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Al-zuhairi K, Hyasat K, Femia G, Gibbs O, Faour A, Hopkins A, Sechi R, Kamand J, Ha A, Juergens C, Rajaratnam R, Liou K, Chiha J, Nguyen P, Lo S, Asrress K. 801 Changing Utility of Coronary Physiology to Guide Treatment Decisions in Patients With Coronary Artery Disease Over the Last Decade. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Arnold R, Amos D, Lowe H, Elder A, Martin S, Moss S, McMaster K, Juergens C, Ryan E, Larnach G, Adams M. 472 Development of a Rural NSW Cardiac Catheter and Coronary Intervention Service Over 14 Years: Impacts on Service and 30 Day AMI Mortality. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moss S, Arnold R, Lowe H, Elder A, Juergens C, McMaster K, Roach A, Larnach G, Adams M, Amos D. 436 A Rural 24/7 Cardiac Catheter Lab Service in Western NSW Local Health District (WNSWLHD): Locally Based Acute Coronary Syndrome (ACS) Care With Low Mortality Over 5 Years. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Burgess S, Juergens C, Nguyen T, Leung M, Robledo K, Thomas L, Mussap C, Zaman S, Lo S, French J. 886 ST-Elevation Myocardial Infarction, Incomplete Revascularization and Gender. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ferreira D, Le A, Khoo J, Nguyen P, Juergens C, Spicer T, Jain M. 624 Surgical Management of Right Atrial Mass Associated With a Vascular Access Catheter. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jayanti S, Juergens C, Makris A, Hennessy A, Nguyen P. 848 Learning Curve in Performing Transradial and Ultrasound Guidance Vascular Access. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Al-zuhairi K, Hyasat K, Femia G, Gibbs O, Faour A, Hopkins A, Sechi R, Juergens C, Rajaratnam R, Liou K, Chiha J, Nguyen P, Lo S, Asrress K. 802 Changing Utility of Intra Coronary Imaging in South Western Sydney Over the Last Decade. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alsadat N, Hyun K, D'Souza M, Chew D, Weaver J, Juergens C, Kritharides L, Hammett C, Brieger D. Revascularization Strategies in Patients With STEMI: Culprit-Only vs Multivessel Revascularization Using Percutaneous Coronary Intervention. THE JOURNAL OF INVASIVE CARDIOLOGY 2019; 31:314-318. [PMID: 31303602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Approximately 50% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have multivessel coronary disease (MVD). Evidence on the best PCI approach for these patients is conflicting. The aim of this study is to examine Australian data from the CONCORDANCE registry to describe the practice and outcomes of patients receiving multivessel vs culprit-only PCI. METHODS Two cohorts were constructed from MVD-STEMI patients undergoing primary PCI at 41 hospitals between 2009 and 2015: culprit-only PCI (n = 587; 87%) and multivessel PCI (n = 82; 12%). Clinical characteristics were described, and the outcomes were all-cause mortality, heart failure, and myocardial reinfarction, in-hospital and at 6-month follow-up. The relative prevalence of each procedure over time was also described. RESULTS The patient cohorts were comparable in age, sex, and cardiovascular risk factors. Patients with higher Killip scores were more likely to receive multivessel PCI (P=.02). The multivessel group was significantly more likely to have in-hospital cardiogenic shock (P<.01), myocardial reinfarction (P=.02), cardiac arrest (P=.02), and stroke (P=.01). There was no difference in the incidence of ischemic events at 6 months, but the multivessel group had a lower rate of planned repeat revascularizations (12% vs 2%; P=.03). There was no difference in the relative frequency of multivessel vs culprit-only PCI during the observation period. CONCLUSIONS The relative frequency of multivessel vs culprit-only PCI has not changed from 2009-2015. Index complete revascularization for STEMI-MVD patients is more likely to be performed in those with worse presentations and is associated with worse in-hospital complications.
