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Sampaio Rodrigues T, Garcia Quarto LJ, Nogueira SC, Koshy AN, Mahajan R, Sanders P, Ekinci EI, Burrell LM, Farouque O, Lim HS. Incidence and progression of atrial fibrillation in patients with and without heart failure using mineralocorticoid receptor antagonists: a meta-analysis. Clin Res Cardiol 2024; 113:884-897. [PMID: 38170251 DOI: 10.1007/s00392-023-02349-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Mineralocorticoid receptor antagonists (MRAs) have emerged as potential therapy to target the underlying arrhythmogenic substrate in atrial fibrillation (AF). Nevertheless, there have been inconsistent results on the impact of MRAs on AF. OBJECTIVE We sought to evaluate the effect of MRAs on AF incidence and progression in patients with and without heart failure. METHODS Electronic databases were searched up to September, 2022 for randomized controlled trials (RCTs) that evaluated MRA use and reported AF outcomes. Primary outcome was a composite of new-onset or recurrent AF. Safety outcomes included hyperkalemia and gynecomastia risks. A random-effects meta-analysis estimated pooled odds ratios (OR) and 95% confidence intervals (CI). RESULTS 12 RCTs, comprising 11,419 patients treated with various MRAs were included [5960 (52%) on MRA]. On follow-up (6-39 months), 714 (5.5%) patients developed AF. MRA therapy was associated with a 32% reduction in the risk of new-onset or recurrent AF [OR 0.68 (95% CI 0.51-0.92), I2 = 40%]. On subgroup analysis, the greatest benefit magnitude was demonstrated in reducing AF recurrence [OR 0.50 (95% CI 0.30-0.83)] and among patients with left ventricular dysfunction [OR 0.59 (95% CI 0.40-0.85)]. Gynecomastia, but not hyperkalemia, was associated with MRA use. Meta-regression analysis demonstrated that therapy duration was a significant interaction factor driving the effect size (Pinteraction = 0.013). CONCLUSION MRA use is associated with a reduction in AF risk, especially AF progression. A prominent effect is seen in patients with heart failure, further augmented by therapy duration. Prospective trials are warranted to evaluate MRA use as upstream therapy for preventing this common arrhythmia.
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Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajiv Mahajan
- University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Prashanthan Sanders
- University of Adelaide, Adelaide, SA, Australia
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Elif I Ekinci
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, University of Melbourne, VIC, Australia
| | - Louise M Burrell
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
- Department of Cardiology, Austin Health, 145 Studley Road, Heidelberg, 3084, Australia.
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Sampaio Rodrigues T, Narendren A, Cailes B, Lim RP, Weinberg L, Testro A, Majumdar A, Sinclair M, Farouque O, Koshy AN. Enhancing pre-transplant cardiac assessment: Validation and utility of the CAD-LT score with CCTA in liver transplant candidates. Int J Cardiol 2024; 403:131895. [PMID: 38395260 DOI: 10.1016/j.ijcard.2024.131895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is increasingly being used in the preoperative workup for liver transplantation (LT). We sought to assess the utility of integrating CCTA with the novel CAD-LT (Coronary Artery Disease in Liver Transplantation) score and its impact on reducing the need for invasive coronary angiography prior to LT. METHODS We conducted a retrospective cohort study of consecutive patients (age ≥ 18 years) who underwent CCTA for LT workup between 2011 and 2018 at the Victorian Liver Transplant Unit, Melbourne, Australia. CAD-LT scores, a traditional risk factor-based criteria, were calculated, and patients stratified as low-, intermediate- or high-risk. RESULTS Overall, 229 patients underwent CCTA. The mean age was 66 ± 5 years (82% male) with a modest-to-high risk factor burden (diabetes, 53%; hypertension, 46%; current or former smoker, 62%). The mean CAD-LT score of our cohort was 12.4 ± 4.0. No patients were classified as low-risk, 49 patients (21.4%) were deemed intermediate-risk and 180 patients (78.6%) were deemed high-risk. A high CAD-LT score (≥ 9) showed high sensitivity (95.3% [95% CI 86-98%]) and modest specificity (27.8% [95% CI 21-35%]) for the detection of obstructive coronary artery disease on CCTA, with a negative predictive value of 94%. Following multidisciplinary discussions, only 41 patients (18%) of patients proceeded to ICA of which 27% received percutaneous coronary intervention. CONCLUSIONS The use of CCTA in patients deemed intermediate- to high-risk by the CAD-LT score has the potential to reduce the need for invasive coronary angiography in patients undergoing LT workup.
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Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, VIC, Australia
| | - Ahthavan Narendren
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; Department of Cardiology, Northern Health, Melbourne, VIC, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, VIC, Australia
| | - Ruth P Lim
- Department of Radiology, The University of Melbourne, VIC, Australia; Department of Radiology, Austin Health, Melbourne, VIC, Australia
| | - Laurence Weinberg
- Department of Medicine, The University of Melbourne, VIC, Australia; Department of Anaesthesiology, The University of Melbourne, VIC, Australia
| | - Adam Testro
- Department of Medicine, The University of Melbourne, VIC, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Avik Majumdar
- Department of Medicine, The University of Melbourne, VIC, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Marie Sinclair
- Department of Medicine, The University of Melbourne, VIC, Australia; Victorian Liver Transplant Unit, Austin Health, Melbourne, VIC, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, VIC, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, VIC, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
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Sampaio Rodrigues T, Koshy AN, Cailes B, Majumdar A, Farouque O. Reply: Coronary CT angiography for predicting early post-liver transplant MACE: Paradigm shift or part of the calculus? Liver Transpl 2024:01445473-990000000-00347. [PMID: 38497743 DOI: 10.1097/lvt.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Avik Majumdar
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Gastroenterology, Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Sampaio Rodrigues T, Garcia Quarto LJ, Nogueira SC, Theuerle JD, Farouque O, Burrell LM, Koshy AN. Door-to-diuretic time and mortality in patients with acute heart failure: A systematic review and meta-analysis. Am Heart J 2024; 269:205-209. [PMID: 38359992 DOI: 10.1016/j.ahj.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024]
Abstract
Early decongestion therapy with intravenous diuretics may be associated with improved outcomes in acute heart failure (AHF), however data is conflicting. This meta-analysis sought to evaluate the impact of door-to-IV diuretic (D2D) time on mortality in patients with AHF. Pooled estimates from observational studies comprising 28,124 patients, early IV diuresis (reference time 30-105 minutes) was associated with a 23% reduction in 30-day mortality in AHF (OR 0.77; 95% CI 0.64-0.93), despite no significant in-hospital death reduction (OR 0.84; 95% CI 0.57-1.24).
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Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
| | | | | | - James D Theuerle
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise M Burrell
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Icahn School of Medicine at Mount Sinai, New York, NY; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Sampaio Rodrigues T, Koshy AN, Gow PJ, Weinberg L, Cailes B, Testro A, Smith G, Lim HS, Teh AW, Lim RP, Farouque O. Atherosclerosis on CT coronary angiography and the risk of long-term cardiovascular events after liver transplantation. Liver Transpl 2024; 30:182-191. [PMID: 37432891 DOI: 10.1097/lvt.0000000000000215] [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: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
Computed tomography coronary angiography (CTCA) is increasingly utilized for preoperative risk stratification before liver transplantation (LT). We sought to assess the predictors of advanced atherosclerosis on CTCA using the recently developed Coronary Artery Disease-Reporting and Data System (CAD-RADS) score and its impact on the prediction of long-term major adverse cardiovascular events (MACE) following LT. We conducted a retrospective cohort study of consecutive patients who underwent CTCA for LT work-up between 2011 and 2018. Advanced atherosclerosis was defined as coronary artery calcium scores > 400 or CAD-RADS score ≥ 3 (≥50% coronary artery stenosis). MACE was defined as myocardial infarction, heart failure, stroke, or resuscitated cardiac arrest. Overall, 229 patients underwent CTCA (mean age 66 ± 5 y, 82% male). Of these, 157 (68.5%) proceeded with LT. The leading etiology of cirrhosis was hepatitis (47%), and 53% of patients had diabetes before transplant. On adjusted analysis, male sex (OR 4.6, 95% CI 1.5-13.8, p = 0.006), diabetes (OR 2.2, 95% CI 1.2-4.2, p = 0.01) and dyslipidemia (OR 3.1, 95% CI 1.3-6.9, p = 0.005) were predictors of advanced atherosclerosis on CTCA. Thirty-two patients (20%) experienced MACE. At a median follow-up of 4 years, CAD-RADS ≥ 3, but not coronary artery calcium scores, was associated with a heightened risk of MACE (HR 5.8, 95% CI 1.6-20.6, p = 0.006). Based on CTCA results, 71 patients (31%) commenced statin therapy which was associated with a lower risk of all-cause mortality (HR 0.48, 95% CI 0.24-0.97, p = 0.04). The standardized CAD-RADS classification on CTCA predicted the occurrence of cardiovascular outcomes following LT, with a potential to increase the utilization of preventive cardiovascular therapies.
