis of a seven-year multicentre experience. Curr Med Res Opin 2020; 36:419-426. [PMID: 31870180 DOI: 10.1080/03007995.2019.1708288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In routine clinical practice, the implantation of a drug-eluting stent (DES) versus a bare metal stent (BMS) for percutaneous coronary intervention (PCI) has been guided by criteria for appropriate use. The cost-effectiveness (CE) of adopting these guidelines, however, is not clear, and was investigated from the perspective of the Australian healthcare payer.Methods and results: Baseline and 12-month follow-up data of 12,710 PCI patients enrolled in the Melbourne Interventional Group (MIG) registry between 2004 and 2011 were analysed. Costs inputs were derived from a clinical costing database and published sources. Propensity-score-matching was performed for DES and BMS groups within sub-groups. Incremental cost-effectiveness ratios (ICERs) were evaluated for all patients, and sub-groups of patients with '0', 1, 2, or ≥3 indications for a DES. The incremental cost per target vessel revascularization avoided for the overall population was $24,683, and for patients with 0, 1, and 2 indications for a DES was $44,635, $33,335, and $23,788, respectively. However, for those with >3 indications, DES compared with BMS was associated with cost savings. At willingness to pay thresholds of $45,000-$75,000, the probability of cost-effectiveness of DES for the overall cohort was 71-91%, '0' indications, 49-67%, 1 indication, 56-82%, 2 indications, 70-90%, and ≥3 indications, 97-99%.Conclusions: The cost-effectiveness of DES compared with BMS increased with increasing risk profile of patients from those who had 1, 2, to ≥3 indications for a DES. When compared with BMS, DES was least cost effective among patients with '0' indications for a DES. Based on these results, selective use of DES implantation is supported. These findings may be useful for evidence-based clinical decision-making.
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Affiliation(s)
- Thathya V Ariyaratne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Molla M Huq
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stephen J Duffy
- Cardiovascular Medicine, Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Bryan P Yan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew E Ajani
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
- Royal Melbourne Hospital, Parkville, Australia
| | - David J Clark
- The Department of Cardiology, Austin Hospital, Heidelberg, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gishel New
- Department of Cardiology, Box Hill Hospital, Box Hill, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
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25
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Bloom J, Dinh DT, Noaman S, Martin C, Brennan AL, Lefkovits J, Reid C, Duffy S, Chan W. ADVERSE IMPACT OF SEVERITY OF CHRONIC KIDNEY DISEASE ON LONG-TERM CLINICAL OUTCOMES FOLLOWING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Noaman S, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Stub D, Biswas S, Clark D, Shaw J, Ajani A, Freeman M, Yip T, Oqueli E, Walton A, Duffy SJ, Chan W. Outcomes of cardiogenic shock complicating acute coronary syndromes. Catheter Cardiovasc Interv 2020; 96:E257-E267. [PMID: 32017332 DOI: 10.1002/ccd.28759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to assess the outcomes of cardiogenic shock (CS) complicating acute coronary syndromes (ACS). BACKGROUND CS remains the leading cause of mortality in patients presenting with ACS despite advances in care. METHODS We studied 13,184 patients undergoing percutaneous coronary intervention (PCI) for all subtypes of ACS enrolled prospectively in a large multicentre Australian registry (Melbourne Interventional Group registry) from 2005 to 2013. All-cause mortality was obtained via linkage to the National Death Index. Patients were divided into those with and those without CS. RESULTS Compared to the non-CS group (n = 12,548, 95.2%), the CS group (n = 636, 4.8%) had a higher proportion of out-of-hospital cardiac arrest (OHCA) (31.1 vs. 2.2%) and ST-elevation myocardial infarction (STEMI) presentation (89 vs. 34%), both p < .01. Patients in the CS group had higher rates of in-hospital (40.4 vs. 1.2%) and 30-day (41 vs. 1.7%) mortality compared to the non-CS group. Long-term mortality over a median follow-up of 4.2 years was higher in the CS group (50.6 vs. 13.8%), p < .001. Trends of in-hospital and 30-day mortality rates of CS complicating ACS were relatively stable from 2005 to 2013. Predictors of long-term NDI-linked mortality within the CS group include severe left ventricular systolic dysfunction (HR 3.0), glomerular filtration rate (GFR) <30 (HR 2.56), GFR 30-59 (HR 1.94), OHCA (HR 1.46), diabetes (HR 1.44), and age (HR 1.02), all p < .05. CONCLUSIONS Rates of CS-related mortality complicating ACS have remained very high and steady over nearly a decade despite progress in STEMI systems of care, PCI techniques, and medical therapy.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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Abstract
