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Rajakariar K, Andrianopoulos N, Gayed D, Liang D, Backhouse B, Ajani AE, Duffy SJ, Brennan A, Roberts L, Reid CM, Oqueli E, Clark D, Freeman M. Outcomes of thrombus aspiration during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Intern Med J 2023; 53:1376-1382. [PMID: 35670161 DOI: 10.1111/imj.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous large multi-centre randomised controlled trials have not provided clear benefit with routine intracoronary thrombus aspiration (TA) as an adjunct to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). AIM To determine whether there is a difference in outcomes with the use of manual TA prior to PCI, compared with PCI alone in a cohort of patients with STEMI. METHODS We analysed data from 6270 consecutive patients undergoing primary PCI for STEMI prospectively enrolled in the Melbourne Interventional Group registry between 2007 and 2018. Multivariable analysis was performed to determine predictors of 30-day major adverse cardiovascular and cerebrovascular events (MACCE) and long-term mortality. RESULTS We compared 1621 (26%) patients undergoing primary PCI with TA to 4649 (74%) patients undergoing PCI alone. Male gender (81% vs 78%; P < 0.01), younger age (61 vs 63 years; P = 0.03), GP-IIb/IIIa use (76% vs 58%, P < 0.01), and current smoking (40% vs 36%; P < 0.01) were more common in the TA group. TA was more likely to be used in patients with complex lesions (83% vs 66%; P < 0.01) with TIMI 0 flow (77% vs 56%; P < 0.01). No significant difference in post-procedural TIMI flow, stroke, 30-day mortality, or long-term mortality were identified. Multivariable analysis demonstrated a reduction in 30-day MACCE (hazard ratio (HR) 0.75; confidence interval (CI) 0.63-0.89; P < 0.01) in the TA group, but was not associated with long-term mortality (HR 0.98; CI 0.85-1.1; P = 0.73). CONCLUSION The use of TA in patients undergoing primary PCI for STEMI was not associated with improved short or long-term mortality when compared with PCI alone.
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Affiliation(s)
- Kevin Rajakariar
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel Gayed
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Danlu Liang
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Brendan Backhouse
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
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Dawson LP, Dinh D, Duffy SJ, Clark D, Reid CM, Brennan A, Andrianopoulos N, Hiew C, Freeman M, Oqueli E, Chan W, Ajani AE. Temporal Trends in Patient Risk Profile and Clinical Outcomes Following Percutaneous Coronary Intervention. Cardiovascular Revascularization Medicine 2021; 31:10-16. [DOI: 10.1016/j.carrev.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
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3
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Biswas S, Dinh D, Andrianopoulos N, Lefkovits J, Ajani A, Duffy SJ, Chan W, Walton A, Brennan A, Clark DJ, Hiew C, Oqueli E, Reid CM, Stub D, Eccleston D. Comparison of Long-Term Outcomes After Percutaneous Coronary Intervention in Patients With Insulin-Treated Versus Non-Insulin Treated Diabetes Mellitus. Am J Cardiol 2021; 148:36-43. [PMID: 33667454 DOI: 10.1016/j.amjcard.2021.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
There are conflicting data on whether patients with insulin-treated diabetes mellitus (ITDM) have poorer outcomes compared with non-insulin treated diabetic (non-ITDM) patients following percutaneous coronary intervention (PCI). We therefore compared clinical outcomes following PCI in ITDM versus non-ITDM patients. We prospectively collected data on 4,579 patients with diabetes underwent PCI between 2005 and 2014 in a large multicenter registry and dichotomized them as having ITDM (n = 1,111) or non-ITDM (n = 3,468). The non-ITDM group was further divided into diet control only (diet-DM; n = 786) and those taking oral hypoglycemic agents (OHG-DM; n = 2,639), and clinical outcomes were compared with ITDM patients. Median follow-up for long-term mortality was 4.2 years (IQR 2.0 to 6.6 years). ITDM patients were more likely to be female, obese, and have severe renal impairment (all p <0.001). Procedural characteristics were similar other than a greater use of drug-eluting stents in ITDM patients. On multivariable analysis, ITDM was an independent predictor of 12-month major adverse cardiovascular and cerebrovascular events (MACCE; OR 1.26, 95% CI 1.02 to1.55, p = 0.03). Dividing the non-ITDM group further by treatment, a progressively higher rate of 12-month MACCE across the 3 groups was observed (13.5% vs 17.9% vs 21.8%; p <0.001). Long-term mortality was similar in the diet-DM and OHG-DM groups, but significantly higher in the ITDM group on Kaplan-Meier analysis (log-rank p <0.001). In conclusion, there is a clear gradient of adverse outcomes with escalation of therapy from diet control to OHGs to insulin.
