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Sahlén AO, Jiang H, Lau YH, Cuenza L, Cader FA, Al-Omary M, Surunchupakorn P, Ho KH, Sung J, Lee D, Honda S, Tan Wei Chieh J, Yap J. Direct Oral Anticoagulation Versus Warfarin in Left Ventricular Thrombus: Pooled Analysis of Randomized Controlled Trials. J Clin Pharmacol 2023; 63:1101-1107. [PMID: 37139934 DOI: 10.1002/jcph.2267] [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: 03/19/2023] [Accepted: 05/02/2023] [Indexed: 05/05/2023]
Abstract
Patients with impaired left ventricular (LV) function can develop LV thrombus, a potentially life-threatening condition due to risk of stroke and embolization. Conventional treatment with vitamin K antagonists (VKAs; e.g., warfarin) puts patients at risk of bleeding, and the use of direct oral anticoagulants (DOACs) appears promising, although data are scant. We searched the published English language literature for randomized controlled trials (RCTs) comparing DOACs with VKAs in LV thrombus. End points were failure to resolve, thromboembolic events (stroke, embolism), bleeding, or any adverse event (composite of thromboembolism or bleeding), or all-cause death. Data were pooled and analyzed in hierarchical Bayesian models. In three eligible RCTs, 141 patients were studied during an average of 4.6 months (53.8 patient-years; n = 71 assigned to DOAC, n = 70 assigned to VKA). A similar number of patients in each treatment arm demonstrated failure to resolve (DOAC: 14/71 vs. VKA: 15/70) and death events (3/71 vs. 4/70). However, patients on DOACs suffered fewer strokes/thromboembolic events (1/71 vs. 7/70; log odds ratio [OR], -2.02 [95% credible interval (CI95 ), -4.53 to -0.31]) and fewer bleeding events (2/71 vs. 9/70; log OR, -1.62 [CI95 , -3.43 to -0.26]), leading to fewer patients on DOACs with any adverse event versus VKAs (3/71 vs. 16/70; log OR, -1.93 [CI95 , -3.33 to -0.75]). In conclusion, pooled analysis of RCT data favors DOACs over VKAs in patients with LV thrombus in terms of both efficacy and safety.
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Affiliation(s)
- Anders Olof Sahlén
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Karolinska Institutet, Huddinge, Sweden
| | - Haowen Jiang
- Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Yee How Lau
- National Heart Centre Singapore, Singapore, Singapore
| | - Lucky Cuenza
- Philippines Heart Center, Quezon City, Philippines
| | - F Aaysha Cader
- Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | | | | | - Ka Hei Ho
- Tuen Mun Hospital, Hong Kong, Hong Kong
| | | | - Derek Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Satoshi Honda
- National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan
| | - Jack Tan Wei Chieh
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jonathan Yap
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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2
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Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, Kasim S, Ahmad B, Idrose AM, Salleh FM, Oyamada S, Hirano Y, Ouchi S, Terakura M, Yokoyama N, Kozuma K, Nanasato M, Higuchi R, Yumoto K, Fukuzawa T, Shimada I, Giannitsis E, Twerenbold R, Minamino T. Correction: An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study. Trials 2023; 24:335. [PMID: 37198646 DOI: 10.1186/s13063-023-07342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Affiliation(s)
- Kenji Inoue
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan.
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Lim Chiw Yeh
- Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Pannipa Suwanasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Sazzli Kasim
- Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Bakhtiar Ahmad
- Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | | | | | | | - Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo Urayasu Hospital, Chiba, Japan
| | - Moriyuki Terakura
- Department of Emergency, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Yokoyama
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiko Yumoto
- Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | | | | | | | - Raphael Twerenbold
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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3
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Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, Kasim S, Ahmad B, Idrose AM, Salleh FM, Oyamada S, Hirano Y, Ouchi S, Terakura M, Yokoyama N, Kozuma K, Nanasato M, Higuchi R, Yumoto K, Fukuzawa T, Shimada I, Giannitsis E, Twerenbold R, Minamino T. An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study. Trials 2022; 23:986. [PMID: 36476401 PMCID: PMC9727900 DOI: 10.1186/s13063-022-06907-4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data. METHODS The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED. CONCLUSIONS This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
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Affiliation(s)
- Kenji Inoue
- grid.482668.60000 0004 1769 1784Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Jack Tan Wei Chieh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Lim Chiw Yeh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Shuo-Ju Chiang
- grid.410769.d0000 0004 0572 8156Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Arintaya Phrommintikul
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Pannipa Suwanasom
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Sazzli Kasim
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Bakhtiar Ahmad
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Alzamani Mohammad Idrose
- grid.412516.50000 0004 0621 7139Division of Emergency, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Farina Mohd Salleh
- grid.419388.f0000 0004 0646 931XDivision of Emergency, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Yohei Hirano
- grid.482669.70000 0004 0569 1541Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo Urayasu Hospital, Chiba, Japan
| | - Moriyuki Terakura
- grid.264706.10000 0000 9239 9995Department of Emergency, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Yokoyama
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mamoru Nanasato
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiko Yumoto
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tomoyuki Fukuzawa
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | | | - Evangelos Giannitsis
- grid.5253.10000 0001 0328 4908Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Raphael Twerenbold
- grid.13648.380000 0001 2180 3484Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tohru Minamino
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Giannitsis E, Blankenberg S, Christenson RH, Frey N, von Haehling S, Hamm CW, Inoue K, Katus HA, Lee CC, McCord J, Möckel M, Chieh JTW, Tubaro M, Wollert KC, Huber K. Critical appraisal of the 2020 ESC guideline recommendations on diagnosis and risk assessment in patients with suspected non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 2021; 110:1353-1368. [PMID: 33635437 PMCID: PMC8405476 DOI: 10.1007/s00392-021-01821-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 10/27/2022]
Abstract
Multiple new recommendations have been introduced in the 2020 ESC guidelines for the management of acute coronary syndromes with a focus on diagnosis, prognosis, and management of patients presenting without persistent ST-segment elevation. Most recommendations are supported by high-quality scientific evidence. The guidelines provide solutions to overcome obstacles presumed to complicate a convenient interpretation of troponin results such as age-, or sex-specific cutoffs, and to give practical advice to overcome delays of laboratory reporting. However, in some areas, scientific support is less well documented or even missing, and other areas are covered rather by expert opinion or subjective recommendations. We aim to provide a critical appraisal on several recommendations, mainly related to the diagnostic and prognostic assessment, highlighting the discrepancies between Guideline recommendations and the existing scientific evidence.
