1
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Landi A, Alasnag M, Heg D, Frigoli E, Malik FTN, Gomez-Blazquez I, Pourbaix S, Chieffo A, Spaulding C, Sainz F, Routledge H, Andò G, Testa L, Sciahbasi A, Contractor H, Jepson N, Mieres J, Imran SS, Noor H, Smits PC, Valgimigli M. Abbreviated or Standard Dual Antiplatelet Therapy by Sex in Patients at High Bleeding Risk: A Prespecified Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiol 2024; 9:35-44. [PMID: 37991745 PMCID: PMC10666042 DOI: 10.1001/jamacardio.2023.4316] [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: 01/28/2023] [Accepted: 09/27/2023] [Indexed: 11/23/2023]
Abstract
Importance Abbreviated dual antiplatelet therapy (DAPT) reduces bleeding with no increase in ischemic events in patients at high bleeding risk (HBR) undergoing percutaneous coronary intervention (PCI). Objectives To evaluate the association of sex with the comparative effectiveness of abbreviated vs standard DAPT in patients with HBR. Design, Setting, and Patients This prespecified subgroup comparative effectiveness analysis followed the Management of High Bleeding Risk Patients Post Bioresorbable Polymer Coated Stent Implantation With an Abbreviated vs Standard DAPT Regimen (MASTER DAPT) trial, a multicenter, randomized, open-label clinical trial conducted at 140 sites in 30 countries and performed from February 28, 2017, to December 5, 2019. A total of 4579 patients with HBR were randomized at 1 month after PCI to abbreviated or standard DAPT. Data were analyzed from July 1 to October 31, 2022. Interventions Abbreviated (immediate DAPT discontinuation, followed by single APT for ≥6 months) or standard (DAPT for ≥2 additional months, followed by single APT for 11 months) treatment groups. Main Outcomes and Measures One-year net adverse clinical events (NACEs) (a composite of death due to any cause, myocardial infarction, stroke, or major bleeding), major adverse cardiac or cerebral events (MACCEs) (a composite of death due to any cause, myocardial infarction, or stroke), and major or clinically relevant nonmajor bleeding (MCB). Results Of the 4579 patients included in the analysis, 1408 (30.7%) were women and 3171 (69.3%) were men (mean [SD] age, 76.0 [8.7] years). Ischemic and bleeding events were similar between sexes. Abbreviated DAPT was associated with comparable NACE rates in men (hazard ratio [HR], 0.97 [95% CI, 0.75-1.24]) and women (HR, 0.87 [95% CI, 0.60-1.26]; P = .65 for interaction). There was evidence of heterogeneity of treatment effect by sex for MACCEs, with a trend toward benefit in women (HR, 0.68 [95% CI, 0.44-1.05]) but not in men (HR, 1.17 [95% CI, 0.88-1.55]; P = .04 for interaction). There was no significant interaction for MCB across sex, although the benefit with abbreviated DAPT was relatively greater in men (HR, 0.65 [95% CI, 0.50-0.84]) than in women (HR, 0.77 [95% CI, 0.53-1.12]; P = .46 for interaction). Results remained consistent in patients with acute coronary syndrome and/or complex PCI. Conclusions and Relevance These findings suggest that women with HBR did not experience higher rates of ischemic or bleeding events compared with men and may derive particular benefit from abbreviated compared with standard DAPT owing to these numerically lower rates of events. Trial Registration ClinicalTrials.gov Identifier: NCT03023020.
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Affiliation(s)
- Antonio Landi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Enrico Frigoli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Ivan Gomez-Blazquez
- Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain
| | - Suzanne Pourbaix
- Department of Cardiology, Hospital de al Citadelle Liège, Liège, Belgium
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Christian Spaulding
- Department of Cardiology, European Hospital Georges Pompidou, Assistance Publique–Hopitaux de Paris, Paris Cité University and Institut National de la Santé et de la Recherche Médicale U970, Paris, France
| | - Fermin Sainz
- Division of Cardiology, Hospital Universitario Marques de Valdecilla, Instituto de Investigación Marques de Valdecilla, Santander, Spain
| | - Helen Routledge
- Department of Cardiology, Worcestershire Royal Hospital, Worcester, United Kingdom
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Testa
- Department of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Hussain Contractor
- Department of Cardiovascular Medicine, Manchester University NHS (National Health Service) Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
- Department of Cardiology, University of New South Wales, Sydney, New South Wales, Australia
| | - Juan Mieres
- Cardiovascular Research Center, Otamendi Hospital, Buenos Aires, Argentina
| | | | - Husam Noor
- Mohammed Bin Khalifa Specialist Cardiac Centre, Awali, Kingdom of Bahrain
| | - Pieter C. Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Department of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
- University of Bern, Bern, Switzerland
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2
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Marjot J, Mackenzie J, Jepson N, Reeves E, Bennett M. Investigation into the effect of hyperbaric hyperoxia on serum cardiac Troponin T levels as a biomarker of cardiac injury. Diving Hyperb Med 2023; 53:281-284. [PMID: 37718303 PMCID: PMC10735667 DOI: 10.28920/dhm53.3.281-284] [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] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
Introduction There is clinical equipoise as to whether hyperoxia is injurious to the myocardium, both in the setting of acute ischaemic insults and on the stable myocardium. This study examined the effect of extreme hyperoxia - in the form of hyperbaric oxygen treatment - on the myocardium through measurement of high-sensitivity cardiac troponin. Methods Forty-eight individuals were enrolled to undergo a series of 30 exposures to hyperbaric oxygen for treatment of non-cardiac pathologies. High-sensitivity troponin T was measured before and after each session. Results There was no clinically significant difference in troponin measurements following acute or recurrent sequential exposures to extreme hyperoxia, despite the studied patient population having a high rate of previous ischaemic heart disease or cardiovascular risk factors. Conclusions This study demonstrates that profound hyperoxaemia does not induce any measurable cardiac injury at a biochemical level. Neither is there a reduction in cardiac troponin to suggest a cardioprotective effect of hyperbaric hyperoxia. This provides some reassurance as to the cardiac safety of the routine use of hyperbaric oxygen treatment in management of non-cardiac pathology.