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Affiliation(s)
- Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Anesthesiology, Austin Health, Melbourne, Victoria, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Gerard Smith
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Ruth P Lim
- Department of Radiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
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Harris G, Chuen J, Farouque O, Hare DL, Hoi A. Case report: Lipoprotein (a) related accelerated atherosclerosis in a young patient: An important differential when considering Takayasu arteritis. Int J Rheum Dis 2024; 27:e15087. [PMID: 38375750 DOI: 10.1111/1756-185x.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/13/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Georgia Harris
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
| | - Jason Chuen
- Department of Vascular Surgery, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Alberta Hoi
- Department of Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
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Gin J, Yeoh J, Hamilton G, Ajani A, Dinh D, Brennan A, Reid CM, Freeman M, Oqueli E, Hiew C, Stub D, Chan W, Picardo S, Yudi M, Horrigan M, Farouque O, Clark D. Real-world long-term survival after non-emergent percutaneous coronary intervention to unprotected left main coronary artery - From the Melbourne Interventional Group (MIG) registry. Cardiovasc Revasc Med 2024; 58:1-6. [PMID: 37500394 DOI: 10.1016/j.carrev.2023.07.005] [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: 07/05/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Current evidence suggests that percutaneous coronary intervention for unprotected left main coronary artery disease (LMPCI) in selected patients is a safe alternative to coronary artery bypass grafting. However, real-world long-term survival data is limited. METHODS We analyzed 24,644 patients from the MIG (Melbourne Interventional Group) registry between 2005 and 2020. We compared baseline clinical and procedural characteristics, in-hospital and 30-day outcomes, and long-term survival between unprotected LMPCI and non-LMPCI among patients without ST-segment elevation myocardial infarction, cardiogenic shock, or cardiac arrest. RESULTS Unprotected LMPCI patients (n = 185) were significantly older (mean age 72.0 vs. 64.6 years, p < 0.001), had higher prevalence of impaired ejection fraction (EF <50 %; 27.3 % vs. 14.9 %, p < 0.001) and lower estimated glomerular filtration rate < 60 ml/min/1.73m2 (40.9 % vs. 21.5 %, p < 0.001), and had greater use of intravascular ultrasound (21 % vs. 1 %, p < 0.001) and drug-eluting stents (p < 0.001). LMPCI was associated with longer hospital stay (4 days vs. 2 days, p < 0.001). There was no significant difference in other in-hospital outcomes, 30-day mortality (0.6 % vs. 0.6 %, p = 0.90), and major adverse cardiac events (1.7 % vs. 3 %, p = 0.28). Although the unadjusted Kaplan-Meier survival to 8 years was significantly less with LMPCI compared to non-LMPCI (p < 0.01), LMPCI was not a predictor of long-term survival up to 8 years after Cox regression analysis (HR 0.67, 95 % CI 0.40-1.13, p = 0.13). CONCLUSION In this study, non-emergent unprotected LMPCI was uncommonly performed, and IVUS was underutilized. Despite greater co-morbidities, LMPCI patients had comparable 30-day outcomes to non-LMPCI, and LMPCI was not an independent predictor of long-term mortality.
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Affiliation(s)
- Julian Gin
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Garry Hamilton
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Chin Hiew
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia; Department of Cardiology, Western Health, Melbourne, Victoria, Australia
| | - Sandra Picardo
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Matias Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nogic J, Cailes B, Yeoh J, Yudi M, Tong D, Farouque O, Brennan A, Dinh D, Brown AJ, Clark D. Natural History and Clinical Outcomes After ST-Segment Elevation Myocardial Infarction Without Stent Insertion. Am J Cardiol 2023; 209:60-65. [PMID: 37863114 DOI: 10.1016/j.amjcard.2023.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/15/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
After restoration of coronary perfusion in patients presenting with ST-segment elevation myocardial infarction (STEMI), discrete severe stenotic coronary lesions are not always apparent. There remains ambiguity whether drug-eluting stent (DES) insertion or initial medical management is best practice. We sought to assess short-term clinical outcomes in patients presenting with STEMI without initial stent insertion. Patients who underwent percutaneous coronary intervention for STEMI between 2014 and 2020 were prospectively enrolled and assessed for inclusion. Patients presenting with in-stent restenosis or stent thrombosis, or who did not survive to hospital discharge were excluded. Of 13,871 patients presenting, 456 (3.3%) were treated without initial stenting. These patients were older than those treated with DES (66.1 ± 13.6 vs 62.3 ± 12.4 years, p <0.001), had higher rates of diabetes (23.5% vs 16.0%, p <0.001) and previous revascularization with either percutaneous coronary intervention (14.0% vs 7.3%, p <0.001) or coronary artery bypass graft (3.5% vs 1.8%, p = 0.008). Thirty-day mortality was elevated in patients treated without stenting compared to those receiving DES (4.2% vs 0.9%, p <0.001), as were rates of myocardial infarction (1.3% vs 0.5%, p = 0.026) and major adverse cardiac events (10.5% vs 2.4%, p <0.001). After propensity matching, a trend toward increased mortality remained (4.2% vs 2.0%, p = 0.055). In conclusion, a no-stenting initial strategy, compared with DES insertion, is associated with increased 30-day mortality in those presenting with STEMI without severe stenosis. These data suggest when appropriate, current-generation DES insertion should be undertaken.
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Affiliation(s)
- Jason Nogic
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia; Monash Cardiovascular Research Centre, Monash University and Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia.
| | - Benjamin Cailes
- Department of Cardiology, Austin Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias Yudi
- Department of Cardiology, Austin Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Tong
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Diem Dinh
- Monash University, Melbourne, Victoria, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and Victorian Heart Hospital, Monash Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Hospital Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
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Gin J, Yeoh J, Thijs V, Clark D, Ho JK, Horrigan M, Farouque O, Al-Fiadh A. Coronary Angiography Complicated by Acute Ischaemic Stroke and the Use of Thrombolysis: a Cardiology Perspective and Narrative Review of Current Literature. Curr Cardiol Rep 2023; 25:1499-1512. [PMID: 37847358 DOI: 10.1007/s11886-023-01962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Coronary angiography-associated acute ischaemic stroke (CAAIS) is an uncommon event but is associated with significant mortality and morbidity. The incidence of CAAIS has increased with a rise in the volume of coronary angiography (CA) and percutaneous coronary intervention (PCI) performed. Intravenous thrombolysis (IVT) is utilized in the general management of acute ischaemic stroke; however, it is associated with a higher risk of intracranial hemorrhage (ICH). As CA or PCI is performed more often in an aging population or high-risk patients that also carry an increased risk of ICH, it is vital to minimize additional complications from the treatment of CAAIS. This article aims to review the pathophysiological mechanisms for CAAIS, clarify the current evidence regarding IVT use in this setting, and thus assist cardiologists in the management of CAAIS. RECENT FINDINGS The pathophysiology for CAAIS may be different from acute ischaemic stroke in the general population. Embolic phenomena from dislodgement of calcium or other debris during manipulation of instrumentation during CA or PCI are likely mechanisms. This may contribute to altered thrombus composition, which affects the efficacy of IVT as suggested in recent studies. Furthermore, IVT in the management of CAAIS has not been evaluated specifically. The utilization of IVT should be carefully considered in CAAIS given a paucity of evidence demonstrating safety and efficacy in this setting. A multidisciplinary pathway that emphasizes the involvement of cardiologists in the treatment decision-making process would aid in thoughtful risk-benefit evaluation for IVT use in CAAIS and reduce adverse patient outcomes. Future studies to assess the impact of this pathway on CAAIS outcomes would be beneficial.
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Affiliation(s)
- Julian Gin
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Vincent Thijs
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Neurology, Austin Health, Melbourne, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jan Kee Ho
- Department of Neurology, Austin Health, Melbourne, VIC, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Ali Al-Fiadh
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
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Driscoll A, Meagher S, Kennedy R, Hare DL, Johnson DF, Asker K, Farouque O, Romaniuk H, Orellana L. Impact of a heart failure nurse practitioner service on rehospitalizations, emergency presentations, and survival in patients hospitalized with acute heart failure. Eur J Cardiovasc Nurs 2023; 22:701-708. [PMID: 36413653 DOI: 10.1093/eurjcn/zvac108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 10/12/2023]
Abstract
AIMS Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12-month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. METHODS AND RESULTS Retrospective, two-group comparative design involving patients (n = 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n = 230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). CONCLUSION Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted.