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Etaher A, Gibbs O, Saad YM, Frost S, Nguyen T, Ferguson I, Juergens C, Chew D, French JK. P2717Type-II MI and chronic myocardial injury rates, invasive management and 4 year mortality among consecutive patients undergoing high sensitivity troponin T testing in the emergency department. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In emergency departments (EDs), assessment of patients with suspected acute coronary syndromes (ACS) represents a major workload and high sensitivity troponin (HsTn) T and I levels are frequently measured. A minority of patients have final diagnosis of myocardial infarction (MI).
Methods and results
Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014, we determined the relative frequencies of 3 patient groups: type-I MI, type-II MI including chronic myocardial injury (CMI), and assessed the use of invasive and pharmacological therapies and 4-year outcomes. Adjudication of MI was according to the 4th universal definition of MI as follows: 1) type-I MI; 2) type-II MI (including acute myocardial injury), and 3) CMI. Of 995 patients (36%) median age 76 years [IQR 65–83]), with at least 2 HsTnT measurements and one >14ng/l, 727 (73%) had chronic myocardial injury, 171 (17%) had type-II MI; and 97 (9.7%) had type-I MI. Patients with type-I MI (mean age 63 years) were younger than those with type-II MI or chronic myocardial injury by 12 and 14 years respectively. The main triggering factors for type-II MI/acute injury included: sepsis (21.1%), acute heart failure (18.3%), tachyarrhythmia (16.9%), anaemia (8.6%) and a combination of factors (16%). In-hospital angiography (62% had PCI) rates were 95% for patients with type-I MI, 24% (7% PCI) for those with type-II MI and 3.4% for CMI. Mortality at 4 years was 55% for type-II MI, 44% for CMI and 18% for type-1 MI (P<0.001; Figure), though after Cox modelling adjusting for age, gender, renal function and COPD, compared to type 1 MI, type-II MI (hazard ratio 1.61 [95% CIs 0.90–2.86]; p=0.106) and CMI (hazard ratio 1.01 [95% CIs 0.59–1.74]; p=0.963) were not independently associated with increased late mortality, largely because patients with type 1 MI were a decade younger.
Conclusion
Among unselected patients undergoing HsTnT testing in EDs, type-II MI including acute myocardial injury was more common than type-I MI. Chronic myocardial injury, which occurred in 3 of 4 patients. While patients with type-II MI acute myocardial injury had higher late mortality rates than type-I MI, though after multivariable analyses mortality rates were not different.
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Burgess S, Juergens C, Nguyen T, Leung M, Thomas L, Mussap C, Lo S, French JK. P6443Late outcomes in patients undergoing PCI for ST elevation myocardial infarction with respect to diabetic status and completeness of revascularisation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
This paper examines the degree to which the poor prognosis of ST elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) can be attributed to incomplete revascularization (ICR).
Background
Cardiovascular disease is the most common cause of death for patients with DM; patients with DM often have complex coronary disease and ICR. In STEMI the relative impact of DM and ICR is uncertain as these two factors frequently co-exist, the potential for confounding is high.
Methods and results
Of 589 consecutive STEMI patients, 22% had DM, who compared to patients without DM were of similar age (59 years), were more often female, had more hypertension and dyslipidaemia, but less often were smokers. A residual SYNTAX Score (rSS) >8, which defined ICR, occurred in 33%. Late cardiac death [median 3.5 years] was 4% among those without DM and 12% in those with DM (p=0.002) (p<0.001), and was 3% among 396 with rSS≤8 and 12% in 193 patients with rSS>8 (p<0.001). Patients with both ICR and DM accounted for only 8% of the STEMI population but 30% of all cardiac deaths. At final follow up (3.5 years) cardiac death rates (see Figure) were 22% in patients with both DM and ICR; these were significantly higher than rates in patients with ICR but no-DM (9%, p=0.034), and those with DM and rSS≤8 (6%, p<0.019). Multivariable analysis for cardiac death found a HR for ICR of 2.89 (95% CI 1.31–6.37; p=0.009) and a HR for DM of 5.18 (95% CI 2.45–10.97, p<0.001).