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Affiliation(s)
- Jack Marjot
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
- Corresponding author: Dr Jack Marjot, Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia, ORCiD ID: 0009-0002-0212-1343.
| | - John Mackenzie
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney
| | - Ewan Reeves
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
| | - Michael Bennett
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney
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3
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Gadeley R, Varcoe RL, Jepson N. Percutaneous thrombin injection: an alternative therapy for iatrogenic carotid artery pseudoaneurysms. EJVES Vasc Forum 2022; 55:52-55. [PMID: 35573708 PMCID: PMC9092963 DOI: 10.1016/j.ejvsvf.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/24/2022] [Accepted: 03/16/2022] [Indexed: 10/30/2022] Open
Abstract
Introduction Case report Discussion There is a paucity of clinical data on the use of thrombin injection to treat iatrogenic carotid artery pseudoaneurysms. This case demonstrates its successful use after conventional approaches were either contraindicated or unsuccessful. Thrombin injection offers an alternative and safe approach in the management of iatrogenic carotid pseudoaneurysms.
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4
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Chen D, Gadeley R, Wang A, Jepson N. Coronary artery perforation after bioresorbable scaffold implantation treated with a new generation covered stent-OCT insights. BMC Cardiovasc Disord 2022; 22:66. [PMID: 35196989 PMCID: PMC8864843 DOI: 10.1186/s12872-022-02501-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Coronary artery perforation is a rare but potentially lethal complication of percutaneous coronary intervention (PCI) with an associated mortality of 7–17%. We report the case of coronary artery perforation complicating Absorb bioresorbable vascular scaffold (BVS) implantation and the associated technical challenges with managing this life-threatening complication. Case report A 46-year-old male was referred to our institution and underwent PCI with an Absorb bioabsorbable vascular scaffold (BVS) to a proximal LAD long segment bifurcation lesion. Following pre-dilation and deployment of the 3.5 × 28 mm Absorb BVS, high pressure post-dilation of the distal scaffold was complicated by a large, Ellis type III coronary perforation with no flow to the distal LAD beyond the rupture, and associated with a large pericardial effusion confirmed on bedside transthoracic echocardiogram (TTE). The insult was temporised with prolonged balloon inflation within the Absorb BVS immediately proximal to the site of perforation, permitting urgent insertion of a pericardial drain. After deflation of the balloon, a 3.0 × 21 mm BeGraft covered stent was deployed across the perforation, restoring normal LAD flow and abolishing the perforation. Cardio-pulmonary resuscitation was not required and the patient remained conscious throughout the procedure. TTE demonstrated normal left ventricular function and the patient was discharged 3 days later. Repeat angiography at 3 months showed patent stents with TIMI III flow, and optical coherence tomography (OCT) showed good expansion and apposition of the proximal Absorb BVS and BeGraft. The patient has remained well 4 years after PCI with no major cardiovascular events. Conclusion The utility of bioresorbable scaffold technology remains controversial although meticulous implantation techniques are associated with improved clinical outcomes. Adoption of the Pre-dilatation, Sizing and Post-dilatation (‘PSP’) method of BVS implantation with routine aggressive vessel preparation and scaffold optimization however may contribute to a higher risk of vessel perforation. The case emphasises the importance of accurate sizing of the vessel with intracoronary imaging and demonstrates the value of newer generation covered stents with single-layer design and slimmer crossing profile producing improved deliverability and procedural success. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02501-3.
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Affiliation(s)
- D Chen
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia.,Eastern Heart Clinic, Barker Street, Randwick, NSW, 2031, Australia
| | - R Gadeley
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia. .,University of New South Wales, Sydney, NSW, 2052, Australia.
| | - A Wang
- University of New South Wales, Sydney, NSW, 2052, Australia
| | - N Jepson
- Prince of Wales Hospital, Barker Street, Randwick, NSW, 2031, Australia.,Eastern Heart Clinic, Barker Street, Randwick, NSW, 2031, Australia.,University of New South Wales, Sydney, NSW, 2052, Australia
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5
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Gharleghi R, Dessalles CA, Lal R, McCraith S, Sarathy K, Jepson N, Otton J, Barakat AI, Beier S. Correction to: 3D Printing for Cardiovascular Applications: From End-to-End Processes to Emerging Developments. Ann Biomed Eng 2022; 50:233. [PMID: 35059916 PMCID: PMC8803732 DOI: 10.1007/s10439-021-02894-w] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ramtin Gharleghi
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Ronil Lal
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | - Sinead McCraith
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Nigel Jepson
- Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School of Medicine, UNSW, Sydney, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | | | - Susann Beier
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia.
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6
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Magdy J, Adikari D, Konecny P, Jepson N. Severe Coronary Vasospasm in the Context of Infection With the Omicron Variant of SARS-CoV-2. Heart Lung Circ 2022. [PMCID: PMC9345554 DOI: 10.1016/j.hlc.2022.06.378] [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: 10/27/2022]
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7
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Lim Z, Prendergast S, Gray R, Erikson A, Sarathy K, Kushwaha V, Jepson N. Transcatheter Aortic Valve Implantation – A Single Centre Experience. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.393] [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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8
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Guiney L, Blake V, Gadley R, Back L, McGrath J, Yu J, Kushwaha V, Ooi S, Pitney M, Jepson N. The ESHC-BVS Registry – 5-Year Outcomes With the Absorb Bioresorbable Vascular Scaffold. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.633] [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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9
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Bhatia KS, Sritharan HP, Ciofani J, Chia J, Allahwala UK, Chui K, Nour D, Vasanthakumar S, Khandadai D, Jayadeva P, Bhagwandeen R, Brieger D, Choong C, Delaney A, Dwivedi G, Harris B, Hillis G, Hudson B, Javorski G, Jepson N, Kanagaratnam L, Kotsiou G, Lee A, Lo ST, MacIsaac AI, McQuillan B, Ranasinghe I, Walton A, Weaver J, Wilson W, Yong ASC, Zhu J, Van Gaal W, Kritharides L, Chow CK, Bhindi R. Association of hypertension with mortality in patients hospitalised with COVID-19. Open Heart 2021; 8:openhrt-2021-001853. [PMID: 34876491 PMCID: PMC8649882 DOI: 10.1136/openhrt-2021-001853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To assess whether hypertension is an independent risk factor for mortality among patients hospitalised with COVID-19, and to evaluate the impact of ACE inhibitor and angiotensin receptor blocker (ARB) use on mortality in patients with a background of hypertension. Method This observational cohort study included all index hospitalisations with laboratory-proven COVID-19 aged ≥18 years across 21 Australian hospitals. Patients with suspected, but not laboratory-proven COVID-19, were excluded. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs. Results 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (adjusted OR (aOR) 1.09, 95% CI 1.07 to 1.12, p<0.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13 to 6.53, p=0.026), chronic kidney disease (aOR 2.33, 95% CI 1.02 to 5.32, p=0.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06 to 4.85, p=0.035). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48 to 1.77, p=0.81). Among patients with hypertension, ACE inhibitor (aOR 1.37, 95% CI 0.61 to 3.08, p=0.61) and ARB (aOR 0.64, 95% CI 0.27 to 1.49, p=0.30) use was not associated with mortality. Conclusions In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.