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Noaman S, O'Brien J, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Sharma A, Chan W, Clark D, Stub D, Biswas S, Freeman M, Ajani A, Yip T, Duffy SJ, Oqueli E. Clinical outcomes following ST-elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention. Catheter Cardiovasc Interv 2020; 96:E406-E415. [PMID: 32087042 DOI: 10.1002/ccd.28802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) secondary to stent thrombosis (ST) compared to those presenting with STEMI secondary to a de novo culprit lesion and treated by percutaneous coronary intervention (PCI). BACKGROUND ST is an infrequent but serious complication of PCI with substantial associated morbidity and mortality, however with limited data. METHODS We studied consecutive patients who underwent PCI for STEMI from 2005 to 2013 enrolled prospectively in the Melbourne Interventional Group registry. Patients were divided into two groups: the ST group comprised patients where the STEMI was due to ST and the de novo group formed the remainder of the STEMI cohort and all patients were treated by PCI. The primary endpoint was 30-day all-cause mortality. RESULTS Compared to the de novo group (n = 3,835), the ST group (n = 128; 3.2% of STEMI) had higher rates of diabetes, hypertension and dyslipidemia, established cardiovascular diseases, myocardial infarction, and peripheral vascular disease, all p < .01. Within the ST group, very-late ST was the most common form of ST, followed by late and early ST (64, 19, and 17%, respectively). There was no significant difference in the primary outcome between the ST group and the de novo group (4.7 vs. 7.1%, p = .29). On multivariate analysis, ST was not an independent predictor of 30-day mortality (odds ratio: 0.62, 95% confidence interval: 0.07-1.09, p = .068). CONCLUSION The short-term prognosis of patients with STEMI secondary to ST who were treated by PCI was comparable to that of patients with STEMI due to de novo lesions.
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Affiliation(s)
- Samer Noaman
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Jessica O'Brien
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anand Sharma
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - William Chan
- University of Melbourne, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Peck KY, Andrianopoulos N, Dinh D, Roberts L, Duffy SJ, Sebastian M, Clark D, Brennan A, Oqueli E, Ajani AE, Reid CM, Freeman M, Teh AW. Role of beta blockers following percutaneous coronary intervention for acute coronary syndrome. Heart 2020; 107:728-733. [PMID: 32887736 DOI: 10.1136/heartjnl-2020-316605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/18/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 11/03/2022] Open
Abstract
AIMS There is a paucity of evidence supporting routine beta blocker (BB) use in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). The aim of this study was to evaluate BB use post PCI and its association with mortality. Furthermore, the study aimed to evaluate the association between BB and mortality in the subgroups of patients with left ventricular ejection fraction (LVEF) <35%, LVEF 35%-50% and LVEF >50%. METHODS Using a large PCI registry, data from patients with ACS between January 2005 and June 2017 who were alive at 30 days were analysed. Those patients taking BB at 30 days were compared with those who were not taking BB. The primary outcome was all-cause mortality. The mean follow-up was 5.3±3.5 years. RESULTS Of the 17 562 patients, 83.3% were on BB. Mortality was lower in the BB group (13.1% vs 19.5%, p=0.0001). Multivariable Cox proportional hazards model showed that BB use was associated with lower overall mortality (adjusted HR 0.87, 95% CI 0.78 to 0.97, p=0.014). In the subgroup analysis, BB use was associated with reduced mortality in LVEF <35% (adjusted HR 0.63, 95% CI 0.44 to 0.91, p=0.013), LVEF 35%-50% (adjusted HR 0.80, 95% CI 0.68 to 0.95, p=0.01), but not LVEF >50% (adjusted HR 1.03, 95% CI 0.87 to 1.21, p=0.74). CONCLUSION BB use remains high and is associated with reduced mortality. This reduction in mortality is primarily seen in those with reduced ejection fraction, but not in those with preserved ejection fraction.