Diabetes, cardiac death & rSS
Conclusions
While ICR in DM patients with STEMI predicts a significantly poorer outcome, the poor prognosis seen in patients with DM is not explained by the degree of ICR alone. Both ICR and DM contribute independently to the risk of cardiac death in STEMI patients.
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. P2708Clopidogrel versus ticagrelor on coronary microvascular and peripheral endothelial function after non-ST elevation acute coronary syndrome: a randomised trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ticagrelor has been shown to reduce microvascular injury and improve peripheral endothelial function compared to clopidogrel in ST-elevation myocardial infarction and stable patients. However, comparable data is lacking in non-ST elevation acute coronary syndromes (NSTE-ACS).
Purpose
To investigate the effects of clopidogrel versus ticagrelor on coronary microvascular function and peripheral endothelial function in NSTE-ACS patients.
Methods
Patients hospitalised for NSTE-ACS were prospectively randomised 1:1 to clopidogrel (300mg loading then 75mg daily) or ticagrelor (180mg loading then 90mg twice-daily). Coronary microvascular function was assessed with index of microcirculatory resistance (IMR) in the infarct related artery (IRA) and non-IRA before and after percutaneous coronary intervention (PCI) using a standard pressure-temperature coronary wire. Peripheral endothelial function was assessed with flow-mediated vasodilation (FMD) of the brachial artery, performed on admission prior to antiplatelet loading and again before discharge, using a pneumatic cuff and 10MHz linear ultrasound transducer.
Results
A total of 40 patients were included for analysis (Figure 1). Median age was 53.5 (IQR 49.0–61.5) years, 35 (87.5%) were male, 11 (27.5%) had diabetes, 19 (47.5%) were smokers. Median peak troponin T was 527 (175–1006.5) ng/L, median GRACE score 91.5 (78.3–103.3) and median SYNTAX score 13 (6–20). Baseline characteristics were similar between both groups. There was no significant difference in the median baseline IMR between the 2 groups in both the IRA (clopidogrel 14.4 [IQR 12.2–18.6] vs ticagrelor 20.8 [11.3–27.4], p=0.22) and non-IRA (14.0 [11.0–22.0] vs 14.0 [10.0–29.5] respectively, p=0.74). 28 patients underwent PCI to the IRA (12 clopidogrel, 16 ticagrelor). There was no significant difference in the median post-PCI IMR between the 2 groups (19.5 [14.5–24.5] vs 29.0 [19.0–35.6] respectively, p=0.11). However, there was significant worsening of post-PCI compared with pre-PCI IMR (19.5 vs 15.0, p=0.049) in the clopidogrel group but not in the ticagrelor group (29.0 vs 25.4, p=0.47). FMD was performed in 23 patients (9 clopidogrel, 14 ticagrelor). Admission median %FMD (change in post-stimulus diameter as a percentage of the baseline diameter) was similar between the 2 groups (13.2% [10.1–17.6] vs 12.2% [10.2–15.8] respectively, p=0.41). There was a trend towards higher median pre-discharge %FMD in the ticagrelor group (12.8% [12.2–18.0]) compared to the clopidogrel group (10.4% [9.5–11.2], p=0.09). There was a trend towards lower pre-discharge %FMD compared to admission in the clopidogrel group (10.4% vs 13.2%, p=0.05) but not the ticagrelor group (12.8% vs 12.2%, p=0.43).
Figure 1
Conclusions
In our NSTE-ACS patients undergoing PCI, ticagrelor resulted in less disruption of coronary microvascular function and may also have beneficial effects on peripheral endothelial function compared to clopidogrel.