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Affiliation(s)
- Andrea Driscoll
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Sharon Meagher
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Rhoda Kennedy
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - David L Hare
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Douglas F Johnson
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- The Royal Melbourne Hospital, Department of General Medicine, Grattan St, Parkville, VIC 3050, Australia
| | - Kristina Asker
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Studley Rd, Heidelberg, VIC 3081, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Romaniuk
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia
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11
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Murphy AC, Koshy AN, Farouque O, Yeo B, Roccisano L, Octavia Y, Yudi MB. Cardiovascular Disease in Patients With Breast Cancer Treated in the Modern Era. Heart Lung Circ 2023:S1443-9506(23)04223-3. [PMID: 37574416 DOI: 10.1016/j.hlc.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 08/15/2023]
Abstract
AIMS With improving cancer survivorship, cardiovascular disease (CVD) has become a leading cause of death in breast cancer (BC) survivors. At present, there is no prospectively validated, contemporary risk assessment tool specific to this patient cohort. Accordingly, we sought to investigate long-term cardiovascular outcomes in early-stage BC patients utilising a well characterised database at a quaternary referral centre. With the assembly of this cohort, we have derived a BC cardiovascular risk index titled the 'CRIB (Cardiovascular Risk Index in Breast Cancer)' to estimate the risk of a major adverse cardiovascular event (MACE) in women undergoing treatment for BC. METHODS A retrospective cohort study was conducted examining all female patients aged ≥18 years of age who underwent treatment for early-stage BC at a cancer centre in Melbourne, Australia, between 2009 and 2019. The primary aim of this study was to assess causes and predictors of MACE. RESULTS A total of 1,173 women with early-stage BC were included. During a median follow-up of 4.4 (1.8-6.7) years, 80 (6.8%) women experienced a MACE. These women were more likely to be older, with a high burden of cardiovascular risk factors and were more likely to have a history of established coronary artery disease (CAD) (p≤0.001 for all). A CRIB ≥3 (2 points: renal impairment, 1 point: age ≥65 years, body mass index [BMI]>27, diabetes, hypertension, history of smoking) demonstrated moderate discrimination (c-statistic 0.75) with appropriate calibration. A CRIB ≥3, which represented 23.9% of our cohort, was associated with a high risk of MACE (odds ratio [OR] 17.85, 95% confidence interval [CI] 6.36-50.05; p<0.001). A total of 138 (11.8%) women died during the study period. Mortality was significantly higher in patients who experienced a MACE (HR 2.72, 95%CI 1.75-4.23; p<0.001). CONCLUSION Cardiovascular risk stratification at the time of BC diagnosis using the novel CRIB may help guide surveillance and the use of cardioprotective therapies as well as identify those who require long-term cardiac follow-up.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia; Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia.
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia
| | - Laura Roccisano
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Yanti Octavia
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
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12
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Lee RN, Sampaio Rodrigues T, Gan JT, Han HC, Mikhail R, Sanders P, Farouque O, Lim HS. Commotio Cordis in Non-Sport-Related Events: A Systematic Review. JACC Clin Electrophysiol 2023; 9:1321-1329. [PMID: 37558288 DOI: 10.1016/j.jacep.2023.01.010] [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: 08/02/2022] [Revised: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Commotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non-sport-related settings. OBJECTIVES The goal of this study was to characterize and compare non-sport-related vs sport-related commotio cordis. METHODS PubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022. RESULTS Of 334 commotio cordis cases identified, 121 (36%) occurred in non-sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non-sport-related events (5% vs 94%, respectively; P < 0.001). Nonprojectile etiologies in non-sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (P = 0.10). The proportion of female victims was significantly higher in non-sport-related events (13% vs 2%, respectively; P = 0.025). Mortality was significantly higher in non-sport-related events (88% vs 66%, respectively; P < 0.001). In non-sport-related events, rates of cardiopulmonary resuscitation (27% vs 97%, respectively; P < 0.001) and defibrillation (17% vs 81%, respectively; P < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 min (80% vs 5%, respectively; P < 0.001). CONCLUSIONS Commotio cordis occurs across a spectrum of non-sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non-sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non-sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.
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Affiliation(s)
- Rafael N Lee
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Thalys Sampaio Rodrigues
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia. https://twitter.com/drThalysSR
| | - Joscelyn T Gan
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Hui-Chen Han
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Rama Mikhail
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia. https://twitter.com/PrashSanders
| | - Omar Farouque
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia.
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13
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Gin J, Chow CL, Voskoboinik A, Nalliah C, Wong C, Van Gaal W, Farouque O, Mohamed U, Lim HS, Kalman JM, Wong GR. Improved Outcomes of Conduction System Pacing in Heart Failure with Reduced Ejection Fraction - A Systematic Review and Meta-analysis. Heart Rhythm 2023:S1547-5271(23)02226-9. [PMID: 37172670 DOI: 10.1016/j.hrthm.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
Conduction system pacing (CSP) - His bundle pacing (HBP) and Left bundle branch area pacing (LBBAP) - are emerging alternatives to biventricular pacing (BVP) for cardiac resynchronization therapy (CRT) in heart failure. However, evidence is largely limited to small and observational studies. We conducted a meta-analysis including a total of 15 randomized control trials (RCTs) and non-RCTs that compare CSP (HBP & LBBAP) with BVP in patients with CRT indications. We assessed the mean differences in QRS duration (QRSd), pacing threshold, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class score. CSP resulted in a pooled mean QRSd improvement of -20.3 ms (95% CI -26.1 - -14.5, p<0.05, I2=87.1%) versus BVP. For LVEF, a weighted mean increase of 5.2% (95% CI 3.5-6.9, p<0.05, I2=55.6) was observed following CSP versus BVP. The mean NYHA score was reduced by -0.40 (95% CI -0.6 - -0.2, p<0.05, I2=61.7) post-CSP versus BVP. Subgroup analysis of outcomes by LBBAP and HBP demonstrated statistically significant weighted mean improvements from both CSP modalities for QRSd and LVEF compared to BVP. LBBAP resulted in NYHA improvement compared to BVP without differences between CSP subgroups. LBBAP is associated with a significantly lowered mean pacing threshold of -0.51V (95% CI -0.68 - -0.38) whilst HBP had increased the mean threshold (0.62V, 95% CI -0.03 - 1.26) compared to BVP, however, this was associated with significant heterogeneity. Overall, both CSP techniques are feasible and effective CRT alternatives for heart failure. Further RCTs are needed to establish long-term efficacy and safety.
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Affiliation(s)
- Julian Gin
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Chee Loong Chow
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Alex Voskoboinik
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Chrishan Nalliah
- Department of Cardiology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Chiew Wong
- Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - William Van Gaal
- Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Uwais Mohamed
- Department of Cardiology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Cardiology, Northern Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Jonathan M Kalman
- Department of Cardiac Electrophysiology, Royal Melbourne Hospital, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Geoffrey R Wong
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Cardiology, Northern Health, Melbourne, Victoria, Australia.
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14
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Koshy AN, Sampaio Rodrigues T, Gow PJ, Cailes B, VanWagner LB, Farouque O. Drug-eluting stent use with abbreviated dual antiplatelet therapy after percutaneous coronary intervention for liver transplantation evaluation. Liver Transpl 2023; 29:459-462. [PMID: 36749286 DOI: 10.1097/lvt.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/11/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Thalys Sampaio Rodrigues
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- The University of Melbourne, Parkville, Victoria, Australia
- Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Centre, Dallas, Texas, USA
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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15
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Hamilton GW, Dinh D, Yeoh J, Brennan AL, Fulcher J, Koshy AN, Yudi MB, Reid CM, Hare DL, Freeman M, Stub D, Chan W, Duffy SJ, Ajani A, Raman J, Farouque O, Clark DJ. Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2023; 16:457-467. [PMID: 36858666 DOI: 10.1016/j.jcin.2022.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft. OBJECTIVES The aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI. METHODS This study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality. RESULTS Overall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non-ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality. CONCLUSIONS Presenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. https://twitter.com/GarryHamilton6
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; School of Population Health, Curtin University, Perth, Australia
| | - David L Hare
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - William Chan
- Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Jaishankar Raman
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia.
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16
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Murphy AC, Farouque O, Koshy AN, Yeo B, Dick R, Nadurata V, Roccisano L, Reid C, Yudi MB. Randomized Controlled Trial of a Smartphone-Based Intervention to Enhance 6-Minute Walk Distance During Breast Cancer Treatment: The SMART-BREAST Trial. Circulation 2023; 147:614-616. [PMID: 36342665 DOI: 10.1161/circulationaha.122.062946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alexandra C Murphy
- Austin Health, Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,The University of Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, Australia (A.C.M., B.Y.).,Epworth Richmond, Melbourne, Australia (A.C.M., R.D., M.B.Y.).,Bendigo Health, Australia (A.C.M., V.N., M.B.Y.)
| | - Omar Farouque
- Austin Health, Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,The University of Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.)
| | - Anoop N Koshy
- Austin Health, Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,The University of Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.)
| | - Belinda Yeo
- Olivia Newton-John Cancer Wellness & Research Centre, Melbourne, Australia (A.C.M., B.Y.).,Epworth Richmond, Melbourne, Australia (A.C.M., R.D., M.B.Y.)
| | | | - Voltaire Nadurata
- Epworth Richmond, Melbourne, Australia (A.C.M., R.D., M.B.Y.).,Bendigo Health, Australia (A.C.M., V.N., M.B.Y.)
| | - Laura Roccisano
- Austin Health, Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,The University of Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.)
| | | | - Matias B Yudi
- Austin Health, Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,The University of Melbourne, Australia (A.C.M., O.F., A.N.K., L.R., M.B.Y.).,Epworth Richmond, Melbourne, Australia (A.C.M., R.D., M.B.Y.).,Bendigo Health, Australia (A.C.M., V.N., M.B.Y.)