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Affiliation(s)
- Kunwardeep S Bhatia
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hari P Sritharan
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jonathan Ciofani
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Justin Chia
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Usaid K Allahwala
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Karina Chui
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Daniel Nour
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Dhanvee Khandadai
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pavithra Jayadeva
- Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rohan Bhagwandeen
- Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - David Brieger
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Christopher Choong
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony Delaney
- Intensive Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Girish Dwivedi
- Cardiology, Harry Perkins Institute of Medical Research, Perth, Australian Capital Territory, Australia.,Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Benjamin Harris
- Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Bernard Hudson
- NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - George Javorski
- Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Nigel Jepson
- Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Logan Kanagaratnam
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - George Kotsiou
- Infectious Diseases and Microbiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Astin Lee
- Cardiology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sidney T Lo
- Cardiology, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Andrew I MacIsaac
- Cardiology Department, St Vincent's Health Australia, Sydney, New South Wales, Australia
| | - Brendan McQuillan
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Isuru Ranasinghe
- Cardiology, The University of Queensland, Saint Lucia, Queensland, Australia.,The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Antony Walton
- Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - James Weaver
- Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - William Wilson
- Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andy S C Yong
- Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - John Zhu
- Cardiology, Lismore Base Hospital, Lismore, New South Wales, Australia
| | | | - Leonard Kritharides
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Clara K Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Ravinay Bhindi
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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10
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Xue H, Saha SC, Beier S, Jepson N, Luo Z. Topological Optimization of Auxetic Coronary Stents Considering Hemodynamics. Front Bioeng Biotechnol 2021; 9:728914. [PMID: 34589473 PMCID: PMC8473832 DOI: 10.3389/fbioe.2021.728914] [Citation(s) in RCA: 3] [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: 06/22/2021] [Accepted: 08/27/2021] [Indexed: 12/05/2022] Open
Abstract
This paper is to design a new type of auxetic metamaterial-inspired structural architectures to innovate coronary stents under hemodynamics via a topological optimization method. The new architectures will low the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR) associated with the mechanical factors and the adverse hemodynamics. A multiscale level-set approach with the numerical homogenization method and computational fluid dynamics is applied to implement auxetic microarchitectures and stenting structure. A homogenized effective modified fluid permeability (MFP) is proposed to efficiently connect design variables with motions of blood flow around the stent, and a Darcy-Stokes system is used to describe the coupling behavior of the stent structure and fluid. The optimization is formulated to include three objectives from different scales: MFP and auxetic property in the microscale and stenting stiffness in the macroscale. The design is numerically validated in the commercial software MATLAB and ANSYS, respectively. The simulation results show that the new design can not only supply desired auxetic behavior to benefit the deliverability and reduce incidence of the mechanical failure but also improve wall shear stress distribution to low the induced adverse hemodynamic changes. Hence, the proposed stenting architectures can help improve safety in stent implantation, to facilitate design of new generation of stents.
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Affiliation(s)
- Huipeng Xue
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Suvash C Saha
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Kensington, NSW, Australia
| | - Nigel Jepson
- Department Cardiology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Zhen Luo
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
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11
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Gharleghi R, Dessalles CA, Lal R, McCraith S, Sarathy K, Jepson N, Otton J, Barakat AI, Beier S. 3D Printing for Cardiovascular Applications: From End-to-End Processes to Emerging Developments. Ann Biomed Eng 2021; 49:1598-1618. [PMID: 34002286 PMCID: PMC8648709 DOI: 10.1007/s10439-021-02784-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/24/2021] [Indexed: 12/16/2022]
Abstract
3D printing as a means of fabrication has seen increasing applications in medicine in the last decade, becoming invaluable for cardiovascular applications. This rapidly developing technology has had a significant impact on cardiovascular research, its clinical translation and education. It has expanded our understanding of the cardiovascular system resulting in better devices, tools and consequently improved patient outcomes. This review discusses the latest developments and future directions of generating medical replicas ('phantoms') for use in the cardiovascular field, detailing the end-to-end process from medical imaging to capture structures of interest, to production and use of 3D printed models. We provide comparisons of available imaging modalities and overview of segmentation and post-processing techniques to process images for printing, detailed exploration of latest 3D printing methods and materials, and a comprehensive, up-to-date review of milestone applications and their impact within the cardiovascular domain across research, clinical use and education. We then provide an in-depth exploration of future technologies and innovations around these methods, capturing opportunities and emerging directions across increasingly realistic representations, bioprinting and tissue engineering, and complementary virtual and mixed reality solutions. The next generation of 3D printing techniques allow patient-specific models that are increasingly realistic, replicating properties, anatomy and function.
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Affiliation(s)
- Ramtin Gharleghi
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Ronil Lal
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | - Sinead McCraith
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia
| | | | - Nigel Jepson
- Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School of Medicine, UNSW, Sydney, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | | | - Susann Beier
- Faculty of Engineering, School of Mechanical and Manufacturing, UNSW, Sydney, Australia.