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Affiliation(s)
- Kah Yong Peck
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louise Roberts
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Health, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Barwon Health, University Hospital, Geelong, Victoria, Australia
| | - David Clark
- Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia.,School of Medicine, Deakin University, Ballarat, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Andrew W Teh
- Department of Cardiology, Eastern Health, Box Hill Hospital, Melbourne, Victoria, Australia .,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, The University of Melbourne, Austin Hospital Clinical School, Melbourne, Victoria, Australia
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Lim M, Dinh DT, Brennan A, Liew D, Reid C, Lefkovits J, Duffy SJ, Andrianopoulos N, Stub D. Clinical Outcomes in Older Patients Undergoing Percutaneous Coronary Intervention for Non-ST-Elevation Acute Coronary Syndromes. Heart Lung Circ 2020; 30:275-281. [PMID: 32622913 DOI: 10.1016/j.hlc.2020.05.102] [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: 04/18/2019] [Revised: 02/26/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Distinguishing the subgroup of older, comorbid patients presenting with non-ST-elevation acute coronary syndromes (NSTEACS) who will benefit from percutaneous coronary intervention (PCI) remains challenging. Identifying risk factors for major adverse cardiac or cerebrovascular events (MACCE) post PCI may help define this cohort. The objective of this study was to describe contemporary outcomes of older patients with NSTEACS undergoing PCI and identify pre-procedural risk factors for MACCE. METHODS We retrospectively reviewed data for 1,875 patients aged ≥80 years entered in the Victorian Cardiac Outcomes Registry (VCOR) who underwent PCI for NSTEACS between 1 January 2013 and 31 December 2017. MACCE was a composite outcome comprising 30-day mortality, myocardial infarction, stroke, major bleeding, target lesion revascularisation or target vessel revascularisation; in-hospital cardiogenic shock or stent thrombosis; and new requirement for dialysis. Patient demographic data and pre-procedural comorbidities were compared between the groups with and without a MACCE. RESULTS The rate of MACCE at 30 days was 8.0% (n=150). Thirty-day (30-day) mortality was 3.0% (n=57). Pre-procedural left ventricular ejection fraction (LVEF)<45% (OR 2.32; 95% CI 1.47-3.68; p<0.001) and eGFR≤30 mL/min/1.73m2 or renal replacement therapy (OR 2.10; 95% CI 1.27-3.46; p<0.01) were independent predictors of a MACCE. CONCLUSIONS Older patients presenting with NSTEACS who have left ventricular systolic dysfunction or renal impairment are at increased risk of MACCE post PCI. Randomised studies are required to determine if invasive management remains beneficial for these patents compared with medical therapy.
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Affiliation(s)
- Michael Lim
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Christopher Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia.