OBJECTIVES The objective of this systematic review was to examine the existing evidence base for the cost-effectiveness or cost-benefit of clinical quality registries (CQRs). DESIGN Systematic review and narrative synthesis. DATA SOURCES Nine electronic bibliographic databases, including MEDLINE, EMBASE and CENTRAL, in the period from January 2000 to August 2019. ELIGIBILITY CRITERIA Any peer-reviewed published study or grey literature in English which had reported on an economic evaluation of one or more CQRs. DATA EXTRACTION AND SYNTHESIS Data were screened, extracted and appraised by two independent reviewers. A narrative synthesis was performed around key attributes of each CQR and on key patient outcomes or changes to healthcare processes or utilisation. A narrative synthesis of the cost-effectiveness associated with CQRs was also conducted. The primary outcome was cost-effectiveness, in terms of the estimated incremental cost-effectiveness ratio (ICER), cost savings or return-on-investment (ROI) attributed to CQR implementation. RESULTS Three studies and one government report met the inclusion criteria for the review. A study of the National Surgical Quality Improvement Programme (NSQIP) in the USA found that the cost-effectiveness of this registry improved over time, based on an ICER of US$8312 per postoperative event avoided. A separate study in Canada estimated the ROI to be US$3.43 per US$1.00 invested in the NSQIP. An evaluation of a post-splenectomy CQR in Australia estimated that registry cost-effectiveness improved from US$234 329 to US$18 358 per life year gained when considering the benefits accrued over the lifetime of the population. The government report evaluating five Australian CQRs estimated an overall return of 1.6-5.5 times the cost of investment. CONCLUSIONS Available data indicate that CQRs can be cost-effective and can lead to significant returns on investment. It is clear that further studies that evaluate the economic and clinical impacts of CQRs are necessary. PROSPERO REGISTRATION NUMBER CRD42018116807.
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Affiliation(s)
- Peter Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ken Chin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Departrment of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Soh SE, Barker AL, Ayton DR, Ahern S, Morello R, Lefkovits J, Brennan AL, Evans S, Zalcberg JR, Reid CM, McNeil JJ. What matters most to patients following percutaneous coronary interventions? A new patient-reported outcome measure developed using Rasch analysis. PLoS One 2019; 14:e0222185. [PMID: 31487318 PMCID: PMC6728040 DOI: 10.1371/journal.pone.0222185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Measuring patient reported outcomes can improve the quality and effectiveness of healthcare interventions. The aim of this study was to identify the final set of items that can be included in a patient-reported outcome measure to assess recovery of patients following percutaneous coronary interventions. METHODS A consecutive sample of 200 patients registered in the Victorian Cardiac Outcomes Registry participated in a telephone survey 30 days following their percutaneous cardiac procedure. Rasch analysis was used to select the best set of items to form a concise and psychometrically sound patient-reported outcome measure. Key measurement properties assessed included overall fit to the Rasch measurement model, unidimensionality, response formats (thresholds), targeting, internal consistency and measurement invariance. RESULTS Five items were identified as being reliable and valid measures of patient-reported outcomes: pain or discomfort, shortness of breath, confidence in performing usual activities, feeling unhappy and having trouble sleeping. Data showed overall fit to a Rasch model of expected item functioning (χ2 16.99; p = 0.07) and all items demonstrated unidimensionality (t-test less than 0.05 threshold value). Internal consistency was acceptable (equivalent Cronbach's α 0.65) given there are only five items, but there was a ceiling effect (mean logit score -1.24) with compromised score precision for patients with better recovery. CONCLUSIONS We identified a succinct set of items that can be used in a patient-reported outcome measure following percutaneous coronary interventions. This patient-report outcome measure has good structural validity and acceptable internal consistency. While further psychometric evaluations are recommended, the items identified capture the patient's perspective of their recovery following a percutaneous coronary intervention.
