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Rajakariar K, Andrianopoulos N, Gayed D, Liang D, Backhouse B, Ajani AE, Duffy SJ, Brennan A, Roberts L, Reid CM, Oqueli E, Clark D, Freeman M. Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Intern Med J 2023; 53:1376-1382. [PMID: 35670161 DOI: 10.1111/imj.15828] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). AIM To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. METHODS We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. RESULTS We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63-0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85-1.1; P = 0.73). CONCLUSION The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone.
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Affiliation(s)
- Kevin Rajakariar
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Gayed
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Danlu Liang
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Brendan Backhouse
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
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Tan M, Dinh D, Gayed D, Liang D, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Roberts L, Reid C, Freeman M, Chandrasekhar J. Associations between DAPT score and long-term mortality post PCI. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1378] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The dual antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive benefit (score ≥2) or harm (score <2) from DAPT beyond 1-year post PCI. There is no study which looked at the DAPT score and long term outcomes post PCI in Australia.
Purpose
We sought to examine long-term mortality after PCI by the DAPT score in patients treated with DAPT per local guidelines.
Methods
We examined data from the MIG PCI database from 2005 to 2018 in whom the DAPT score could be derived and grouped them as score ≥2 or <2. Long-term mortality was assessed from National Death Index linkage. The primary endpoint was long-term mortality examined using survival analysis. Secondary endpoints included 30-day ischaemic outcomes and in-hospital major bleeding.
Results
Out of 27,740 patients in the study, 9,401 (33.9%) had DAPT score ≥2. They were younger and included more females and higher prevalence of renal impairment. DAPT score ≥2 patients had higher in-hospital major bleeding, 30-day mortality, MI and target vessel revascularisation. DAPT score ≥2 patients had lower long-term survival to 12 years (p<0.001 for all).
Conclusion
A third of all-comer PCI patients had DAPT score ≥2 with greater short-term risk of ischaemic and bleeding outcomes, as well as long-term mortality. Theoretically, those with DAPT score ≥2 would benefit from longer duration of DAPT as ischaemic risk outweighs bleeding risk. However, given our finding of increased short-term bleeding risk and long-term mortality, dynamic bleeding risk assessment should be undertaken to guide pharmacotherapy strategies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Tan
- Eastern Health , Melbourne , Australia
| | - D Dinh
- Monash University , Melbourne , Australia
| | - D Gayed
- Eastern Health , Melbourne , Australia
| | - D Liang
- Eastern Health , Melbourne , Australia
| | - A Brennan
- Monash University , Melbourne , Australia
| | - S Duffy
- Alfred Health , Melbourne , Australia
| | - D Clark
- Austin Hospital , Melbourne , Australia
| | - A Ajani
- Royal Melbourne Hospital , Melbourne , Australia
| | - E Oqueli
- Ballarat Health , Melbourne , Australia
| | - L Roberts
- Eastern Health , Melbourne , Australia
| | - C Reid
- Curtin University , Perth , Australia
| | - M Freeman
- Eastern Health , Melbourne , Australia
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Rajakariar K, Gayed D, Backhouse B, Dyett J, Rowe M, Chandrasekhar J. THE UTILITY OF VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION IN PATIENTS WITH ACUTE ISCHAEMIC VENTRICULAR SEPTAL DEFECT AND CARDIOGENIC SHOCK. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03918-3] [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: 11/27/2022]
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Ralota KK, Lim H, Rajakariar K, Maher N, Ganeshanathan V, Wong G, Roberts L, Gayed D, Liang D, Backhouse B, Chandrasekhar J. DIFFERENCES IN CARDIAC PRESENTATIONS BETWEEN THE COVID AND PRE-COVID ERA: SINGLE TERTIARY CENTRE EXPERIENCE FROM MELBOURNE, AUSTRALIA. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03130-8] [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: 11/29/2022]
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Low A, Liang D, Rajakariar K, Gayed D, Backhouse B, Gould M, Schwarer A, Cooke J, Freeman M. A Rapid and Reversible Case of Restrictive Cardiomyopathy Secondary to Loeffler’s Hypereosinophilic Carditis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.054] [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: 11/24/2022]
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Liang D, Nguyen M, L'Abbate C, Gayed D, Rajakariar K, Backhouse B, Cooke J, Teh A. mRNA COVID-19 Vaccine (mCV) Related Myocarditis in Monozygotic Dichorionic Diamniotic (DCDA) Twins. Heart Lung Circ 2022. [PMCID: PMC9345540 DOI: 10.1016/j.hlc.2022.06.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Backhouse B, Rajakariar K, Gayed D, Liang D, Freeman M. A Case of Massive Primary Cardiac Lymphoma. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.209] [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: 10/16/2022]