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12
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Gadeley R, Kushwaha V, Jepson N. Transcatheter Aortic Valve Replacement and Multi-vessel PCI in an Inoperable Patient–10-year Follow-up. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.341] [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: 10/20/2022]
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13
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Jepson N, Rienks R, Smart D, Bennett MH, Mitchell SJ, Turner M. South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers. Diving Hyperb Med 2020; 50:273-277. [PMID: 32957130 DOI: 10.28920/dhm50.3.273-277] [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] [Received: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 11/05/2022]
Abstract
The South Pacific Underwater Medicine Society (SPUMS) diving medical for recreational scuba divers was last reviewed in 2011. From 2011 to 2019, considerable advancements have occurred in cardiovascular risk assessment relevant to divers. The SPUMS 48th (2019) Annual Scientific Meeting theme was cardiovascular risk assessment in diving. The meeting had multiple presentations updating scientific information about assessing cardiovascular risk. These were distilled into a new set of guidelines at the final conference workshop. SPUMS guidelines for medical risk assessment in recreational diving have subsequently been updated and modified including a new Appendix C: Suggested evaluation of the cardiovascular system for divers. The revised evaluation of the cardiovascular system for divers covers the following topics: 1. Background information on the relevance of cardiovascular risk and diving; 2. Defining which divers with cardiovascular problems should not dive, or whom require treatment interventions before further review; 3. Recommended screening procedures (flowchart) for divers aged 45 and over; 4. Assessment of divers with known or symptomatic cardiovascular disease, including guidance on assessing divers with specific diagnoses such as hypertension, atrial fibrillation, cardiac pacemaker, immersion pulmonary oedema, takotsubo cardiomyopathy, hypertrophic cardiomyopathy and persistent (patent) foramen ovale; 5. Additional cardiovascular health questions included in the SPUMS guidelines for medical risk assessment in recreational diving; 6. Updated general cardiovascular medical risk assessment advice; 7. Referencing of relevant literature. The essential elements of this guideline are presented in this paper.
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Affiliation(s)
- Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Rienk Rienks
- Central Military Hospital, Lundlaan, Utrecht, the Netherlands
| | - David Smart
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Australia.,Corresponding author: Clinical Professor David Smart, Department of Diving and Hyperbaric Medicine, K3 East, Royal Hobart Hospital, Tasmania 7000, Australia,
| | - Michael H Bennett
- Wales Anaesthesia and Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Simon J Mitchell
- Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Mark Turner
- Bristol Heart Institute, Bristol, United Kingdom
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Loh PH, Lassen JF, Jepson N, Koo BK, Chen S, Harding SA, Hu F, Lo S, Ahmad WAW, Ye F, Guagliumi G, Hiremath MS, Uemura S, Wang L, Whelan A, Low A. Asia Pacific consensus document on coronary bifurcation interventions. EUROINTERVENTION 2020; 16:e706-e714. [PMID: 32250248 DOI: 10.4244/eij-d-19-00977] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/17/2023]
Abstract
Coronary bifurcation intervention is common but complex. Progress in this field has been made in recent years with considerable contribution from the Asia Pacific (APAC) region. However, the standard of practice varies across the APAC region due to differences in culture, socioeconomic state and healthcare set-up. Practice may also differ from the rest of the world. Hence, a panel of experts was invited to discuss topics relevant to bifurcation intervention in order to make a concerted effort to achieve consensus that is applicable within the region and in line with available evidence.
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Affiliation(s)
- Poay Huan Loh
- National University Heart Center Singapore and National University of Singapore, Singapore
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15
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Sarathy K, Pitney M, Konecny P, Jepson N. Letter to the Editor: CSANZ Consensus Guidelines for Interventional Cardiology Services Delivery During COVID-19 Pandemic in Australia and New Zealand. Heart Lung Circ 2020; 29:1260-1261. [PMID: 32646639 PMCID: PMC7338017 DOI: 10.1016/j.hlc.2020.05.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 10/27/2022]
Affiliation(s)
- Kiran Sarathy
- Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Mark Pitney
- Prince of Wales Hospital, University of New South Wales, Sutherland Hospital, Eastern Heart Clinic, Sutherland Heart Clinic, Sydney, NSW, Australia
| | - Pamela Konecny
- University of New South Wales, St. George Hospital, Sydney, NSW, Australia
| | - Nigel Jepson
- Prince of Wales Hospital, University of New South Wales, Eastern Heart Clinic, Sydney, NSW, Australia.
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Yong G, Walton T, Ng M, Gurvitch R, Worthley S, Whitbourn R, Jepson N, Bhindi R, Shang K, Sinhal A. Performance and Safety of Transfemoral TAVI With SAPIEN XT in Australian Patients With Severe Aortic Stenosis at Intermediate Surgical Risk: SOLACE-AU Trial. Heart Lung Circ 2020; 29:1839-1846. [PMID: 32712017 DOI: 10.1016/j.hlc.2020.04.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/18/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To determine the safety and performance of the SAPIEN XT transcatheter heart valve (THV) in Australian patients with severe aortic stenosis (AS) and intermediate surgical risk. METHODS Eligible patients in this multi-centre, prospective, consecutively enrolled, non-randomised, clinical trial, received transcatheter aortic valve replacement via femoral artery access. Follow-up visits were at discharge, 30 days, and 6, 12, and 24 months. The primary endpoint was Valve Academic Research Consortium-2 composite safety at 30 days: all-cause mortality, all stroke, life-threatening bleeding, acute kidney injury-Stage 3, coronary artery obstruction requiring intervention, major vascular complication, and valve-related dysfunction requiring repeat procedure. Other endpoints were device success (successful vascular access, delivery, and deployment; correct position; intended performance mean aortic valve gradient <20 mmHg, mild or less paravalvular aortic regurgitation [PAR]; and only one valve implanted) and New York Heart Association functional class (NYHA). Kaplan-Meier (KM) estimates were calculated for the primary endpoint. RESULTS At baseline, mean patient (N=199) age was 85.5 years, mean Society of Thoracic Surgeon score was 5.9, and 78.4% were in NYHA class III/IV. The primary composite endpoint KM estimate was 12.1%. Device success was 88.8%. SAPIEN XT was implanted in the proper location in 98.5% (n=2: valve-in-valve procedures, n=1: no implant due to left main coronary artery occlusion). No device malfunctions were reported. The post procedure PAR was mild or less in 93.8% of patients. Mean aortic gradient decreased from baseline (50.0 mmHg) to 2 years (10.3 mmHg). Most patients (90.9%) were in NYHA class I/II at 30 days. New permanent pacemaker rate was 8.1%. Stroke at 30 days was 3.5% (1.5% disabling). CONCLUSION SAPIEN XT was safe and improved heart failure symptoms and valve haemodynamics in this cohort of Australian patients.