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17
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Lim HS, Farouque O, Sanders P. Racial and Ethnic Differences in Bystander CPR. N Engl J Med 2023; 388:e11. [PMID: 36724338 DOI: 10.1056/nejmc2215238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Han S Lim
- Austin Health, Melbourne, VIC, Australia
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18
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Toner L, Proimos H, Scully T, Ko J, Koshy A, Horrigan M, Lim HS, Lin T, Farouque O. Late recurrence of atrial fibrillation and flutter in patients referred for elective electrical cardioversion. Kardiologiia 2023; 63:54-59. [PMID: 36749202 DOI: 10.18087/cardio.2023.1.n2145] [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] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/28/2022] [Indexed: 02/08/2023]
Abstract
Aim The primary aim was to ascertain long-term rates of atrial fibrillation (AF) recurrence in this all-comer patient population undergoing elective electrical cardioversion (DCR). Secondary aims included procedural DCR success, clinical predictors of long-term maintenance of sinus rhythm (SR) and AF related hospitalizations.Material and Methods A retrospective cohort study was conducted. Consecutive patients (n=316) undergoing elective DCR were included.Results Successful immediate reversion to SR was attained in 266 (84 %) of patients. 224 (84 %) patients were followed up for a median period of 3.5 years (IQR 2.7-4.3). Most patients (150 [67 %]) had recurrence of AF / flutter at a median time of 240 days. Clinical predictors of AF recurrence included a history of AF (HR 0.63, p=0.038) and a dilated left atrium (HR 4.13, p=0.048). Maintenance of SR was associated with fewer unplanned hospitalizations for AF (HR 3.25, p<0.01).Conclusion There was high procedural success post DCR. However, long-term rates of AF recurrence were high, and AF recurrences were associated with increased hospitalizations. These findings underscore the importance of clinical vigilance and multi-modal management as part of a comprehensive and effective rhythm control strategy.
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Affiliation(s)
| | | | | | | | | | | | - Han S Lim
- Austin Hospital; University of Melbourne
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19
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Hamilton GW, Yeoh J, Dinh D, Reid CM, Yudi MB, Freeman M, Brennan A, Stub D, Oqueli E, Sebastian M, Duffy SJ, Horrigan M, Farouque O, Ajani A, Clark DJ. Trends and Real-World Safety of Patients Undergoing Percutaneous Coronary Intervention for Symptomatic Stable Ischaemic Heart Disease in Australia. Heart Lung Circ 2022; 31:1619-1629. [PMID: 36856290 DOI: 10.1016/j.hlc.2022.08.019] [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: 04/27/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) in stable ischaemic heart disease (SIHD) has not been shown to improve prognosis but can alleviate symptoms and improve quality of life. Appropriately selected patients with symptoms refractory to medical therapy therefore stand to benefit, provided safety is proven. METHODS Consecutive patients undergoing PCI for SIHD between 2005-2018 in a prospective registry were included. Yearly comparisons evaluated trends, and a sub-analysis was performed comparing proximal left anterior descending artery (prox-LAD) to other-than-proximal LAD (non-pLAD) PCI. Outcomes included peri-procedural characteristics, in-hospital and 30-day event rates including MACE, and 5-year National Death Index (NDI) linked mortality. RESULTS There were 9,421 procedures included. Over time, patients were increasingly co-morbid and had higher rates of AHA/ACC class B2/C lesions, ostial stenoses, bifurcation lesions, and chronic total occlusions (all p-for-trend ≤0.001). Over 14 years, major bleeding reduced (1.05% in 2005/06 vs 0.29% in 2017/18, p-for-trend <0.001), while other in-hospital and 30-day event rates were stably low. There were only seven (0.07%) in hospital deaths and 5-year mortality was 10.3%. No differences were found in outcomes between patients who underwent prox-LAD compared to non-pLAD PCI. Major independent predictors of NDI linked all-cause mortality included an eGFR <30 mL/min/1.73 m2 (HR 4.06, 95% CI 3.26-5.06), chronic obstructive pulmonary disease (COPD) (HR 2.25, 95% CI 1.89-2.67) and LVEF <30% (HR 2.13, 95% CI 1.57-2.89). CONCLUSIONS Although patient and procedural complexity increased over time, a high degree of procedural success and safety was maintained, including in those undergoing prox-LAD PCI. These real-world data can enhance shared decision making discussions regarding whether PCI should be pursued in patients with symptomatic SIHD refractory to medical therapy.
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Affiliation(s)
- Garry W Hamilton
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Vic, Australia
| | - Martin Sebastian
- Department of Cardiology, University Hospital Geelong, Vic, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Vic, Australia.
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Blackie H, Thijs V, Churilov L, Han HC, Lin T, Teh AW, Jones EF, Horrigan M, Farouque O, Lim HS. Atrial Tachyarrhythmias and Stroke: Temporal Relationship and Stroke Subtypes. Cerebrovasc Dis 2022; 52:166-170. [PMID: 36088906 DOI: 10.1159/000526088] [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] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background and Purpose:</i></b> Research into the temporal relationship between atrial tachyarrhythmias (atrial tachycardia [AT] and atrial fibrillation [AF]) and stroke has produced conflicting findings. Systematic categorization of stroke subtypes may help clarify the discussion. <b><i>Objectives:</i></b> The objective of the study was to examine the presence and timing of AT/AF in relation to ischemic stroke subtypes, categorized as either cardioembolic (CE) or non-CE. <b><i>Methods:</i></b> Consecutive patients presenting to the Austin Hospital with acute stroke from 2012 to 2019 and a cardiac implantable electronic device (CIED) were identified. Using a case-control design, the temporal proximity of AT/AF episodes in the 90 days prior to stroke was compared in the CE and non-CE stroke groups. <b><i>Results:</i></b> 5,591 patients presented to the Austin Hospital with acute stroke from 2012 to 2019, of whom 31 patients with an ischemic stroke and a CIED with ≥90 days of monitoring were identified. Twelve strokes were adjudicated as CE and 19 as non-CE by a stroke neurologist. Six of the 12 CE stroke patients (50%) experienced AT/AF within 30 days preceding their stroke, while none of the 19 non-CE stroke patients recorded any AT/AF in the same period (<i>p</i> = 0.001). Four CE stroke patients (33%) had no AT/AF preceding their strokes at any time. The odds ratio for CE stroke was highest (39; 95% confidence interval [CI]: 1.92–791.5) when AT/AF occurred in the 30 days prior, declining to 20.65 (95% CI: 1.00–427.66) and 6.07 (95% CI: 0.94–39.04) in the subsequent 31–60- and 61–90-day windows, respectively. <b><i>Conclusions:</i></b> CE strokes were associated with a significantly higher proportion of preceding AT/AF compared with non-CE strokes. These findings support a potential temporal relationship between AT/AF and CE stroke and demonstrate that stroke subtyping can better characterize the relationship between AF and ischemic stroke. However, this study’s findings are limited by its sample size and small number of informative cases.
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Affiliation(s)
- Hugh Blackie
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia,
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,
| | - Vincent Thijs
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Stroke, Austin Health, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Tina Lin
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Cardiology, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth F Jones
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
- Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
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21
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Brieger D, Chew D, Goodman S, Hammett C, Lefkovits J, Farouque O, Atherton J, Hyun K, D'Souza M. Balancing the Risks of Recurrent Ischaemic and Bleeding Events in a Stable Post ACS Population. Heart Lung Circ 2022; 31:1349-1359. [PMID: 35863981 DOI: 10.1016/j.hlc.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To better guide decisions regarding antithrombotic treatment in individual patients surviving 6 months following an acute coronary syndrome (ACS) by balancing between subsequent recurrent ischaemic and bleeding risk. METHODS Patients surviving 6 months following an ACS were followed in an Australian registry. Ischaemic (composite of cardiovascular death, myocardial infarction or stroke) and bleeding (≥BARC 2) events were collected. A dual binary outcome modelling strategy was used arriving at a common set of variables from which bleeding and ischaemic risk could be independently determined in individual patients. Patients in whom bleeding rates exceeded composite ischaemic event rates during the follow-up period were identified. RESULTS The cohort comprised 5,905 patients in whom 215 experienced an ischaemic event and 49 a bleeding event. The single set of variables included in both ischaemic and bleeding models (C-statistics 0.71 and 0.72 respectively) included modified TIGRIS1 ischaemic score, mode of revascularisation, history of heart failure, anaemia, multivessel disease, readmission within 6 months of index ACS and age >75. In the majority, ischaemic events were more frequent than bleeding events. In higher risk patients post coronary artery bypass grafting (CABG), bleeding events were more frequent than recurrent ischaemic events. CONCLUSION The risk of recurrent ischaemic events exceeds bleeding in most patients followed 6 to 24 months following an ACS. Post CABG patients with comorbidities have a higher risk of bleeding over this period during which time attention should be directed towards modifiable bleeding risk factors including requirement for dual antiplatelet therapy.