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Affiliation(s)
- Evangelos Giannitsis
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Norbert Frey
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Kenji Inoue
- Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hugo A Katus
- Medizinische Klinik III, Department of Cardiology, Angiology and Pulmology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - James McCord
- Henry Ford Heart and Vascular Institute Detroit, Detroit, MI, USA
| | - Martin Möckel
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Campus Mitte and Virchow, Berlin, Germany
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre and Sengkang General Hospital, Singapore, Singapore
| | | | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria.,Medical School, Sigmund Freud University, Vienna, Austria
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5
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Wood D, Asma S, Bettcher D, Wei Chieh JT, Greenland R, Italianer F, Krug E, McGuire H, Wong-Rieger D, Eiselé JL, Mwangi J, Markbreiter J, Canham L, White A. Global Coalition for the Fight Against Heart Disease and Stroke: A Global Coalition for WHF Second Global Summit on Circulatory Health. Glob Heart 2017; 13:37-44. [PMID: 29248363 DOI: 10.1016/j.gheart.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- David Wood
- World Heart Federation, Geneva, Switzerland; Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Samira Asma
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jack Tan Wei Chieh
- World Heart Federation, Geneva, Switzerland; National Heart Centre Singapore, Singapore; Asian Pacific Society of Cardiology, Kuala Lumpur, Malaysia
| | - Rohan Greenland
- National Heart Foundation of Australia, Canberra, Australian Capital Territory, Australia; Asia-Pacific Heart Network, Singapore
| | - Floris Italianer
- World Heart Federation, Geneva, Switzerland; Hartstichting, the Hague, the Netherlands
| | | | | | - Durhane Wong-Rieger
- Canadian Organization for Rare Disorders, Toronto, Ontario, Canada; International Alliance of Patients' Organizations, London, United Kingdom
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6
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Choong Hou K, Sin Yoong Kong K, Kee Yi Shern T, Tan Wei Chieh J. Impact of Chronic Kidney Insufficiency on Cardiovascular Outcomes in Patients that Undergo Coronary Revascularization: A Historical Review. ACTA ACUST UNITED AC 2016; 24:8. [PMID: 27917389 PMCID: PMC5110577 DOI: 10.7603/s40602-016-0008-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic kidney disease (CKD) is associated with poorer short and long-term cardiovascular morbidity and mortality. Even after the commencement of haemodialysis in end stage renal failure patients, mortality exceeds 20% in the first year1. More than 50% of these deaths are contributed by cardiovascular diseases (CVD), of which 20% are caused by acute myocardial infarction2. Consequent to these findings, the degree and impact of coronary revascularization on CKD patients represents a clinical challenge, especially in the setting of advanced stages of CKD.
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Affiliation(s)
- Koh Choong Hou
- Department of Cardiovascular Medicine, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
| | - Kenny Sin Yoong Kong
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
| | - Terence Kee Yi Shern
- Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, Singapore 169608
| | - Jack Tan Wei Chieh
- Department of Cardiovascular Medicine, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore 169609
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Soeda T, Park SJ, Jang Y, Lee S, Mizuno K, Itoh T, Chieh JTW, Lee H, Jia H, Yu B, Uemura S, Saito Y, Jang IK. INCIDENCE AND PREDICTORS OF STENT EDGE MEDIAL DISRUPTION: AN IN VIVO OPTICAL COHERENCE TOMOGRAPHY STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61893-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Coronary perforation is a potentially fatal complication during percutaneous coronary intervention (PCI). Reports have shown that it occurs in 0.2 to 0.6% of all patients undergoing the procedures. [1-3] Though the frequency of coronary perforation is low, it is a serious and potentially life-threatening situation that warrants prompt recognition and management. Here we illustrate a case of coronary perforation, and review the incidence, causes, clinical sequelae and management of coronary perforation in the current contemporary practice.
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Affiliation(s)
- Ang Chin Yong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jack Tan Wei Chieh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
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