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Affiliation(s)
- Gerald Yong
- Fiona Stanley Hospital, Perth, WA, Australia.
| | | | - Martin Ng
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | | | | | - Robert Whitbourn
- St Vincent's Hospital Melbourne & Melbourne University, Melbourne, Vic, Australia
| | - Nigel Jepson
- Prince of Wales Public Hospital and Eastern Heart Clinic, Sydney, NSW, Australia; University of NSW, Sydney, NSW, Australia
| | | | - Kan Shang
- Edwards Lifesciences, Irvine, CA, USA
| | - Ajay Sinhal
- Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
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Gray R, Brassil J, Jepson N. P1699 A case of atrial myxoma presenting with acute stroke. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1062] [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
A 73-year-old female presented with sudden reduced level of consciousness on the background of rheumatoid arthritis and dyslipidaemia. On examination she had a Glascow Coma Score of 12 and an irregularly irregular pulse. The electrocardiograph confirmed atrial fibrillation and showed widespread T wave inversion. A computed tomography cerebral angiogram showed an acute basilar artery occlusion. She was transferred to a tertiary centre where she had successful endovascular clot retrieval. An urgent transthoracic echocardiogram (figure 1) showed apical hypertrophy, normal systolic function and a large right atrial mass. The left atrial size was normal. A transoesophageal echocardiogram (figure 3) confirmed a large pedunculated mobile mass with a hypermobile septum consistent with a patent foramen ovale. There was no right to left doppler flow, however the atrial mass obstructed the course, and a bubble study was positive. The cardiac magnetic resonance image (figure 2) showed a 47 x 48 mm pedunculated lesion within the right atrium, arising from the intraventricular septum, demonstrating moderate T2 signal intensity, and intermediate T1 signal intensity, with avid enhancement, consistent with a right atrial myxoma. There was increased apical wall thickening at 15mm which confirmed apical hypertrophic cardiomyopathy. An open surgical resection and left atrial appendage ligation was performed on day 11 of admission. Histopathology confirmed an atrial myxoma. She had an excellent neurological recovery with only mild diplopia. The mechanism of stroke was likely atrial fibrillation secondary to increased left atrial pressure from apical hypertrophic cardiomyopathy. However, the unexpected finding of a right atrial myxoma with a corresponding patent foramen ovale provides a second possible mechanism.
Abstract P1699 Figure. Right atrial Myxoma
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Affiliation(s)
- R Gray
- Prince of Wales Hospital, Sydney, Australia
| | - J Brassil
- Prince of Wales Hospital, Sydney, Australia
| | - N Jepson
- Prince of Wales Hospital, Sydney, Australia
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18
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Jeyaprakash P, Khor L, Madan K, Sivapathan S, Hill L, Robledo K, Hallani H, Roy P, Ellenberger K, Jepson N, Roy J, Pressley L, Patal S, Thomas L, French J, Burgess S. 887 STEMI in the Time of COVID-19: NSW Data. Heart Lung Circ 2020. [PMCID: PMC8435296 DOI: 10.1016/j.hlc.2020.09.894] [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: 10/25/2022]
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19
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Allan M, Vickers D, Pitney M, Jepson N. Rotational Atherectomy Combined with Drug Coated-Balloons for in-Stent Restenosis. Cardiovascular Revascularization Medicine 2019; 20:559-562. [DOI: 10.1016/j.carrev.2018.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
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20
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Costa JR, Abizaid A, Whitbourn R, Serruys PW, Jepson N, Steinwender C, Stuteville M, Ediebah D, Sudhir K, Bartorelli AL. Three-year clinical outcomes of patients treated with everolimus-eluting bioresorbable vascular scaffolds: Final results of the ABSORB EXTEND trial. Catheter Cardiovasc Interv 2018; 93:E1-E7. [PMID: 30286520 DOI: 10.1002/ccd.27715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is still limited data on the very long term clinical outcomes after ABSORB BRS in daily practice. We sought to evaluate the 3 year-performance of the Absorb bioresorbable vascular scaffolds for the treatment of low/moderate complexity patients enrolled in the ABSORB EXTEND trial. METHODS ABSORB EXTEND is a prospective, single-arm, open-label clinical study in which 812 patients were enrolled at 56 sites. This study allowed the treatment of lesions ≤28 mm in length and reference vessel diameter of 2.0-3.8 mm (as assessed by on-line QCA). To determine the independent predictors of MACE, a multivariable logistic regression model was built using a stepwise (forward/backward) procedure. RESULTS Average population age was 61 years and 26.5% had diabetes. Most patients had single target lesion (92.4%). Adequate scaffold deployment (PSP) was achieved in 14.2% of the cases. At three years, the composite endpoints of MACE and ischemia-driven target vessel failure were 9.2% and 10.6%, respectively. The cumulative rate of ARC definite/probable thrombosis was 2.2%, with 1.2% of the cases occurring after the 1st year. Independent predictors of MACE were hypertension and the need for "bail out" stent. CONCLUSION At three-year follow-up, the use of ABSORB in low/moderate complex PCI was associated with low and acceptable rates of major adverse clinical events, despite the infrequent use of the recommended contemporary scaffold deployment technique. However, scaffold thrombosis rate was higher than reported with current generation of metallic DES. The study is registered on clinicaltrials.gov (unique identifier NCT01023789).