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Affiliation(s)
- Sze-Ee Soh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Anna L. Barker
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini R. Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Renata Morello
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L. Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susan Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John R. Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Western Australia, Australia
| | - John J. McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Papapostolou S, Andrianopoulos N, Duffy SJ, Brennan AL, Ajani AE, Clark DJ, Reid CM, Freeman M, Sebastian M, Selkrig L, Yudi MB, Noaman SQ, Chan W. Long-term clinical outcomes of transient and persistent no-reflow following percutaneous coronary intervention (PCI): a multicentre Australian registry. EUROINTERVENTION 2019; 14:185-193. [PMID: 28966156 DOI: 10.4244/eij-d-17-00269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate long-term outcomes of transient versus persistent no-reflow. METHODS AND RESULTS A total of 17,547 patients with normal flow post percutaneous coronary intervention (PCI) were compared to 590 patients (3.2%) with transient no-reflow and 144 patients (0.8%) with persistent no-reflow. Long-term all-cause mortality was obtained by linkage with the National Death Index (NDI). No-reflow patients were more likely to have presented with ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA) or cardiogenic shock (all p<0.01). Long-term NDI-linked all-cause mortality was highest in patients with persistent no-reflow (31%) followed by transient no-reflow (22%) and normal flow (14%) over a median follow-up of 5.2, 5.5 and 4.5 years, respectively (all p<0.0001). Kaplan-Meier survival estimates demonstrated a graded increase in all-cause mortality from normal flow, to transient to persistent no-reflow (p<0.01), with the highest mortality occurring early (<30 days) in the persistent no-reflow group (p<0.0001). Multivariate Cox proportional hazards modelling identified glomerular filtration rate <30 mL/min, ejection fraction <30%, persistent no-reflow and transient no-reflow as independent predictors of increased hazard for all-cause mortality (all p<0.05). CONCLUSIONS Transient and persistent no-reflow were associated with a stepwise reduction in long-term survival. The presence of even transient no-reflow appears to be an important predictor of adverse long-term outcome.
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Affiliation(s)
- Stavroula Papapostolou
- Department of Cardiovascular Medicine, Alfred Health, The Alfred Hospital, Melbourne, VIC, Australia
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30
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Noaman S, Goh CY, Vogrin S, Brennan AL, Andrianopoulos N, Dinh DT, Lefkovits J, Reid CM, Walton A, Al-Mukhtar O, Biswas S, Stub D, Duffy SJ, Cox N, Chan W. Comparison of short-term clinical outcomes of proximal versus nonproximal lesion location in patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction: The PROXIMITI study. Catheter Cardiovasc Interv 2019; 93:32-40. [PMID: 30019827 DOI: 10.1002/ccd.27665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the association of proximal and nonproximal location of culprit coronary lesions with clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). BACKGROUND Proximal culprit lesion location in patients presenting with STEMI is associated with increased mortality when compared to distal culprit lesions in the thrombolytic era. The impact of lesion location on clinical outcomes in the era of PCI remains unclear. METHODS We analyzed 3,283 patients with STEMI who enrolled in the Victorian Cardiac Outcomes Registry. We compared outcomes in those with proximal lesion location versus patients with nonproximal location. RESULTS Of 3,283 participants, 1,376 (41.9%) had a proximal lesion location. Patients with proximal lesion location presented with greater rates of cardiogenic shock and out-of-hospital cardiac arrest, and left ventricular systolic dysfunction, all P < .01. Procedural success rates were similar (96% vs. 95%, P = .08). Patients with proximal lesion location had higher rates of in-hospital and 30-day mortality, major adverse cardiac events (MACE; mortality, myocardial infarction, stent thrombosis, and unplanned revascularization) and major adverse cardiac and cerebrovascular events (MACCE; MACE, and stroke) compared to the nonproximal group, all P < .001. However, on multivariable regression analysis, proximal lesion location was not independently associated with MACE during in-hospital stay or at 30-days (OR 1.32, 95% CI 0.95-1.83, P = .09 and OR 1.23, 95% CI 0.92-1.65, P = .15) respectively. CONCLUSIONS Patients with proximal lesion location had greater hemodynamic instability and higher-risk features; however, proximal lesions per se were not independently associated with worse clinical outcomes compared to nonproximal lesions.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Cheng Yee Goh
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Antony Walton