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Backhouse B, Lim V, Rajakariar K, Gayed D, Liang D, Chandrasekhar J. Does the SYNTAX Score Affect Decision Making in Heart Team Meetings? A Single, Non-Surgical Centre Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.576] [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: 10/16/2022]
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Rajakariar K, Vos A, Siriratnam P, Liang L, Backhouse B, Gayed D, Choi P, Goods C, Freeman M. Recurrent Cardioembolic Strokes in the Setting of Anomalous Left Coronary Artery From the Pulmonary Artery (ALCAPA). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.282] [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: 10/16/2022]
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Liang D, Dinh D, Gayed D, Tan M, Clark D, Duffy S, Brennan A, Ajani A, Oquiel E, Roberts L, Cooke J, Reid C, Chandrasekhar J, Freeman M. Are Public Holidays, Sporting Events and Significant Historical Events Triggers of ST-elevation Myocardial Infarction (STEMI) Presentations in Victoria? A Melbourne Interventional Group (MIG) Observational Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.257] [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: 11/26/2022]
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Gayed D, Dinh D, Liang D, Tan M, Oquiel E, Duffy S, Ajani A, Brennan A, Clark D, Roberts L, Reid C, Freeman M. Is There a Mortality Benefit of Statin Use for Secondary Prevention of Coronary Artery Disease (CAD) in an Older Population? Insights from the Melbourne Interventional Group (MIG) Registry. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.302] [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: 11/24/2022]
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Tan M, Dinh D, Gayed D, Liang D, Brennan A, Duffy S, Clark D, Ajani A, Oqueli E, Roberts L, Reid C, Freeman M, Chandrasekhar J. Associations Between DAPT Score and Long-term Mortality Post PCI. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.260] [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: 11/29/2022]
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Kunniardy P, Koshy A, Meehan G, Murphy A, Gayed D, Ramchand J, Clark D, Farouque O, Yudi M. Do Patients Over 85 Years who Present with NSTEMI and Admitted Under General Medical Units Need Cardiology Consultation? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.372] [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: 10/26/2022]
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Gayed D, Azraai M, Liu B, McMaster C, O’Donavan R, Patel S, Liew D, Burrell L. An Audit Of Glucose Lowering Therapies in Patients With Type 2 Diabetes and Hospitalisation for Heart Failure. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.524] [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: 11/16/2022]
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Patel SK, Velkoska E, Gayed D, Ramchand J, Lesmana J, Burrell LM. Left ventricular hypertrophy in experimental chronic kidney disease is associated with reduced expression of cardiac Kruppel-like factor 15. BMC Nephrol 2018; 19:159. [PMID: 29970016 PMCID: PMC6029153 DOI: 10.1186/s12882-018-0955-9] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background Left ventricular hypertrophy (LVH) increases the risk of death in chronic kidney disease (CKD). The transcription factor Kruppel-like factor 15 (KLF15) is expressed in the heart and regulates cardiac remodelling through inhibition of hypertrophy and fibrosis. It is unknown if KLF15 expression is changed in CKD induced LVH, or whether expression is modulated by blood pressure reduction using angiotensin converting enzyme (ACE) inhibition. Methods CKD was induced in Sprague–Dawley rats by subtotal nephrectomy (STNx), and rats received vehicle (n = 10) or ACE inhibition (ramipril, 1 mg/kg/day, n = 10) for 4 weeks. Control, sham-operated rats (n = 9) received vehicle. Cardiac structure and function and expression of KLF15 were assessed. Results STNx caused impaired kidney function (P < 0.001), hypertension (P < 0.01), LVH (P < 0.001) and fibrosis (P < 0.05). LVH was associated with increased gene expression of hypertrophic markers, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP, P < 0.01) and connective tissue growth factor (CTGF) (P < 0.05). Cardiac KLF15 mRNA and protein expression were reduced (P < 0.05) in STNx and levels of the transcription regulator, GATA binding protein 4 were increased (P < 0.05). Ramipril reduced blood pressure (P < 0.001), LVH (P < 0.001) and fibrosis (P < 0.05), and increased cardiac KLF15 gene (P < 0.05) and protein levels (P < 0.01). This was associated with reduced ANP, BNP and CTGF mRNA (all P < 0.05). Conclusion This is the first evidence that loss of cardiac KLF15 in CKD induced LVH is associated with unchecked trophic and fibrotic signalling, and that ACE inhibition ameliorates loss of cardiac KLF15.