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Affiliation(s)
| | | | | | - Patrick W Serruys
- Thoraxcenter Erasmus University Medical Center, Rotterdam, The Netherlands
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21
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Lam CF, Yu J, Li J, Pitney M, Ooi SY, Jepson N. TCTAP A-021 Clinical Outcomes of Women Undergoing Percutaneous Coronary Intervention at a Metropolitan Australian Teaching Hospital. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.03.047] [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: 11/16/2022]
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22
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Lam C, Yu J, Li J, Pitney M, Ooi S, Jepson N. Clinical Outcomes of Women Undergoing Percutaneous Coronary Intervention at a Metropolitan Teaching Hospital. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.906] [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: 10/28/2022]
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23
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McGrath J, Guiney L, Li J, Vickers D, Mikhail P, Yu J, Blake V, Robaei D, Back L, Ooi S, Pitney M, Jepson N. Long-Term Clinical Outcomes Following Implantation of Bioresorbable Vascular Scaffolds: Experience From Two Australian Centres. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.944] [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: 10/28/2022]
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24
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Ford TJ, Nguyen K, Brassil J, Kushwaha V, Friedman D, Allan R, Pitney M, Jepson N. Balloon Aortic Valvuloplasty in the Transcatheter Valve Era: Single Centre Indications and Early Safety Data in a High Risk Population. Heart Lung Circ 2017; 27:595-600. [PMID: 28688833 DOI: 10.1016/j.hlc.2017.05.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/20/2017] [Accepted: 05/09/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The introduction of transcatheter aortic valve implantation (TAVI) has generated a renewed interest in the techniques available to treat high-risk patients with severe aortic stenosis (AS). We report our single centre experience with balloon aortic valvuloplasty (BAV) focussing on indications, procedural success and 30-day outcomes. METHODS We retrospectively reviewed all patients that underwent BAV procedures at our institution between August 2012 and August 2014. Procedural success and complications were adjudicated according to VARC-2 criteria. RESULTS Fifty-one consecutive adult patients with severe symptomatic AS underwent a total of 55 BAV procedures. The patients had a mean age of 88±5.7 years and all had extensive comorbidities with a high surgical risk (mean logistic EuroSCORE of 25.22%±14.5%). Indications for BAV included palliation of symptoms n=42 (76%); bridge to definitive valve replacement (n=6, 11%); and evaluation of response (n=6, 11%). The procedure was completed in all patients with no intraprocedural deaths (within 24hours) and low 30-day mortality at 3.9% (n=2). Minor vascular complications occurred in 11.8% (n=6), whilst permanent pacemaker implantation was required in 5.8% (n=3). There were no cases of myocardial infarction, stroke, tamponade, severe aortic regurgitation or major vascular complications during 30-day follow-up. CONCLUSIONS Balloon aortic valvuloplasty may be performed safely and effectively with high procedural success and low 30-day complications, even in a very high-risk and elderly cohort of patients in whom the role of TAVI is uncertain or inappropriate.
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Affiliation(s)
- Thomas J Ford
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Katherine Nguyen
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Joseph Brassil
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Virag Kushwaha
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Daniel Friedman
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Roger Allan
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Mark Pitney
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Nigel Jepson
- Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia.
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Jepson N, Chen D. Coronary stent technology: a narrative review. Med J Aust 2017; 206:413-414. [DOI: 10.5694/mja16.01251] [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] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 11/11/2016] [Indexed: 11/17/2022]
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Robaei D, Carlyle A, Jepson N. “Full bioresorbable jacket”: Alternative to very long segment metallic stenting in a young patient with diffuse coronary artery disease. Int J Cardiol 2016; 223:361-363. [DOI: 10.1016/j.ijcard.2016.08.179] [Citation(s) in RCA: 2] [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] [Received: 07/23/2016] [Accepted: 08/07/2016] [Indexed: 10/21/2022]
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27
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Lynch C, Sarathy K, Yu J, Jepson N, Ooi SY, Liou K. TCT-364 Radial vs Femoral Access for Coronary Angiography and Intervention in the Elderly (>75) - a Meta-analysis and Subgroup Analysis (All studies vs Octagenarian studies, N. America studies vs Rest of the World studies). J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Liou K, Jepson N, Kushwaha V, Yu J, Ooi SY. TCT-543 Calculation of Serial Index of Microvascular Resistance with Adjusted Wedge Pressure in Patients with Non-ST Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.680] [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: 10/20/2022]
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de Ribamar Costa J, Abizaid A, Bartorelli A, Whitbourn R, Jepson N, Perin M, Steinwender C, Stuteville M, Ediebah D, Sudhir K, Serruys P. One-year clinical outcomes of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting metallic stents: a propensity score comparison of patients enrolled in the ABSORB EXTEND and SPIRIT trials. EUROINTERVENTION 2016; 12:1255-1262. [DOI: 10.4244/eijv12i10a206] [Citation(s) in RCA: 6] [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] [Indexed: 11/23/2022]
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30
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Liou K, Jepson N, Kushwaha V, Yu J, Cranney G, Ooi SY. TCT-526 The Index of Microvascular Resistance Predicts Immediate Recovery of Left Ventricular Systolic Function Following PCI in Patients with NSTEACS. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.663] [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: 11/25/2022]
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31
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Roy J, Akhunji Z, Kushwaha V, Mackie J, Jepson N. Phaeochromocytoma presenting with labile blood pressures following coronary artery bypass grafting. J Card Surg 2016; 31:721-724. [PMID: 27699857 DOI: 10.1111/jocs.12852] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pheochromocytomas have been reported prior to and during coronary artery bypass surgery. We present a patient with an undiagnosed pheochromocytoma who presented with labile hypertension following coronary artery bypass surgery. This case calls attention to the inclusion of an undiagnosed pheochromocytoma in the differential diagnosis for all patients who develop labile hypertension in the postoperative period following cardiac surgery.
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Affiliation(s)
- James Roy
- Department of Cardiology, Eastern Heart Clinic, The Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Zakir Akhunji
- Department of Cardiology, Eastern Heart Clinic, The Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Virag Kushwaha
- Department of Cardiology, Eastern Heart Clinic, The Prince of Wales Hospital, Randwick, Sydney, Australia
| | - James Mackie
- Department of Nephrology, The Prince of Wales Hospital, Randwick, Sydney, Australia
| | - Nigel Jepson
- Department of Cardiology, Eastern Heart Clinic, The Prince of Wales Hospital, Randwick, Sydney, Australia
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Robaei D, Back L, Ooi SY, Pitney M, Jepson N. Twelve-Month Outcomes With a Bioresorbable Everolimus-Eluting Scaffold: Results of the ESHC-BVS Registry at Two Australian Centers. J Invasive Cardiol 2016; 28:316-322. [PMID: 26567454] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular) is a relatively new type of coronary stent designed to provide temporary vessel scaffolding following percutaneous coronary intervention. International use of the device has grown despite a relative paucity of clinical data regarding the performance of the device and the optimal strategy for its use. We report 12-month clinical data on the Absorb BVS from a real-world registry in order to contribute to the overall understanding of the BVS device. METHODS AND RESULTS Absorb BVS implantation was attempted in 152 lesions in 100 patients at two Sydney hospitals, as part of the prospective ESHC-BVS registry. Patients selected harbored a range of complex lesions as encountered in real-world practice. Type-C lesions made up 37% of all lesions treated, with 64% of these being long lesions (>20 mm). Device success was achieved in 98.8% of cases. Predilation was performed in all scaffolds and postdilation was performed in 95% of scaffolds to a mean of 19.6 ± 4.6 atm. Twelve-month follow-up data were available for 99% of patients. At 12 months, the cumulative incidence of target-lesion revascularization was 4%, while the incidence of myocardial infarction was 2% and the incidence of scaffold thrombosis was 1%. There were no deaths in the follow-up period. CONCLUSION In a cohort including complex lesions encountered in real-world practice, the Absorb BVS was associated with low rates of target-lesion revascularization, myocardial infarction, and scaffold thrombosis at 12 months when used with a strategy of meticulous lesion preparation, routine postdilation, and 12 months of dual-antiplatelet therapy.