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Affiliation(s)
- David Brieger
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia.
| | - Derek Chew
- Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | | | | | - John Atherton
- Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Karice Hyun
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mario D'Souza
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia
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22
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Koshy AN, Dinh DT, Fulcher J, Brennan AL, Murphy AC, Duffy SJ, Reid CM, Ajani AE, Freeman M, Hiew C, Oqueli E, Farouque O, Yudi MB, Clark DJ. Long-term mortality in asymptomatic patients with stable ischemic heart disease undergoing percutaneous coronary intervention. Am Heart J 2022; 244:77-85. [PMID: 34780716 DOI: 10.1016/j.ahj.2021.10.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/27/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Patients with stable ischemic heart disease (SIHD) may present with a variety of symptoms including typical angina, angina equivalents such as dyspnea or no symptoms. We sought to determine whether symptom status affects periprocedural safety and long-term mortality in patients undergoing PCI. METHODS Prospectively enrolled consecutive patients undergoing PCI for SIHD at six hospitals in Australia between 2005 to 2018 as part of the Melbourne Interventional Group registry. Symptom status was recorded at the time of PCI and patients undergoing staged PCI were excluded. RESULTS Overall, 11,730 patients with SIHD were followed up for a median period of 5 years (maximum 14.0 years, interquartile range 2.2-9.0 years) with 1,317 (11.2%) being asymptomatic. Asymptomatic patients were older, and more likely to be male, have triple-vessel disease, with multiple comorbidities including renal failure, diabetes and heart failure (all P < .01). These patients had significantly higher rates of periprocedural complications and major adverse cardiovascular events at 30-days. Long-term mortality was significantly higher in asymptomatic patients (27.2% vs 18.0%, P < .001). On cox regression for long-term mortality, after adjustment for more important clinical variables, asymptomatic status was an independent predictor (Hazard ratio (HR) 1.39 95% CI 1.16-1.66, P < .001). CONCLUSIONS In a real-world cohort of patients undergoing revascularization for SIHD, absence of symptoms was associated with higher rates of periprocedural complications and, after adjustment for more important clinical variables, was an independent predictor of long-term mortality. As the primary goal of revascularization in SIHD remains angina relief, the appropriateness of PCI in the absence of symptoms warrants justification.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Diem T Dinh
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Jordan Fulcher
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Stephen J Duffy
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- The University of Melbourne, Parkville, Victoria; Center of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; The University of Melbourne, Parkville, Victoria; School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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23
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Al-Mukhtar O, Peter K, Gooley R, Farouque O, Van Gaal W, Hiew C, Layland J, Oqueli E, Lefkovits J, Brennan A, Reid C, Walton A, Stub D, Kaye D, Lo S, Cox N, Chan W. Contemporary Practice of Heparin Prescription and Its Monitoring via Activated Clotting Time in Percutaneous Coronary Intervention in Victoria, Australia. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.571] [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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24
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Murphy A, Koshy A, Farouque O, Yeo B, Roccisano L, Octavia Y, Yudi M. Cardiovascular Disease in Patients With Breast Cancer Treated in the Modern Era. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.490] [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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25
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Koshy AN, Nerlekar N, Gow PJ, Lim R, Smith G, Galea M, Rodriques TS, Lim HS, Teh A, Farouque O. A prospective natural history study of coronary atherosclerosis following liver transplantation. Atherosclerosis 2022; 344:40-48. [DOI: 10.1016/j.atherosclerosis.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
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26
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Chalinor H, Bodek S, Bojadzieva J, Farouque O, Hare D, Johns J, Kearney L, Lim H, Lin T, Mirzaee S, Ramchand J, Salmon L, Stutterd C, Teh A, Valente G, Wallis M. The Introduction and Development of a Genetic Counsellor-led Cardiac Genetics Service in a Metropolitan Hospital. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.012] [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: 10/18/2022]
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27
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Murphy A, Farouque O, Koshy A, Yeo B, Dick R, Nadurata V, Roccisano L, Reid C, Yudi M. SMARTphone-based Cardiovascular Risk Reduction in BREAST Cancer Patients [SMART-BREAST]: A Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.008] [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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28
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Murphy AC, Koshy AN, Farouque O, Yeo B, Raman J, Kearney L, Yudi MB. Factor Xa Inhibition for the Treatment of Venous Thromboembolism Associated With Cancer: A Meta-Analysis of the Randomised Controlled Trials. Heart Lung Circ 2021; 31:716-725. [PMID: 34896013 DOI: 10.1016/j.hlc.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Until recently, guidelines recommended the use of low-molecular weight heparin (LMWH) as standard of care for VTE in patients with cancer. Despite the proven efficacy of direct oral anticoagulants (DOACs) for treatment of VTE, there is equipoise supporting their use in cancer patients. METHODS A systematic review of PubMed, Medline and EMBASE identified four randomised controlled trials (RCTs) in patients with cancer and VTE comparing a factor Xa inhibitor (FXaI) to LMWH. A meta-analysis was performed with a primary outcome of VTE recurrence and key secondary outcomes of major bleeding, clinically relevant non-major bleeding (CRNMB) and gastrointestinal (GI) bleeding. RESULTS Four RCTs with 2,907 patients were included. 1,451 patients were randomised to FXaI and 1,456 to LMWH. VTE recurrence was lower in the FXaI group (RR 0.62, 95%CI 0.44-0.87; p=0.01; I2=24.90), with an absolute risk difference of -4% equating to a number needed to treat of 25 for prevention of recurrent VTE with FXaI. No significant difference in major bleeding was noted between groups (RR 1.33, 95%CI 0.84-2.11; p=0.23). Rates of GI bleeding (RR 1.87, 95%CI 1.06-3.29; p=0.03) and CRNMB (RR 1.57, 95%CI 1.11-2.23; p=0.01) were greater with FXaIs. CONCLUSION In patients with cancer and VTE, the rate of VTE recurrence was significantly lower with FXaI than with LMWH without an increased risk of major bleeding. Our data supports the use of FXaIs as the standard of care for the treatment of VTE in this population.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia; Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia
| | - Jaishankar Raman
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia; Department of Medicine, Deakin University, Geelong, Australia; Department of Medicine, The University of Illinois, Urbana-Champaign, IL, USA
| | - Leighton Kearney
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia.
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29
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Ha FJ, Han HC, Sanders P, La Gerche A, Teh AW, Farouque O, Lim HS. Sudden cardiac death related to physical exercise in the young: a nationwide cohort study of Australia. Intern Med J 2021; 53:497-502. [PMID: 34719841 DOI: 10.1111/imj.15606] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) during physical exercise is devastating. We aimed to evaluate causes and circumstances of exercise-related SCD in the young in Australia. METHODS We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10-35 years between 2000-2016. Included cases had undertaken physical exercise at time of event. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. RESULTS Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) (median age 27 years [interquartile range [IQR] 21-32 years], 92% male) were related to sports/physical exercise. Thirteen cases (12%) occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Amongst Aboriginal and Torres Strait Islanders (n=10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. CONCLUSIONS This study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post-arrest chain of survival. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,St Vincent's Hospital Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, South Australia, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
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30
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Theuerle JD, Al-Fiadh AH, Wong E, Patel SK, Ashraf G, Nguyen T, Wong TY, Ierino FL, Burrell LM, Farouque O. Retinal microvascular function predicts chronic kidney disease in patients with cardiovascular risk factors. Atherosclerosis 2021; 341:63-70. [PMID: 34756728 DOI: 10.1016/j.atherosclerosis.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Endothelial dysfunction is a precursor to atherosclerosis and is implicated in the coexistence between cardiovascular disease (CVD) and chronic kidney disease (CKD). We examined whether retinal microvascular dysfunction is present in subjects with renal impairment and predictive of long-term CKD progression in patients with CVD. METHODS In a single centre prospective observational study, 253 subjects with coronary artery disease and CVD risk factors underwent dynamic retinal vessel analysis. Retinal microvascular dysfunction was quantified by measuring retinal arteriolar and venular dilatation in response to flicker light stimulation. Serial renal function assessment was performed over a median period of 9.3 years using estimated GFR (eGFR). RESULTS Flicker light-induced retinal arteriolar dilatation (FI-RAD) was attenuated in patients with baseline eGFR <90 mL/min/1.73 m2, compared to those with normal renal function (eGFR ≥90 mL/min/1.73 m2) (1.0 [0.4-2.1]% vs. 2.0 [0.8-3.6]%; p < 0.01). In patients with normal renal function, subjects with the lowest FI-RAD responses exhibited the greatest annual decline in eGFR. In uni- and multivariable analysis, among subjects with normal renal function, a 1% decrease in FI-RAD was associated with an accelerated decline in eGFR of 0.10 (0.01, 0.15; p = 0.03) and 0.07 mL/min/1.73 m2 per year (0.00, 0.14; p = 0.06), respectively. FI-RAD was not predictive of CKD progression in subjects with baseline eGFR <90 mL/min/1.73 m2. CONCLUSIONS Retinal arteriolar endothelial dysfunction is present in patients with CVD who have early-stage CKD, and serves as an indicator of long-term CKD progression in those with normal renal function.