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Monash University, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Ariyaratne TV, Ademi Z, Huq M, Rosenfeldt F, Duffy SJ, Parkinson B, Yap CH, Smith J, Billah B, Yan BP, Brennan AL, Tran L, Reid CM. The Real-World Cost-Effectiveness of Coronary Artery Bypass Surgery Versus Stenting in High-Risk Patients: Propensity Score-Matched Analysis of a Single-Centre Experience. Appl Health Econ Health Policy 2018; 16:661-674. [PMID: 29998450 DOI: 10.1007/s40258-018-0407-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND There are limited economic evaluations comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease (MVCAD) in contemporary, routine clinical practice. OBJECTIVE The aim was to perform a cost-effectiveness analysis comparing CABG and PCI in patients with MVCAD, from the perspective of the Australian public hospital payer, using observational data sources. METHODS Clinical data from the Melbourne Interventional Group (MIG) and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) registries were analysed for 1022 CABG (treatment) and 978 PCI (comparator) procedures performed between June 2009 and December 2013. Clinical records were linked to same-hospital admissions and national death index (NDI) data. The incremental cost-effectiveness ratios (ICERs) per major adverse cardiac and cerebrovascular event (MACCE) avoided were evaluated. The propensity score bin bootstrap (PSBB) approach was used to validate base-case results. RESULTS At mean follow-up of 2.7 years, CABG compared with PCI was associated with increased costs and greater all-cause mortality, but a significantly lower rate of MACCE. An ICER of $55,255 (Australian dollars)/MACCE avoided was observed for the overall cohort. The ICER varied across comparisons against bare metal stents (ICER $25,815/MACCE avoided), all drug-eluting stents (DES) ($56,861), second-generation DES ($42,925), and third-generation of DES ($88,535). Moderate-to-low ICERs were apparent for high-risk subgroups, including those with chronic kidney disease ($62,299), diabetes ($42,819), history of myocardial infarction ($30,431), left main coronary artery disease ($38,864), and heart failure ($36,966). CONCLUSIONS At early follow-up, high-risk subgroups had lower ICERs than the overall cohort when CABG was compared with PCI. A personalised, multidisciplinary approach to treatment of patients may enhance cost containment, as well as improving clinical outcomes following revascularisation strategies.
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Affiliation(s)
- Thathya V Ariyaratne
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Molla Huq
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Franklin Rosenfeldt
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Cheng-Hon Yap
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Cardiothoracic Unit, Geelong Hospital, Geelong, VIC, Australia
| | - Julian Smith
- Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, VIC, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Bryan P Yan
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Lavinia Tran
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine (DEPM), Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, 6th Floor, 99 Commercial Rd, Melbourne, VIC, 3004, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
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O'Brien J, Reid CM, Andrianopoulos N, Ajani AE, Clark DJ, Krum H, Loane P, Freeman M, Sebastian M, Brennan AL, Shaw J, Dart AM, Duffy SJ. Heart Rate as a Predictor of Outcome Following Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:1113-1120. [PMID: 30107905 DOI: 10.1016/j.amjcard.2018.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Data from previous studies of patients with heart failure and coronary artery disease suggest that those with higher resting heart rates (HRs) have worse cardiovascular outcomes. We sought to evaluate whether HR immediately before percutaneous coronary intervention (PCI) is an independent predictor for 30-day outcome. We analyzed the outcome of 3,720 patients who had HR recorded before PCI from the Melbourne Interventional Group registry. HR and outcomes were analyzed by quintiles, and secondarily by dichotomizing into <70 or ≥70 beats/min. Patients with cardiogenic shock, intra-aortic balloon pump or inotropic support, and out-of-hospital arrest were excluded. The mean ± SD HR was 70.9 ± 14.7 beats/min. HR by quintile was 55 ± 5, 64 ± 2, 70 ± 1, 77 ± 3, and 93 ± 13 beats/min, respectively. Patients with higher HR were more likely to be women, current smokers, have higher systolic and diastolic blood pressure, atrial fibrillation, recent heart failure, lower ejection fraction, and ST-elevation myocardial infarction as the indication for the PCI (all p ≤0.002). However, rates of treated hypertension, multivessel disease, previous myocardial infarction, PCI, and coronary bypass surgery were lower (all p ≤0.004). Increased HR was associated with higher 30-day mortality (p for trend = 0.04), target vessel revascularization (p for trend = 0.003), and 30-day major adverse cardiac events (MACE) (p for trend = 0.004). In a multivariable analysis, HR was an independent predictor of 30-day MACE (OR 1.21 per quintile; 95% confidence interval (CI): 1.06 to 1.39, p = 0.004). When dichotomized into <70 or ≥70 beats/min, HR independently predicted both 30-day MACE (OR 1.59, 95% CI 1.08 to 2.36, p = 0.02) and 30-day mortality (OR 2.80, 95% CI 1.10 to 7.08, p = 0.03). In conclusion, HR immediately before PCI is an independent predictor of adverse 30-day cardiovascular outcomes.