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Affiliation(s)
| | | | | | | | - Nigel Jepson
- Eastern Heart Clinic, Prince of Wales Hospital, Level 3 Campus Centre Building, Barker St, Randwick NSW 2031, Australia.
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Lynch C, Sarathy K, Yu J, Jepson N, Ooi S, Liou K. Radial vs Femoral Access for Coronary Angiography and Intervention in the Elderly (>75) - A Meta-Analysis. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.450] [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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35
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Ng B, Jepson N, Alford K. More Than a Mere Case of Pericarditis? Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.641] [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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Liou K, Ooi S, Jepson N. Bifurcation Percutaneous Coronary Intervention With Bio-resorbable Scaffold: Pushing the Boundary. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.391] [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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37
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Liou K, Jepson N. Bioresorbable scaffold—the holy grail of percutaneous coronary intervention: fact or myth? J Thorac Dis 2016; 8:E589-92. [DOI: 10.21037/jtd.2016.05.27] [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: 11/06/2022]
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Abstract
Bioresorbable scaffolds (BRS) are a promising new interventional treatment strategy for coronary artery disease (CAD). They are intended to overcome some of the shortcomings of metal drug-eluting stents (DES), mainly late reinterventions which occur at a consistent rate after one year and have not been reduced by the use of local drug elution. Initial experience in non-complex lesions established efficacy in opening the vessel and the concept of bioresorption. However, with the use of BRS in more complex lesions, the incidence of BRS failure, including both scaffold restenosis and thrombosis, has also increased. Therefore, understanding of both the pathophysiology and of the available treatment options of scaffold failure remains an important issue in ensuring procedural and long-term clinical success.
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Affiliation(s)
- Cordula Felix
- Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Liou K, Jepson N, Buckley N, Chen V, Thomas S, Russell EA, Ooi SY. Design and Rationale for the Endothelin-1 Receptor Antagonism in the Prevention of Microvascular Injury in Patients with non-ST Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention (ENDORA-PCI) Trial. Cardiovasc Drugs Ther 2016; 30:169-75. [DOI: 10.1007/s10557-016-6641-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liou K, Nagaraja V, Jepson N, Ooi SY. Optimal duration of dual antiplatelet therapy following drug-eluting stents implantation: A meta-analysis of 7 randomised controlled trials. Int J Cardiol 2015; 201:578-80. [DOI: 10.1016/j.ijcard.2015.03.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/20/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Abstract
Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.
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Abstract
BACKGROUND Acute coronary syndrome (ACS), includes acute myocardial infarction and unstable angina, is common and may prove fatal. Hyperbaric oxygen therapy (HBOT) will improve oxygen supply to the threatened heart and may reduce the volume of heart muscle that perishes. The addition of HBOT to standard treatment may reduce death rate and other major adverse outcomes.This an update of a review previously published in May 2004 and June 2010. OBJECTIVES The aim of this review was to assess the evidence for the effects of adjunctive HBOT in the treatment of ACS. We compared treatment regimens including adjunctive HBOT against similar regimens excluding HBOT. Where regimens differed significantly between studies this is clearly stated and the implications discussed. All comparisons were made using an intention to treat analysis where this was possible. Efficacy was estimated from randomised trial comparisons but no attempt was made to evaluate the likely effectiveness that might be achieved in routine clinical practice. Specifically, we addressed:Does the adjunctive administration of HBOT to people with acute coronary syndrome (unstable angina or infarction) result in a reduction in the risk of death?Does the adjunctive administration of HBOT to people with acute coronary syndrome result in a reduction in the risk of major adverse cardiac events (MACE), that is: cardiac death, myocardial infarction, and target vessel revascularization by operative or percutaneous intervention?Is the administration of HBOT safe in both the short and long term? SEARCH METHODS We updated the search of the following sources in September 2014, but found no additional relevant citations since the previous search in June 2010 (CENTRAL), MEDLINE, EMBASE, CINAHL and DORCTHIM. Relevant journals were handsearched and researchers in the field contacted. We applied no language restrictions. SELECTION CRITERIA Randomised studies comparing the effect on ACS of regimens that include HBOT with those that exclude HBOT. DATA COLLECTION AND ANALYSIS Three authors independently evaluated the quality of trials using the guidelines of the Cochrane Handbook and extracted data from included trials. Binary outcomes were analysed using risk ratios (RR) and continuous outcomes using the mean difference (MD) and both are presented with 95% confidence intervals. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS No new trials were located in our most recent search in September 2014. Six trials with 665 participants contributed to this review. These trials were small and subject to potential bias. Only two reported randomisation procedures in detail and in only one trial was allocation concealed. While only modest numbers of participants were lost to follow-up, in general there is little information on the longer-term outcome for participants. Patients with acute coronary syndrome allocated to HBOT were associated with a reduction in the risk of death by around 42% (RR: 0.58, (95% CI 0.36 to 0.92), 5 trials, 614 participants; low quality evidence).In general, HBOT was well-tolerated. No patients were reported as suffering neurological oxygen toxicity and only a single patient was reported to have significant barotrauma to the tympanic membrane. One trial suggested a significant incidence of claustrophobia in single occupancy chambers of 15% (RR of claustrophobia with HBOT 31.6, 95% CI 1.92 to 521). AUTHORS' CONCLUSIONS For people with ACS, there is some evidence from small trials to suggest that HBOT is associated with a reduction in the risk of death, the volume of damaged muscle, the risk of MACE and time to relief from ischaemic pain. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously, and an appropriately powered trial of high methodological rigour is justified to define those patients (if any) who can be expected to derive most benefit from HBOT. The routine application of HBOT to these patients cannot be justified from this review.