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Affiliation(s)
- Sheila K Patel
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
| | - Elena Velkoska
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Daniel Gayed
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Jay Ramchand
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Jessica Lesmana
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Louise M Burrell
- Department of Medicine, Austin Health, The University of Melbourne, Level 7 Lance Townsend Building, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
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Burrell LM, Gayed D, Griggs K, Patel SK, Velkoska E. Adverse cardiac effects of exogenous angiotensin 1-7 in rats with subtotal nephrectomy are prevented by ACE inhibition. PLoS One 2017; 12:e0171975. [PMID: 28192475 PMCID: PMC5305254 DOI: 10.1371/journal.pone.0171975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/30/2017] [Indexed: 11/18/2022] Open
Abstract
We previously reported that exogenous angiotensin (Ang) 1–7 has adverse cardiac effects in experimental kidney failure due to its action to increase cardiac angiotensin converting enzyme (ACE) activity. This study investigated if the addition of an ACE inhibitor (ACEi) to Ang 1–7 infusion would unmask any beneficial effects of Ang 1–7 on the heart in experimental kidney failure. Male Sprague–Dawley rats underwent subtotal nephrectomy (STNx) and were treated with vehicle, the ACEi ramipril (oral 1mg/kg/day), Ang 1–7 (subcutaneous 24 μg/kg/h) or dual therapy (all groups, n = 12). A control group (n = 10) of sham-operated rats were also studied. STNx led to hypertension, renal impairment, cardiac hypertrophy and fibrosis, and increased both left ventricular ACE2 activity and ACE binding. STNx was not associated with changes in plasma levels of ACE, ACE2 or angiotensin peptides. Ramipril reduced blood pressure, improved cardiac hypertrophy and fibrosis and inhibited cardiac ACE. Ang 1–7 infusion increased blood pressure, cardiac interstitial fibrosis and cardiac ACE binding compared to untreated STNx rats. Although in STNx rats, the addition of ACEi to Ang 1–7 prevented any deleterious cardiac effects of Ang 1–7, a limitation of the study is that the large increase in plasma Ang 1–7 with ramipril may have masked any effect of infused Ang 1–7.
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Affiliation(s)
- Louise M. Burrell
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Daniel Gayed
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Karen Griggs
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Sheila K. Patel
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
| | - Elena Velkoska
- Department of Medicine, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
- * E-mail:
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Gayed D, Farouque O, Clark D, Jones N, Theuerle J, Kalten K, Ramchand J, Yudi M. Should All Patients Presenting With ST-Elevation Myocardial Infarction Be Screened for Familial Hypercholesterolaemia? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.784] [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: 11/15/2022]
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Jones N, Yudi M, Theuerle J, Gayed D, Proimos G, Jones E, Calafiore P, Ramchand J. ST-Elevation Secondary to Metastatic Tumour Infiltrate of the Right Heart. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.579] [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: 10/21/2022]
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Velkoska E, Lesmana J, Gayed D, Griggs K, Patel S, Burrell L. The ACE2 Activator Diminazene Improves Cardiac Structure and Function in an Experimental Model of Kidney Disease. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.192] [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: 11/26/2022]
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Theuerle J, Farouque O, Clark D, Gayed D, Goh C, Tsang D, Ramchand J, Yudi M. Is Complex Percutaneous Coronary Intervention Associated With Worse Long-Term Mortality? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.420] [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]
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Yudi M, Goh C, Tsang D, Ramchand J, Gayed D, Theuerle J, Kalten K, Clark D, Farouque O. Is the New Definition of “Clinically Relevant Myocardial Infarction” After Coronary Revascularisation Prognostically Significant? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.421] [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]
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Gayed D, Farouque O, Clark D, Theuerle J, Goh C, Tsang D, Ramchand J, Yudi M. Is a Family History of Premature Coronary Artery Disease (CAD) Associated With Worse Long-Term Mortality in Patients With Established CAD? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.778] [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: 10/21/2022]
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