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Brennan AL, Bayles T, Andrianopoulos N, Reid CM, Selkrig L, Noaman S, Dihn D, Ajani AE, Clark DJ, Duffy SJ. P3577Trends and clinical outcomes of percutaneous coronary intervention for chronic total occlusions - Results from an Australian multi-centre interventional registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A L Brennan
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - T Bayles
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - N Andrianopoulos
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - C M Reid
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - L Selkrig
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - S Noaman
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - D Dihn
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - A E Ajani
- Royal Melbourne Hospital, Department of Cardiology, Melbourne, Australia
| | - D J Clark
- Austin Hospital, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
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Dinh DT, Tacey M, Brennan AL, Andrianopoulos N, Liew D, Reid C, Lefkovits J. P2643Risk-adjusting key outcome measures in a clinical quality registry of PCI: development of a highly predictive model without the need to exclude very high risk conditions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D T Dinh
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - M Tacey
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A L Brennan
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - N Andrianopoulos
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - D Liew
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - C Reid
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Lefkovits
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
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Dinh DT, Wang Y, Brennan AL, Duffy SJ, Stub D, Reid CM, Lefkovits J. Delays in primary percutaneous coronary treatment for patients with ST‐elevation myocardial infarction. Med J Aust 2018; 209:130-131. [DOI: 10.5694/mja17.01186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/08/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Diem T Dinh
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
| | - Yishen Wang
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
- The Northern Hospital, Melbourne, VIC
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
| | - Dion Stub
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
- Curtin University, Perth, WA
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education (CCRE) in Therapeutics, Monash University, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
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Stub D, Lefkovits J, Brennan AL, Dinh D, Brien R, Duffy SJ, Cox N, Nadurata V, Clark DJ, Andrianopoulos N, Harper R, McNeil J, Reid CM. The Establishment of the Victorian Cardiac Outcomes Registry (VCOR): Monitoring and Optimising Outcomes for Cardiac Patients in Victoria. Heart Lung Circ 2018; 27:451-463. [DOI: 10.1016/j.hlc.2017.07.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/11/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
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Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Kalten K, Brennan AL, Lefkovits J, Hiew C, Oqueli E, Reid CM, Duffy SJ, Clark DJ. The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry. BMJ Open 2017; 7:e016874. [PMID: 28988174 PMCID: PMC5640050 DOI: 10.1136/bmjopen-2017-016874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary prevention pharmacotherapy. METHODS Consecutive patients from the Melbourne Interventional Group registry (2005-2013) who were alive at 30 days post-ACS presentation were included in our observational cohort study. Patients were divided into four categories based on their smoking status: non-smoker; ex-smoker (quit >1 month before ACS); recent quitter (smoker at presentation but quit by 30 days) and persistent smoker (smoker at presentation and at 30 days). The primary endpoint was survival ascertained through the Australian National Death Index linkage. A Cox-proportional hazards model was used to estimate the adjusted HR and 95% CI for survival. RESULTS Of the 9375 patients included, 2728 (29.1%) never smoked, 3712 (39.6%) were ex-smokers, 1612 (17.2%) were recent quitters and 1323 (14.1%) were persistent smokers. Cox-proportional hazard modelling revealed, compared with those who had never smoked, that persistent smoking (HR 1.78, 95% CI 1.36 to 2.32, p<0.001) was an independent predictor of increased hazard (mean follow-up 3.9±2.2 years) while being a recent quitter (HR 1.27, 95% CI 0.96 to 1.68, p=0.10) or an ex-smoker (HR 1.03, 95% CI 0.87 to 1.22, p=0.72) were not. CONCLUSIONS In a contemporary cohort of patients with ACS, those who continued to smoke had an 80% risk of lower survival while those who quit had comparable survival to lifelong non-smokers. This underscores the importance of smoking cessation in secondary prevention despite the improvement in management of ACS with PCI and pharmacotherapy.