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Yeoh J, Andrianopoulos N, Reid CM, Yudi MB, Hamilton G, Freeman M, Noaman S, Oqueli E, Picardo S, Brennan A, Chan W, Stub D, Duffy S, Farouque O, Ajani A, Clark DJ. Long-term outcomes following percutaneous coronary intervention to an unprotected left main coronary artery in cardiogenic shock. Int J Cardiol 2020; 308:20-25. [PMID: 32192748 DOI: 10.1016/j.ijcard.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/27/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In cardiogenic shock with severe left main coronary artery stenosis (LM), limited information exists on short and longer-term outcomes. We sought to determine the outcomes of unprotected LM PCI in cardiogenic shock. METHODS Excluding patients with previous CABG, consecutive patients undergoing PCI in cardiogenic shock from the Melbourne Intervention Group registry between 2005 and 2013 were analysed. Those post LM PCI were compared to those post non-LM PCI. Patient and procedural data were collected with 30-day and 12-month follow-up. Australian National Death Index linkage was performed for long-term mortality analysis. RESULTS After excluding previous CABG, 18,069 procedures were performed during 1st January 2005 to 30th November 2013, 601 procedures in the setting of cardiogenic shock. Of these, 45 were performed to an isolated LM and 556 to a non-LM. Those with LM PCI were older and more likely to have a baseline left ventricular ejection fraction (LVEF) of <45%. The in-hospital, 30-day, 12-month and long-term mortality to 9 years in cardiogenic shock after LM PCI was 64.4%, 66.7%, 73.3% and 80.0% compared to 36.5%, 36.9%, 40.5% and 46.0%, after non-LM PCI (p < 0.001). On multivariate analysis, LM PCI was a significant independent predictor of long-term mortality (HR1.59, 95%CI 1.00-2.53, p = 0.048). Landmark analysis of survivors to discharge found the long-term mortality of LM PCI approaches 60% compared to 27% for those with non-LM PCI (p = 0.003). CONCLUSION Long-term outcomes after PCI to LM in cardiogenic shock are poor, with much of the excess in mortality occurring early. However, reasonable long-term survival was found beyond the initial high-risk period.
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Affiliation(s)
- Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Garry Hamilton
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Melaine Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Australia
| | - Sandra Picardo
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia
| | - William Chan
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Dion Stub
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Stephen Duffy
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Andrew Ajani
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia.
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Dawson LP, Cole JA, Lancefield TF, Ajani AE, Andrianopoulos N, Thrift AG, Clark DJ, Brennan AL, Freeman M, O'Brien J, Sebastian M, Chan W, Shaw JA, Dinh D, Reid CM, Duffy SJ. Incidence and risk factors for stroke following percutaneous coronary intervention. Int J Stroke 2020; 15:909-922. [PMID: 32248767 DOI: 10.1177/1747493020912607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. AIMS This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. METHODS Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005-2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997-1999) and predefined variables assessed for association with inpatient or outpatient stroke. RESULTS Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30-45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old. CONCLUSIONS Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Justin A Cole
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Jessica O'Brien
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Martin Sebastian
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Perth, Australia
| | - Stephen J Duffy
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia.,Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Dawson LP, Dinh D, Duffy S, Brennan A, Clark D, Reid CM, Blusztein D, Stub D, Andrianopoulos N, Freeman M, Oqueli E, Ajani AE. Short- and long-term outcomes of out-of-hospital cardiac arrest following ST-elevation myocardial infarction managed with percutaneous coronary intervention. Resuscitation 2020; 150:121-129. [PMID: 32209377 DOI: 10.1016/j.resuscitation.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) is frequently associated with ST-elevation myocardial infarction (STEMI) and has a high mortality. We aimed to identify differences in characteristics and very long-term outcomes for STEMI patients with and without OHCA managed with percutaneous coronary intervention (PCI). METHODS We analysed data from 12,637 PCI patient procedures for STEMI in the multi-centre Melbourne Interventional Group registry between January 2005 and December 2018. Multivariable models examined associations with OHCA presentation and 30-day mortality. Long-term outcomes were assessed through linkage with the Australian National Death Index. RESULTS Compared with patients without OHCA (N = 11,580), patients with OHCA (N = 1057) were younger, more often male, had less cardiovascular risk factors, and more often presented with cardiogenic shock. OHCA preceded an increasing proportion of STEMI PCI cases from 2005 to 2018 (2.4% vs. 9.2%). Factors independently associated with OHCA presentation were younger age, male gender, prior valve surgery, multi-vessel disease, LAD culprit, small vessel diameter, and renal impairment on presentation. Patients with OHCA had lower procedural success, higher rates of bleeding and stroke, larger infarct size (measured by peak CK), and higher 30-day mortality (37% vs. 5%; all p < 0.05). Cardiogenic shock, renal impairment and lower ejection fraction were independently associated with 30-day mortality. Long-term mortality was 44% vs. 20% (median follow-up 4.6 years), with Cox regression analysis demonstrating no difference in survival if patients survived beyond 30 days (HR 1.18, 95% CI 0.95-1.47). CONCLUSIONS OHCA has a high short-term mortality and precedes an increasing proportion of STEMI PCI cases. Thirty-day survivors have an excellent long-term prognosis.