Acknowledgement/Funding
Dr. James Xu is funded by a post-graduate scholarship from the Australian Government Research Training Program (RTP)
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Juergens C. Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial. EUROINTERVENTION 2019; 15:e522-e530. [PMID: 31113763 DOI: 10.4244/eij-d-19-00336] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. METHODS AND RESULTS This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Transradial access reduced the primary outcome (RR 0.37, 95% CI: 0.17-0.81; p=0.013), mostly driven by ACUITY major bleeding (RR 0.343, 95% CI: 0.123-0.959; p=0.041) when compared with the transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance (p=0.76). Ultrasound guidance, however, reduced mean access time (93 sec vs. 111 sec; p=0.009), attempts (1.47 vs. 1.9; p<0.0001), difficult accesses (4.5% vs. 9.2%; p=0.0007), venepuncture (4.1% vs. 9.2%; p<0.0001) and improved first-pass success (73% vs. 59.7%; p<0.0001). CONCLUSIONS Transradial access significantly reduced the composite outcome compared to transfemoral access. Ultrasound guidance did not reduce the primary outcome compared to the standard technique, but significantly improved the efficiency and overall success rate of arterial access.
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Xu J, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Intravascular Ultrasound (IVUS) Analysis of Intensive Plaque Modification with Rotational Atherectomy with or without Adjunctive Cutting Balloon for Extremely Calcified Coronary Lesions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Badie T, Xu J, Kadappu K, Kachwalla H, Gibbs O, Faour A, Kee A, Rajaratnam R, Leung D, French J, Juergens C. Standard Versus Ultrasound-Guided Radial and Femoral Access (SURF) - A Randomised Controlled Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pender P, Faour A, Gibbs O, Dang V, Hopkins A, Leung D, Mussap C, French J, Juergens C, Lo S. Use of Mechanical Cardiac Support (MCS) for ST-elevated Myocardial Infarction with Cardiogenic Shock(STEMI-CS) in a Non-transplant Centre. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nguyen P, Makris A, Hennessy A, Park K, Chen V, Jayanti S, Juergens C. Ultrasonic Assessment of Subclinical Radial Artery Stenosis After Transradial Angiography. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nguyen NN, Faour A, Lo S, Hopkins A, Juergens C, French J, Hee L, Mussap C. Long Term Clinical Outcomes for All-comer Denovo Coronary Artery Lesions Treated with SeQuent Please Paclitaxel-Coated Balloons. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Otton J, Li Z, Koh E, Adams D, Mok K, Harvey M, Ling S, Sungala N, Moylan E, Ng W, Xiong G, Juergens C, Delaney G. Establishment of a Cardio-Oncology Service for Assessment and Management of Acute and Late Cardiovascular Conditions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sharma L, Faour A, Nguyen T, Holmes L, Gibbs O, Dimitri H, Juergens C, Richards D, Thomas L, French J. Simple Indices of Infarct Size Post ST-Elevation Myocardial Infarction (STEMI) Provides Similar Risk Stratification to Cardiac MRI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Juergens C. Outcomes in Femoral Access Patients with Large Abdominal Circumference. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Xu J, Lo S, Mussap C, French J, Rajaratnam R, Kadappu K, Premawardhana U, Nguyen P, Juergens C, Leung D. Clopidogrel Versus Ticagrelor on Coronary Microvascular Function After Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS): A Randomised Trial. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Femia G, Assas J, Sharma L, Idris H, Gibbs O, Hopkins A, Rajaratnam R, Juergens C, Mussap C, French J, Lo S. Prognostic Impact of Proximal versus Distal Dominant Right Coronary Artery (RCA) Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Assad J, Pender P, Faour A, Leung D, Rajaratnam R, Mussap C, Juergens C, Lo S. Pericardiocentesis for Pericardial Effusion – a Single Centre Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Etaher A, Gibbs O, Saad Y, Frost S, Nguyen T, Ferguson I, Juergens C, Chew D, French J. Type-II MI and Chronic Myocardial Injury Rates, Invasive Management and 4 Year Mortality Among Consecutive Patients Undergoing High Sensitivity Troponin T Testing in the Emergency Department. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Alazrag W, Saad Y, Alazhary A, Shugman I, Mussap C, Juergens C, Ferguson I, French J. Use of a High Sensitivity Troponin T Assay in the Assessment and Disposition of Patients Attending a Tertiary Australian Emergency Department. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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