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Affiliation(s)
- Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Andrew E Ajani
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Katie Kalten
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, Barwon Health, Geelong, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Western Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
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Wlodarczyk J, Ajani AE, Kemp D, Andrianopoulos N, Brennan AL, Duffy SJ, Clark DJ, Reid CM. Incidence, Predictors and Outcomes of Major Bleeding in Patients Following Percutaneous Coronary Interventions in Australia. Heart Lung Circ 2016; 25:107-17. [DOI: 10.1016/j.hlc.2015.06.826] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/10/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Lim HS, Andrianopoulos N, Sugumar H, Stub D, Brennan AL, Lim CC, Barlis P, Van Gaal W, Reid CM, Charter K, Sebastian M, New G, Ajani AE, Farouque O, Duffy SJ, Clark DJ. Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock. Int J Cardiol 2015; 195:259-64. [DOI: 10.1016/j.ijcard.2015.05.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
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Brennan AL, Andrianopoulos N, Duffy SJ, Reid CM, Clark DJ, Loane P, New G, Black A, Yan BP, Brooks M, Roberts L, Carroll EA, Lefkovits J, Ajani AE. Trends in door-to-balloon time and outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction: an Australian perspective. Intern Med J 2015; 44:471-7. [PMID: 24606571 DOI: 10.1111/imj.12405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines for patients with ST-elevation myocardial infarction include a door-to-balloon time (DTBT) of ≤90 min for primary percutaneous coronary intervention. AIM The aim of this study was to assess temporal trends (2006-2010) in DTBT and determine if a reduction in DTBT was associated with improved clinical outcomes. METHODS We compared annual median DTBT in 1926 STEMI patients undergoing primary percutaneous coronary intervention from the Melbourne Interventional Group registry. ST-elevation myocardial infarction presenting >12 h and rescue percutaneous coronary intervention was excluded. Major adverse cardiac events were analysed according to DTBT (dichotomised as ≤90 min vs >90 min). A multivariable analysis for predictors of mortality (including DTBT) was performed. RESULTS Baseline demographics, clinical and procedural characteristics were similar in the STEMI cohort across the 5 years, apart from an increase in out-of-hospital cardiac arrest (3.6% in 2006 vs 9.4% in 2010, P < 0.0001) and cardiogenic shock (7.7-9.6%, P = 0.07). The median DTBT (interquartile range) was reduced from 95 (74-130) min in 2006 to 75 (51-100) min in 2010 (P < 0.01). In this period, the proportion of patients achieving a DTBT of ≤90 min increased from 45% to 67% (P < 0.01). Lower mortality and major adverse cardiac event rates were observed with DTBT ≤90 min (all P < 0.01). Multivariable analysis showed that a DTBT of ≤90 min was associated with improved clinical outcomes at 12 months (odds ratio 0.48; 95% confidence interval 0.33-0.73, P < 0.01). CONCLUSION There has been a decline in median DTBT in the Melbourne Interventional Group registry over 5 years. DTBT of ≤90 min is associated with improved clinical outcomes at 12 months.