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Affiliation(s)
- James D Theuerle
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Ali H Al-Fiadh
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Edmond Wong
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Sheila K Patel
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Gizem Ashraf
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Thanh Nguyen
- The Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Louise M Burrell
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia.
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Yudi MB, Clark DJ, Tsang D, Jelinek M, Kalten K, Joshi SB, Phan K, Ramchand J, Nasis A, Amerena J, Koshy AN, Murphy AC, Arunothayaraj S, Si S, Reid CM, Farouque O. SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes: a randomized controlled trial. Coron Artery Dis 2021; 32:432-440. [PMID: 32868661 DOI: 10.1097/mca.0000000000000938] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are well-documented treatment gaps in secondary prevention of coronary heart disease with a lack of clearly defined strategies to assist early physical activity after acute coronary syndromes (ACS). Smartphone technology may provide an innovative platform to close these gaps. OBJECTIVES The primary goal of this study was to assess whether a smartphone-based, early cardiac rehabilitation program improved exercise capacity in patients with ACS. METHODS A total of 206 patients with ACS across six tertiary Australian hospitals were included in this randomized controlled trial. Participants were randomized to usual care (UC; including referral to traditional cardiac rehabilitation), with or without an adjunctive smartphone-based cardiac rehabilitation program (S-CRP) upon hospital discharge. The primary endpoint was change in exercise capacity, measured by the change in 6-minute walk test distance at 8 weeks when compared to baseline, between groups. Secondary endpoints included uptake and adherence to cardiac rehabilitation, changes in cardiac risk factors, psychological well-being and quality of life status. RESULTS Of the 168 patients with complete follow-up (age 56 ± 10 years; 16% females), 83 were in the S-CRP. At 8-week follow-up, the S-CRP group had a clinically significant improvement in 6-minute walk test distance (Δ117 ± 76 vs. Δ91 ± 110 m; P = 0.02). Patients in the S-CRP were more likely to participate (87% vs. 51%, P < 0.001) and adhere (72% vs. 22%, P < 0.001) to a cardiac rehabilitation program. Compared to UC, patients receiving S-CRP had similar smoking cessation rates, LDL-cholesterol levels, blood pressure reduction, depression, anxiety and quality of life measures (all P = NS). CONCLUSION In patients with ACS, a S-CRP, as an adjunct to UC improved exercise capacity at 8 weeks in addition to participation and adherence to cardiac rehabilitation (Australian New Zealand Clinical Trials Registry; ACTRN12616000426482).
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Affiliation(s)
- Matias B Yudi
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
| | - David J Clark
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
| | | | - Michael Jelinek
- Department of Medicine, University of Melbourne
- Department of Cardiology, St Vincent's Hospital
| | | | | | - Khoa Phan
- Department of Cardiology, Royal Melbourne Hospital
| | - Jay Ramchand
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
| | | | - John Amerena
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
| | | | - Si Si
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health
- Department of Medicine, University of Melbourne
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32
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Koshy AN, Gow PJ, Han HC, Teh AW, Jones R, Testro A, Lim HS, McCaughan G, Jeffrey GP, Crawford M, Macdonald G, Fawcett J, Wigg A, Chen JWC, Gane EJ, Munn SR, Clark DJ, Yudi MB, Farouque O. Cardiovascular mortality following liver transplantation: predictors and temporal trends over 30 years. Eur Heart J Qual Care Clin Outcomes 2021; 6:243-253. [PMID: 32011663 DOI: 10.1093/ehjqcco/qcaa009] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
AIMS There has been significant evolution in operative and post-transplant therapies following liver transplantation (LT). We sought to study their impact on cardiovascular (CV) mortality, particularly in the longer term. METHODS AND RESULTS A retrospective cohort study was conducted of all adult LTs in Australia and New Zealand across three 11-year eras from 1985 to assess prevalence, modes, and predictors of early (≤30 days) and late (>30 days) CV mortality. A total of 4265 patients were followed-up for 37 409 person-years. Overall, 1328 patients died, and CV mortality accounted for 228 (17.2%) deaths. Both early and late CV mortality fell significantly across the eras (P < 0.001). However, CV aetiologies were consistently the leading cause of early mortality and accounted for ∼40% of early deaths in the contemporary era. Cardiovascular deaths occurred significantly later than non-cardiac aetiologies (8.8 vs. 5.2 years, P < 0.001). On multivariable Cox regression, coronary artery disease [hazard ratio (HR) 4.6, 95% confidence interval (CI) 1.2-21.6; P = 0.04] and era of transplantation (HR 0.44; 95% CI 0.28-0.70; P = 0.01) were predictors of early CV mortality, while advancing age (HR 1.05, 95% CI 1.02-1.10; P = 0.005) was an independent predictors of late CV mortality. Most common modes of CV death were cardiac arrest, cerebrovascular events, and myocardial infarction. CONCLUSION Despite reductions in CV mortality post-LT over 30 years, they still account for a substantial proportion of early and late deaths. The late occurrence of CV deaths highlights the importance of longitudinal follow-up to study the efficacy of targeted risk-reduction strategies in this unique patient population.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Robert Jones
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey McCaughan
- Department of Liver Transplantation, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Gary P Jeffrey
- Department of Liver Transplantation, Sir Charles Gardiner Hospital, Perth, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia
| | - Michael Crawford
- Department of Liver Transplantation, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Graeme Macdonald
- Department of Liver Transplantation, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Jonathan Fawcett
- Department of Liver Transplantation, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Alan Wigg
- Department of Liver Transplantation, Flinders Medical Centre, Adelaide, Australia
| | - John W C Chen
- Department of Liver Transplantation, Flinders Medical Centre, Adelaide, Australia
| | | | | | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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33
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Robertson M, Chung W, Liu D, Seagar R, O'Halloran T, Koshy AN, Horrigan M, Farouque O, Gow P, Angus P. Cardiac Risk Stratification in Liver Transplantation: Results of a Tiered Assessment Protocol Based on Traditional Cardiovascular Risk Factors. Liver Transpl 2021; 27:1007-1018. [PMID: 33606328 DOI: 10.1002/lt.26025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/13/2023]
Abstract
Coronary artery disease (CAD) confers increased perioperative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there are limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors. We peformed a single-center, prospective, observational study of consecutive adult patients undergoing LT assessment (2010-2017). Patients were stratified into low-risk (LR), intermediate-risk (IR), or high-risk (HR) cardiac groups and received standardized investigations with selective use of transthoracic echocardiography (TTE), dobutamine stress echocardiography (DSE), computed tomography coronary angiography (CTCA), and coronary angiography (CA). Primary outcomes were cardiac events (CEs) and cardiovascular death up to 30 days after LT. Overall, 569 patients were included, with 76 patients identified as LR, 256 as IR, and 237 as HR. Cardiac risk factors included diabetes mellitus (26.0%), smoking history (47.3%), hypertension (17.8%), hypercholesterolemia (7.2%), family (17.0%) or prior history of heart disease (6.0%), and obesity (27.6%). Of the patients, 42.0% had ≥2 risk factors. Overall compliance with the protocol was 90.3%. Abnormal findings on TTE, DSE, and CTCA were documented in 3, 23, and 44 patients, respectively, and 12 patients were not listed for transplantation following cardiac assessment (1 LR, 2 IR, and 9 HR). Moderate or severe CAD was identified in 25.4% of HR patients on CTCA following a normal DSE. CEs were recorded in 7 patients (1.2%), with 2 cardiovascular deaths (0.4%). Cardiac risk stratification based on traditional cardiac risk factors with the selective use of DSE, CTCA, and CA is a safe and feasible approach that results in a low perioperative cardiac event rate.