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Affiliation(s)
- Michael H Bennett
- Department of Anaesthesia, Prince of Wales Clinical School, University of NSW, Sydney, NSW, Australia
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Chen SL, Zhang JJ, Ye F, Tian NL, Sheiban I, Jepson N, Paiboon C, Sansoto T, Kwan TW, Wen SY, Wang HC, Jiang TM, Wang Y, Chen LL, Qiu CG, Zhang YJ, Chen MX, De Maria A. Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug-eluting stent. Catheter Cardiovasc Interv 2015; 85 Suppl 1:696-705. [PMID: 25631678 DOI: 10.1002/ccd.25857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/07/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Shao-Liang Chen
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | | | - Fei Ye
- Cardiology, Nanjing Heart Center; Nanjing China
| | - Nai-Liang Tian
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | - Imad Sheiban
- Cardiology, San Giovanni Battista Hospital, University of Turin; Turin Italy
| | - Nigel Jepson
- Cardiology, Hospital of Prince Wales; Sydney Australia
| | | | - Teugh Sansoto
- Cardiology, Medistra Hospital, University of Indonesia Medical School; Indonesia
| | - Tak W. Kwan
- Cardiology, Mount Sinai Beth Israel Hospital; New York New York
| | - Shang-Yu Wen
- Cardiology, Daqing Oil General Hospital; Daqing China
| | - Hai-Chang Wang
- Cardiology, Xijing Hospital; Xi'an 4th Military Medical University; Xi'an China
| | - Tie-Ming Jiang
- Cardiology, Tianjing Policemen Medical College Hospital; Tianjing China
| | - Yan Wang
- Cardiology, Xia'Men Zhongshan Hospital; Xia'men China
| | | | - Chun-Guang Qiu
- Cardiology, Henan Provincial People's Hospital; Zhenzhou China
| | | | - Meng-Xuan Chen
- Cardiology, Emory College of Art and Science; Atlanta Georgia
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Liou K, Jepson N, Kellar P, Ng B, Isbister J, Giles R, Friedman D, Allan R, Lau A, Pitney M, Ooi SY. Prognostic Significance of Peri-procedural Myocardial Infarction in the Era of High Sensitivity Troponin: A Validation of the Joint ACCF/AHA/ESC/WHF Universal Definition of Type 4a Myocardial Infarction with High Sensitivity Troponin T. Heart Lung Circ 2015; 24:673-81. [PMID: 25697382 DOI: 10.1016/j.hlc.2015.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/01/2015] [Accepted: 01/05/2015] [Indexed: 11/18/2022]
Abstract
AIMS This study aims to validate the joint ACCF/AHA/ESC/WHF Universal Definition of peri-procedural myocardial infarction (PMI) with high sensitivity troponin T (hsTnT). METHODS A retrospective cohort study encompassing patients admitted to our institution between May 2012 and April 2013 was performed. RESULTS 630 patients underwent percutaneous coronary interventions during the study period. Among them, 459 patients met the inclusion criteria and were eligible for analyses. 76.9% of these patients were male, while the mean age was 68.6. PMI was observed in 4.3% of the patients based on the Universal Definition. The predictors of PMI were chronic kidney disease (OR: 3.0, p=0.026), family history of cardiovascular disease (OR: 2.7, p=0.043) and use of IIb/IIIa inhibitors (OR 4.2, p=0.01). MACE was reported in 4.4% of the patients at 12 months, and was significantly and independently associated with PMI (OR 7.3, p=0.003) in a multivariate model which accounted for lesion complexity, patients' baseline clinical information, dual-antiplatelet status at follow-up and various procedural characteristics. The post-procedural hsTnT was much higher in those who suffered MACE than those who did not (156 v.s. 43 ng/L, p<0.001). CONCLUSION PMI as defined by the current Universal Definition using hsTnT is an independent predictor of adverse clinical outcome at 12 months in patients undergoing PCI. Accordingly, PMI remains a clinically relevant factor in current practice and should be considered a key outcome measure in clinical trials and a potential target for therapy.
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Affiliation(s)
- Kevin Liou
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia.
| | - Nigel Jepson
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Petrina Kellar
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Ben Ng
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Julia Isbister
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Robert Giles
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Daniel Friedman
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Roger Allan
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Antony Lau
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
| | - Mark Pitney
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia
| | - Sze-Yuan Ooi
- Eastern Heart Clinic, Prince of Wales Hospital, Randwick, NSW Australia; University of New South Wales, Randwick, NSW, Australia
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Robaei D, Back L, Atique S, Tan R, Ooi S, Giles R, Farshid A, Pitney M, Jepson N. Australian multi-centre experience with bioresorbable vascular scaffolds in “real-world” coronary disease - twelve-month outcomes. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.358] [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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Robaei D, Back L, Ooi S, Giles R, Pitney M, Jepson N. Long-term safety of an Everolimus-eluting bioresorbable scaffold: two year clinical outcomes in a wide spectrum of coronary lesions. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.398] [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: 10/23/2022]
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Ford T, Nguyen K, Pitney M, Friedman D, Lau A, Giles R, Allan R, Jepson N. Balloon aortic valvuloplasty: contemporary single centre experience in the TAVI era. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.360] [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: 10/23/2022]
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Vickers D, Robaei D, Carlyle A, Lau A, Giles R, Ooi S, Pitney M, Jepson N. Routine debulking rotational atherectomy preparation before drug eluting balloons for the management of in-stent restenosis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.441] [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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Spies M, Robaei D, Baker L, Jepson N. Mediastinal haematoma complicating percutaneous coronary intervention via the radial artery. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.402] [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: 10/23/2022]
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Nagaraja V, Liou K, Jepson N, Eslick G, Ooi S. Prolonged infusion of bivalirudin improves outcomes in patients undergoing percutaneous coronary intervention: A systematic review and meta-analysis of randomised trials. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.430] [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: 10/23/2022]
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