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Affiliation(s)
- A L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
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Cole JA, Brennan AL, Ajani AE, Yan BP, Duffy SJ, Loane P, Reid CM, Yudi MB, New G, Black A, Shaw J, Clark DJ, Andrianopoulos N. Cardiovascular Medication Use Following Percutaneous Coronary Intervention: The Australian Experience. Cardiovasc Ther 2014; 32:47-51. [DOI: 10.1111/1755-5922.12060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Justin A. Cole
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- Alfred Hospital; Melbourne Vic. Australia
| | - Angela L. Brennan
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- Alfred Hospital; Melbourne Vic. Australia
| | - Andrew E. Ajani
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- Royal Melbourne Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - Bryan P. Yan
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- The Chinese University of Hong Kong; Hong Kong China
| | - Stephen J. Duffy
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- Alfred Hospital; Melbourne Vic. Australia
| | - Philippa Loane
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
| | | | - Gishel New
- Box Hill Hospital; Melbourne Vic. Australia
- Eastern Health Medical School; Monash University; Melbourne Vic. Australia
| | - Alexander Black
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
- Royal Melbourne Hospital; Melbourne Vic. Australia
- Geelong Hospital; Melbourne Vic. Australia
- Deakin University; Melbourne Vic. Australia
| | - James Shaw
- Alfred Hospital; Melbourne Vic. Australia
| | | | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine; Centre of Cardiovascular Research and Education in Therapeutics; Monash University; Melbourne Vic. Australia
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Andrianopoulos N, Chan W, Reid C, Brennan AL, Yan B, Yip T, Clark DJ, New G, Ajani AE, Duffy SJ. PW245 Australia’s First PCI Registry-Derived Logistic and Additive Risk Score Calculations Predicting Post-Procedural Adverse Outcomes. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.2340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Baradi A, Andrianopoulos N, Brennan AL, Teh A, Tong D, Ajani AE, Jackson D, Roberts L, Freeman M, New G. PM185 Trends in Mortality following Percutaneous Coronary Intervention. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Baradi A, Andrianopoulos N, Brennan AL, Jackson DK, Teh A, Yip T, Oquiel E, Roberts L, New G, Freeman M. O001 Is Geography Destiny? Pre-hospital Delay in Primary Percutaneous Coronary Intervention (PCI) and Correlation with Area of Residence. Glob Heart 2014. [DOI: 10.1016/j.gheart.2014.03.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sugumar H, Lancefield TF, Andrianopoulos N, Duffy SJ, Ajani AE, Freeman M, Buxton B, Brennan AL, Yan BP, Dinh DT, Smith JA, Charter K, Farouque O, Reid CM, Clark DJ. Impact of renal function in patients with multi-vessel coronary disease on long-term mortality following coronary artery bypass grafting compared with percutaneous coronary intervention. Int J Cardiol 2014; 172:442-9. [PMID: 24521692 DOI: 10.1016/j.ijcard.2014.01.096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 01/11/2014] [Accepted: 01/19/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Comorbidities, such as diabetes, affect revascularization strategy for coronary disease. We sought to determine if the degree of renal impairment affected long-term mortality after percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) in patients with multi-vessel coronary disease (MVD). METHODS AND RESULTS 8970 patients with MVD undergoing revascularization between 2004 and 2008, in two multi-center parallel PCI and CABG Australian registries were assigned to three groups based on their estimated glomerular filtration rate (eGFR)≥60 mL/min/1.73 m2 (n=1678:839), 30-59 mL/min/1.73 m2 (n=452:226) and <30 mL/min/1.73 m2 (n=74:37). We used 2:1 propensity matching to compare 3306 patients undergoing primary CABG versus PCI. Shock, myocardial infarction (MI)<24 h, previous CABG, valve surgery or PCI were exclusions. Long-term mortality (mean 3.1 years) was compared with Cox-proportional hazard-adjusted modeling. Observed long-term mortality rates (CABG vs. PCI) were 4.5% vs. 4.3% p=0.84, 12.8% vs. 17.3% p=0.12, and 23.0% vs. 40.5% p=0.05 in the three strata, respectively. In patients with eGFR≥60 mL/min/1.73 m2, long-term mortality between PCI and CABG (HR 0.99, 95% CI 0.65-1.49, p=0.95) was similar. However, amongst patients with eGFR 30-59 mL/min/1.73 m2, there was a significant mortality hazard with PCI (HR 2.00, 95% CI 1.32-3.04, p=0.001). In patients with eGFR<30 mL/min/1.73 m2, there was a trend for hazard with PCI (HR 1.66, 95% CI 0.80-3.46, p=0.17). CONCLUSION Long-term mortality in MVD patients with preserved renal function was very low and similar between PCI and CABG. However there was a long-term mortality hazard associated with PCI amongst patients with moderate renal impairment.