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Affiliation(s)
- Marcus Robertson
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - William Chung
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Dorothy Liu
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rosemary Seagar
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tess O'Halloran
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia
| | - Anoop N Koshy
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia.,Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Paul Gow
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Peter Angus
- Liver Transplant Unit, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
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34
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Koshy AN, Gow PJ, Testro A, Teh AW, Ko J, Lim HS, Han HC, Weinberg L, VanWagner LB, Farouque O. Relationship between QT interval prolongation and structural abnormalities in cirrhotic cardiomyopathy: A change in the current paradigm. Am J Transplant 2021; 21:2240-2245. [PMID: 33453141 PMCID: PMC8819736 DOI: 10.1111/ajt.16500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 01/25/2023]
Abstract
It is postulated that cardiac structural abnormalities observed in cirrhotic cardiomyopathy (CCM) contribute to the electrophysiologic abnormality of QT interval (QTc) prolongation. We sought to evaluate whether QTc prolongation is associated with intrinsic abnormalities in cardiac structure and function that characterize CCM. Consecutive patients undergoing liver transplant work-up between 2010 and 2018 were included. Measures of cardiac function on stress testing including cardiac reserve and chronotropic incompetence were collected prospectively and a corrected QTc ≥ 440 ms was considered prolonged. Overall, 439 patients were included and 65.1% had a prolonged QTc. There were no differences in markers of left ventricular and atrial remodeling, or resting systolic and diastolic function across QTc groups. The proportion of patients that met the criteria for a low cardiac reserve (39.2 vs 36.6%, p = .66) or chronotropic incompetence (18.1 vs 21.3%, p = .52) was not different in those with a QTc ≥ 440 vs <440 ms. Further, there was no association between QTc prolongation and CCM by either the 2005 World College of Gastroenterology or modified 2020 Cirrhotic Cardiomyopathy Consortium criteria. QT interval prolongation was not associated with structural or functional cardiac abnormalities that characterize CCM. These findings suggest that CCM and QT interval prolongation in cirrhosis may be two separate entities with distinct pathophysiological origins.
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Affiliation(s)
- Anoop N. Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J. Gow
- The University of Melbourne, Parkville, Victoria, Australia,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Victoria, Australia,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Andrew W. Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,The University of Melbourne, Parkville, Victoria, Australia
| | - Jefferson Ko
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Han S. Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,The University of Melbourne, Parkville, Victoria, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,The University of Melbourne, Parkville, Victoria, Australia
| | - Laurence Weinberg
- The University of Melbourne, Parkville, Victoria, Australia,Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Lisa B. VanWagner
- Division of Gastroenterology & Hepatology and Preventive Medicine-Epidemiology Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia,The University of Melbourne, Parkville, Victoria, Australia
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35
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Koshy AN, Gow PJ, Farouque O. Cirrhotic Cardiomyopathy: An Evolving Diagnostic Entity With Long-Term Clinical Sequelae. Liver Transpl 2021; 27:794-796. [PMID: 33683815 DOI: 10.1002/lt.26046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Paul J Gow
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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36
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Ha F, So J, Han HC, La Gerche A, Teh A, Sanders P, Farouque O, Lim H. Sudden cardiac death related to physical exercise and sports in the young: a nationwide cohort study of Australia. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.377] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sudden cardiac death (SCD) during physical exercise is uncommon but devastating.
Purpose
We aimed to determine risk factors, causes and circumstances of sports and exercise-related SCD in the young in Australia.
Methods
We retrospectively reviewed the National Coronial Information System (NCIS) registry for deaths in Australia relating to cardiovascular disease (CVD) in cases aged 10 to 35 years between 2000-2016. Included cases had been undertaking sports or physical exercise at time of event. We collected baseline demographics and circumstances of death including location, type of physical exercise, whether the event was witnessed, and engagement of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival.
Results
Over a 17-year period, 1,925 SCD cases were identified of which 110 cases (6%) related to sports/physical exercise were included in final analysis. Median age was 27 years (interquartile range [IQR] 21-32 years) with most being male (92%). Median BMI was 27 kg/m2 (IQR, 23-30) with 13 cases (12%) occurring in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequently practiced at time of event. Prior symptoms were present in 39% (chest pain 37%, presyncope/syncope 26%). Most were witnessed (87%) with bystander CPR in 70%. AED use prior to ambulance arrival was 8%.
Conclusions
This study demonstrates the high occurrence of CAD and SADS in exercise-related SCD in the young. Although events were commonly witnessed, an AED was seldom used prior to ambulance arrival highlighting an important opportunity to improve outcomes in the post-arrest chain of survival.
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Affiliation(s)
- F Ha
- Austin Hospital, Department of Cardiology, Melbourne, Australia
| | - J So
- Austin Hospital, Department of Cardiology, Melbourne, Australia
| | - HC Han
- Austin Hospital, Department of Cardiology, Melbourne, Australia
| | - A La Gerche
- St Vincent"s Hospital, Department of Cardiology, Melbourne, Australia
| | - A Teh
- Austin Hospital, Department of Cardiology, Melbourne, Australia
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - O Farouque
- Austin Hospital, Department of Cardiology, Melbourne, Australia
| | - H Lim
- Austin Hospital, Department of Cardiology, Melbourne, Australia
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37
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Rodrigues TS, Koshy AN, Gow PJ, Clark DJ, Horrigan M, Farouque O. FEASIBILITY AND SAFETY OF DRUG-ELUTING STENT IMPLANTATION IN PATIENTS WITH END-STAGE LIVER DISEASE PRIOR TO LIVER TRANSPLANTATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02459-1] [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: 11/28/2022]
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38
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Koshy AN, Nerlekar N, Gow PJ, Lim RP, Smith G, Galea M, Abdelganne L, Rodrigues TS, Teh AW, Lim HS, Farouque O. EARLY PROGRESSION OF CORONARY ATHEROSCLEROSIS IN PATIENTS FOLLOWING LIVER TRANSPLANTATION: RESULTS FROM SERIAL COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Murphy AC, Farouque O, Yeo B, Dick R, Koshy AN, Roccisano L, Reid C, Raman J, Kearney L, Yudi MB. SMARTphone Based Cardiovascular Risk Reduction in BREAST Cancer Patients (SMART-BREAST): A Randomised Controlled Trial Protocol. Heart Lung Circ 2021; 30:1314-1319. [PMID: 33896706 DOI: 10.1016/j.hlc.2021.03.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Breast cancer survivors are at greater risk for cardiovascular-related mortality compared to women without breast cancer. Accordingly, attention to reducing the risk of cardiovascular disease must be a priority in the long-term management of these patients. With the exponential rise in cancer survivors, there is a need for innovative cardio-oncology programs. This paper describes the study design of a randomised controlled trial assessing the effectiveness of a smartphone-based cardiovascular risk reduction program in improving physical activity and cardiovascular health in patients undergoing treatment for breast cancer. METHODS AND ANALYSIS The aim of this study is to assess the efficacy and usability of a smartphone-based model of care for exercise promotion, cardiovascular risk reduction and community engagement in women undergoing treatment for breast cancer. This will be achieved by testing our personalised smartphone application "BreastMate", as an adjunct to standard care in a single-blinded, parallel, randomised controlled trial. The primary outcome of the trial is change in exercise capacity, as measured by the 6-minute walk test distance at 12 months compared to baseline. Secondary endpoints include improvements in cardiovascular risk factor status and quality of life, received dose intensity of chemotherapy and major adverse cardiovascular events. ETHICS Multicentre ethical approval has been granted by the Austin Hospital (HREC/47081/Austin/2018). DISSEMINATION OF RESULTS The analysed results will be published in a peer reviewed journal on completion of the clinical trial. REGISTRATION DETAILS SMART-BREAST has been prospectively registered with the Australia and New Zealand Clinical Trials Registry (ANZCTR12620000007932).
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia; Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia; Department of Cardiology, Epworth HealthCare, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia
| | - Ron Dick
- Department of Cardiology, Epworth HealthCare, Melbourne, Vic, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia
| | - Laura Roccisano
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Christopher Reid
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jaishankar Raman
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia; Department of Medicine, Deakin University, Geelong, Vic, Australia; Department of Medicine, The University of Illinois, Champaign, IL, USA
| | - Leighton Kearney
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Vic, Australia; Department of Cardiology, Epworth HealthCare, Melbourne, Vic, Australia.
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40
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Scully TG, Toner L, Yeoh J, Farouque O, Yudi MB, Horrigan M, Clark DJ. Safety and Long-Term Clinical Outcomes of Fractional Flow Reserve Guided Coronary Revascularisation. Heart Lung Circ 2021; 30:1343-1347. [PMID: 33781698 DOI: 10.1016/j.hlc.2021.02.009] [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: 07/13/2020] [Revised: 12/31/2020] [Accepted: 02/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increasingly, fractional flow reserve (FFR) is employed to assess coronary artery stenoses although there is limited real world long-term outcome data with a recent report questioning its safety. This study aimed to assess the in-hospital complications and clinical outcomes up to 10 years after FFR-guided revascularisation at a tertiary Australian hospital. METHODS The cohort comprised 274 consecutive patients undergoing FFR from 2010 to 2015 with follow-up to 2020. In-hospital complications and long-term outcomes were compared between patients with FFR≤0.80 and FFR>0.80. Major adverse cardiac events (MACE) comprised cardiac death, myocardial infarction (MI) and target vessel revascularisation (TVR). RESULTS The FFR was ≤0.80 in 166 and >0.80 in 108 patients. Stable coronary disease was present in 95%. Revascularisation was undertaken in 86.7% of the FFR≤0.80 group and in 2.8% of the group with an FFR>0.80. In-hospital adverse events were 3.3% with no pressure wire-related coronary dissection, stroke or death. At median follow-up of 5 years, patients with FFR≤0.80 and FFR>0.80 had a similar rate of cardiac death (2.6% versus 5.0%, p=0.335) and MI (2.6% versus 6.9%, p=0.154). In the FFR>0.80 group, MACE (17.8% v 7.9%; p=0.018) and TVR (12.9% v 5.3%; p=0.033) were significantly higher. CONCLUSION This observational study highlights the safety and long-term effectiveness of FFR-guided coronary revascularisation in patients with predominantly stable disease.