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Affiliation(s)
- Hariharan Sugumar
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | | | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Brian Buxton
- Department of Cardiac Surgery, Austin Hospital, Melbourne, Victoria, Australia; Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bryan P Yan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; Department of Cardiology, Prince of Wales Hospital, Hong Kong, China
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Julian A Smith
- Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Kerrie Charter
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David J Clark
- Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
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Barry PJ, Flight WG, Biesty J, Clough D, Small I, Johnson S, Brennan AL, Bright-Thomas RJ, Webb AK, Jones AM, Horsley AR. P102 Sweat chloride is not a useful marker of clinical response to Ivacaftor. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ariyaratne TV, Ademi Z, Duffy SJ, Andrianopoulos N, Billah B, Brennan AL, New G, Black A, Ajani AE, Clark DJ, Yan BP, Yap CH, Reid CM. Cardiovascular readmissions and excess costs following percutaneous coronary intervention in patients with chronic kidney disease: Data from a large multi-centre Australian registry. Int J Cardiol 2013; 168:2783-90. [DOI: 10.1016/j.ijcard.2013.03.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/29/2013] [Accepted: 03/26/2013] [Indexed: 01/06/2023]
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Brennan AL, Andrianopoulos N, Duffy S, Ajani AE, Clark D, Lefkovits J, Black A, Brooks M, Yan B, New G, Loane P, Roberts L, Reid C. TRENDS IN DOOR-TO-BALLOON TIME AND OUTCOMES FOLLOWING PRIMARY PCI FOR STEMI. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60149-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chan W, Ajani AE, Clark DJ, Stub D, Andrianopoulos N, Brennan AL, New G, Sebastian M, Johnston R, Walton A, Reid CM, Dart AM, Duffy SJ. Impact of periprocedural atrial fibrillation on short-term clinical outcomes following percutaneous coronary intervention. Am J Cardiol 2012; 109:471-7. [PMID: 22177002 DOI: 10.1016/j.amjcard.2011.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/07/2011] [Accepted: 10/07/2011] [Indexed: 11/18/2022]
Abstract
There are few data on the incidence and clinical outcomes of patients with atrial fibrillation (AF) treated in the era of percutaneous coronary intervention (PCI). We analyzed 30-day clinical outcomes in 3,307 consecutive patients with and without AF (sinus rhythm) undergoing PCI from January 2007 through December 2008 enrolled in a multicenter Australian registry. Periprocedural AF was present in 162 patients (4.9%). AF was associated with older age (74.1 ± 8.9 vs 63.9 ± 11.9 years, p <0.001), higher baseline serum creatinine (0.13 ± 0.14 vs 0.10 ± 0.13 mmol/L, p = 0.01), and lower left ventricular ejection fraction (49.5 ± 13.2% vs 53.4% ± 11.6%, p <0.001). Significantly more patients with AF had a history of heart failure and cerebrovascular and peripheral arterial diseases (p ≤0.01 for all comparisons). Periprocedural glycoprotein IIb/IIIa inhibitor (31.5% vs 31.4%, p = 0.98) and antithrombin use were not different between groups, but in-hospital bleeding complications were higher in patients with AF (5.0% vs 2.1%, p = 0.015). Fewer patients with AF received drug-eluting stents (p = 0.004). AF was associated with a greater than fourfold increase in 30-day mortality (9.9% vs 2.2%, p <0.0001) and readmission rates at 30 days (p = 0.01). Fewer patients with AF were on dual antiplatelet therapy at 30 days (86.3% vs 94.3%, p <0.0001), although 28.1% of patients with AF were on triple therapy (dual antiplatelet therapy plus oral anticoagulation). In conclusion, patients with periprocedural AF represent a very high-risk group. Excess 30-day morbidity and mortality after PCI may be due to the higher incidence of co-morbidities, bleeding complications, and suboptimal antiplatelet therapy.
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Affiliation(s)
- William Chan
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
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Yan BP, Ajani AE, Clark DJ, Duffy SJ, Andrianopoulos N, Brennan AL, Loane P, Reid CM. Recent trends in Australian percutaneous coronary intervention practice: insights from the Melbourne Interventional Group registry. Med J Aust 2011; 195:122-7. [DOI: 10.5694/j.1326-5377.2011.tb03238.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 02/22/2011] [Indexed: 01/21/2023]
Affiliation(s)
- Bryan P Yan
- Chinese University of Hong Kong, Hong Kong
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Andrew E Ajani
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
| | | | | | - Nick Andrianopoulos
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
- Centre for Research Excellence in Patient Safety, Monash University, Melbourne, VIC
| | - Angela L Brennan
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Philippa Loane
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Christopher M Reid
- Monash Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
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