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Affiliation(s)
- Timothy G Scully
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Liam Toner
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
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41
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Ha FJ, Farouque O, Lim HS. Response by Ha et al to Letter Regarding Article, "Sudden Cardiac Death in the Young: Incidence, Trends and Risk Factors in a Nationwide Study". Circ Cardiovasc Qual Outcomes 2021; 14:e007775. [PMID: 33641337 DOI: 10.1161/circoutcomes.121.007775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,St Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (O.F., H.S.L.)
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42
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Kunniardy P, Koshy AN, Meehan G, Murphy AC, Ramchand J, Clark DJ, Farouque O, Yudi MB. Invasive versus Conservative Management in Patients ≥85 years presenting with Non-ST Elevation Myocardial Infarction. Intern Med J 2021; 52:1167-1173. [PMID: 33647172 DOI: 10.1111/imj.15258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines recommend early coronary angiography (CA) in patients with non-ST-elevation myocardial infarction (NSTEMI), irrespective of age. However, elderly patients are less likely to be treated according to these guidelines due to their perceived high risk and medical comorbidities. Whether an invasive strategy is associated with improved survival in patients aged ≥85 years remains uncertain due to their exclusion from randomised trials. METHODS Consecutive patients aged ≥85 years presenting to a tertiary centre with NSTEMI between 2008-18 were included in this retrospective cohort study. Patients were stratified based on whether they underwent invasive management with CA with a view to revascularisation versus conservative management. The primary outcome was long-term mortality. RESULTS Of 7,591 patients with NSTEMI, 1052 patients ≥85years were included. 99(9.4%) patients underwent CA. Those undergoing CA were more likely to be younger, male, live independently, without mobility or cognitive issues (all p<0.01). Overall, 495(47%) patients died during a mean follow-up of 1.3±1 year. On Cox regression, after adjusting for age, pre-morbid functional status, cognition and cardiovascular risk factors, invasive management was the strongest predictor for survival (HR 0.47; 95%CI 0.26-0.85; p=0.01). Invasive management was associated with a trend to increased risk of in-hospital bleeding (6.1% vs 2.6%, p=0.054) with no significant difference in stroke (2.0% vs 3.8%, p=0.37). CONCLUSION In patients aged ≥85 years who presented with NSTEMI, invasive management was associated with improved survival without significant differences in bleeding or stroke. A randomised controlled study assessing the efficacy and safety of invasive management in very elderly patients with NSTEMI is warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Phelia Kunniardy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgie Meehan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jay Ramchand
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Heart and Vascular Institute, Cleveland Clinic Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Koshy AN, Ko J, Farouque O, Cooray SD, Han HC, Cailes B, Gow PJ, Weinberg L, Testro A, Lim HS, Teh AW. Effect of QT interval prolongation on cardiac arrest following liver transplantation and derivation of a risk index. Am J Transplant 2021; 21:593-603. [PMID: 32530547 DOI: 10.1111/ajt.16145] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/19/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 01/25/2023]
Abstract
Liver transplantation (LT) has a 4-fold higher risk of periprocedural cardiac arrest and ventricular arrhythmias (CA/VAs) compared with other noncardiac surgeries. Prolongation of the corrected QT interval (QTc) is common in patients with liver cirrhosis. Whether it is associated with an increased risk of CA/VAs following LT is unclear. Rates of 30-day CA/VAs post-LT were assessed in consecutive adults undergoing LT between 2010 and 2017. Pretransplant QTc was measured by a cardiologist blinded to clinical outcomes. Among 408 patients included, CA/VAs occurred in 26 patients (6.4%). QTc was significantly longer in CA/VA patients (475 ± 34 vs 450 ± 34 ms, P < .001). Optimal QTc cut-off for prediction of CA/VAs was ≥480 ms. After adjustment, QTc ≥480 ms remained the strongest predictor for the occurrence of CA/VAs (odds ratio [OR] 5.2, 95% confidence interval [CI] 2.2-12.6). A point-based cardiac arrest risk index (CARI) was derived with the bootstrap method for yielding optimism-corrected coefficients (2 points: QTc ≥480, 1 point: Model for End-Stage Liver Disease [MELD] ≥30, 1 point: age ≥65, and 1 point: male). CARI score ≥3 demonstrated moderate discrimination (c-statistic 0.79, optimism-corrected c-statistic 0.77) with appropriate calibration. QTc ≥480 ms was associated with a 5-fold increase in the risk of CA/VAs. The CARI score may identify patients at higher risk of these events. Whether heightened perioperative cardiac surveillance, avoidance of QT prolonging medications, or beta blockers could mitigate the risk of CA/VAs in this population merits further study.
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Affiliation(s)
- Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Jefferson Ko
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Shamil D Cooray
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Cailes
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Paul J Gow
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Laurence Weinberg
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia.,Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Victoria, Australia.,Victorian Liver Transplant Unit, Austin Hospital, Melbourne, Victoria, Australia
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia.,Cardiology Department, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
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Sampaio RT, Koshy A, Gow P, Clark D, Horrigan M, Farouque O. Feasibility and Safety of Drug-Eluting Stent Implantation in Patients with End-Stage Liver Disease Prior to Liver Transplantation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.287] [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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Murphy AC, Koshy AN, Cameron W, Horrigan M, Kearney L, Yeo B, Farouque O, Yudi MB. Transcatheter aortic valve replacement in patients with a history of cancer: Periprocedural and long-term outcomes. Catheter Cardiovasc Interv 2021; 97:157-164. [PMID: 32497385 DOI: 10.1002/ccd.28969] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND A history of cancer is incorporated into the surgical risk assessment of patients undergoing surgical aortic valve replacement through the Society for Thoracic Surgeons score. However, the prognostic significance of cancer in patients treated with transcatheter aortic valve replacement (TAVR) is unclear. As the cancer survivorship population increases, it is imperative to establish the efficacy and safety of TAVR in patients with severe symptomatic aortic stenosis (AS) and a history of malignancy. OBJECTIVES The primary goal of this study was to assess the periprocedural outcomes and long-term mortality in patients with a history of cancer undergoing TAVR. METHODS A systematic review of PubMed, MEDLINE, and EMBASE was conducted to identify studies reporting outcomes in patients with a history of malignancy undergoing TAVR. A meta-analysis was performed using a random-effects model with a primary outcome of all-cause mortality and cardiac mortality at the longest follow-up. On secondary analyses, procedural safety was assessed. RESULTS A total of 13 observational studies with 10,916 patients were identified in the systematic review. Seven studies including 6,323 patients were included in the quantitative analysis. Short-term mortality (relative risk [RR] 0.61, 95%CI 0.36-1.01; p = .06) and long-term all-cause mortality (RR 1.24, 95%CI 0.95-1.63; p = .11) were not significantly different when comparing patients with and without a history of cancer. No significant difference in the rate of periprocedural complications including stroke, bleeding, acute kidney injury, and pacemaker implantation was noted. CONCLUSION In patients with severe AS undergoing TAVR, a history of cancer was not associated with adverse short or long-term survival. Based on these findings, TAVR should be considered in all patients with severe symptomatic AS, irrespective of their history of malignancy.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Cameron
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Leighton Kearney
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton-John Cancer and Wellness Centre, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Sampaio Rodrigues T, Koshy A, Gow P, Nerlekar N, Testro A, Lim R, Smith G, Farouque O. Long-Term Prognostic Value of Coronary Artery Disease - Reporting and Data System (CAD-RADS) Score for Cardiovascular Events in Asymptomatic Liver Transplant Recipients. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.229] [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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Toner L, Proimos H, Scully T, Ko J, Koshy A, Lim H, Lin T, Farouque O. Delayed Recurrence of Atrial Fibrillation and Flutter in Patients Referred for Electrical Cardioversion: A 5-year Study in a Real-World Setting. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.142] [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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Theuerle J, Al-Fiadh A, Collins A, Patel S, Barnes M, O'Donoghue F, Burrell L, Farouque O. Retinal Microvascular Endothelial Function is Impaired in Subjects With Obstructive Sleep Apnoea. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.325] [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: 11/28/2022]
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Sampaio Rodrigues T, Nerlekar N, Gow P, Testro A, Lim R, Smith G, Farouque O. Risk Factors for Advanced Atherosclerosis Detected on Computed Tomography Coronary Angiography in Patients with Liver Cirrhosis. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.241] [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: 11/17/2022]
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Theuerle J, Al-Fiadh A, Wong E, Patel S, Burrell L, Farouque O. Retinal Microvascular Endothelial Function is Impaired in Subjects With Chronic Kidney Disease. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.324] [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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