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Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Stephen Duffy
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - David Blusztein
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia.
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10
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Ariyaratne TV, Ademi Z, Ofori-Asenso R, Huq MM, Duffy SJ, Yan BP, Ajani AE, Clark DJ, Billah B, Brennan AL, New G, Andrianopoulos N, Reid CM. The cost-effectiveness of guideline-driven use of drug-eluting stents: propensity-score matched analysis of a seven-year multicentre experience. Curr Med Res Opin 2020; 36:419-426. [PMID: 31870180 DOI: 10.1080/03007995.2019.1708288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In routine clinical practice, the implantation of a drug-eluting stent (DES) versus a bare metal stent (BMS) for percutaneous coronary intervention (PCI) has been guided by criteria for appropriate use. The cost-effectiveness (CE) of adopting these guidelines, however, is not clear, and was investigated from the perspective of the Australian healthcare payer.Methods and results: Baseline and 12-month follow-up data of 12,710 PCI patients enrolled in the Melbourne Interventional Group (MIG) registry between 2004 and 2011 were analysed. Costs inputs were derived from a clinical costing database and published sources. Propensity-score-matching was performed for DES and BMS groups within sub-groups. Incremental cost-effectiveness ratios (ICERs) were evaluated for all patients, and sub-groups of patients with '0', 1, 2, or ≥3 indications for a DES. The incremental cost per target vessel revascularization avoided for the overall population was $24,683, and for patients with 0, 1, and 2 indications for a DES was $44,635, $33,335, and $23,788, respectively. However, for those with >3 indications, DES compared with BMS was associated with cost savings. At willingness to pay thresholds of $45,000-$75,000, the probability of cost-effectiveness of DES for the overall cohort was 71-91%, '0' indications, 49-67%, 1 indication, 56-82%, 2 indications, 70-90%, and ≥3 indications, 97-99%.Conclusions: The cost-effectiveness of DES compared with BMS increased with increasing risk profile of patients from those who had 1, 2, to ≥3 indications for a DES. When compared with BMS, DES was least cost effective among patients with '0' indications for a DES. Based on these results, selective use of DES implantation is supported. These findings may be useful for evidence-based clinical decision-making.
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Affiliation(s)
- Thathya V Ariyaratne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Richard Ofori-Asenso
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Molla M Huq
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Stephen J Duffy
- Cardiovascular Medicine, Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Bryan P Yan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Andrew E Ajani
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong
- Royal Melbourne Hospital, Parkville, Australia
| | - David J Clark
- The Department of Cardiology, Austin Hospital, Heidelberg, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gishel New
- Department of Cardiology, Box Hill Hospital, Box Hill, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
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11
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Noaman S, Andrianopoulos N, Brennan AL, Dinh D, Reid C, Stub D, Biswas S, Clark D, Shaw J, Ajani A, Freeman M, Yip T, Oqueli E, Walton A, Duffy SJ, Chan W. Outcomes of cardiogenic shock complicating acute coronary syndromes. Catheter Cardiovasc Interv 2020; 96:E257-E267. [PMID: 32017332 DOI: 10.1002/ccd.28759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/29/2019] [Revised: 12/24/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to assess the outcomes of cardiogenic shock (CS) complicating acute coronary syndromes (ACS). BACKGROUND CS remains the leading cause of mortality in patients presenting with ACS despite advances in care. METHODS We studied 13,184 patients undergoing percutaneous coronary intervention (PCI) for all subtypes of ACS enrolled prospectively in a large multicentre Australian registry (Melbourne Interventional Group registry) from 2005 to 2013. All-cause mortality was obtained via linkage to the National Death Index. Patients were divided into those with and those without CS. RESULTS Compared to the non-CS group (n = 12,548, 95.2%), the CS group (n = 636, 4.8%) had a higher proportion of out-of-hospital cardiac arrest (OHCA) (31.1 vs. 2.2%) and ST-elevation myocardial infarction (STEMI) presentation (89 vs. 34%), both p < .01. Patients in the CS group had higher rates of in-hospital (40.4 vs. 1.2%) and 30-day (41 vs. 1.7%) mortality compared to the non-CS group. Long-term mortality over a median follow-up of 4.2 years was higher in the CS group (50.6 vs. 13.8%), p < .001. Trends of in-hospital and 30-day mortality rates of CS complicating ACS were relatively stable from 2005 to 2013. Predictors of long-term NDI-linked mortality within the CS group include severe left ventricular systolic dysfunction (HR 3.0), glomerular filtration rate (GFR) <30 (HR 2.56), GFR 30-59 (HR 1.94), OHCA (HR 1.46), diabetes (HR 1.44), and age (HR 1.02), all p < .05. CONCLUSIONS Rates of CS-related mortality complicating ACS have remained very high and steady over nearly a decade despite progress in STEMI systems of care, PCI techniques, and medical therapy.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Angela L Brennan
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - James Shaw
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andrew Ajani
- Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Thomas Yip
- Department of Cardiology, Geelong University Hospital, Geelong, Victoria, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.,Clinical Research Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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12
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Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Brennan A, Murphy AC, Lefkovits J, Reid CM, Oqueli E, Sebastian M, Duffy SJ, Clark DJ. Prognostic significance of suboptimal secondary prevention pharmacotherapy after acute coronary syndromes. Intern Med J 2020; 51:366-374. [PMID: 31943665 DOI: 10.1111/imj.14750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Optimal secondary prevention pharmacotherapy is the cornerstone of post-acute coronary syndrome (ACS) management. The prognostic impact of not receiving five guideline-recommended therapies is poorly described. AIM To ascertain the prognostic significance of suboptimal pharmacotherapy in ACS survivors. METHODS Consecutive patients with ACS from the Melbourne Interventional Group registry who were alive at 30 days following their index percutaneous coronary intervention were included. Patients were divided into three categories based on the number of secondary prevention medications prescribed. The optimal medical therapy (OMT), near-optimal medical therapy (NMT), suboptimal medical therapy (SMT) groups were prescribed 5, 4 and ≤ 3 medications, respectively. Primary endpoint was long-term mortality. Cox-proportional hazard modelling was undertaken to assess independent predictors of survival. RESULTS Of the 9375 patients included, 5678 (60.6%) received OMT, 2903 (31.0%) received NMT and 794 (8.5%) received SMT. Patients receiving SMT were older, more likely to be female and had higher burden of comorbidities (renal impairment, congestive heart failure, diabetes, peripheral vascular disease; P < 0.01 for all). SMT was associated with higher long-term mortality at 3.9 ± 2.2 years when compared to NMT and OMT (16.8% vs 10.5% vs 8.2%, P < 0.001). Compared to OMT, SMT was an independent predictor of long-term mortality (hazard ratio, HR 1.62, 95% confidence interval, CI 1.30-2.02, P < 0.01) while NMT was associated with a clinically significant 14% mortality hazard (HR 1.14, 95% CI 0.97-1.34, P = 0.11). CONCLUSIONS There is a graded long-term hazard associated with not receiving OMT after an ACS. Improvements in secondary prevention pharmacotherapy models of care are warranted to further decrease the long-term mortality.
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Affiliation(s)
- Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Andrew E Ajani
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
| | - Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Martin Sebastian
- Department of Cardiology, Barwon Health, Geelong, Victoria, Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia.,Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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13
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Gellatly RM, Connell C, Tan C, Andrianopoulos N, Ajani AE, Clark DJ, Nanayakkara S, Sebastian M, Brennan A, Freeman M, O'Brien J, Selkrig LA, Reid CM, Duffy SJ. Trends of Use and Outcomes Associated With Glycoprotein-IIb/IIIa Inhibitors in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Ann Pharmacother 2019; 54:414-422. [PMID: 31766865 DOI: 10.1177/1060028019889550] [Citation(s) in RCA: 5] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Glycoprotein IIb/IIIa inhibitors (GPIs) are a treatment option in the management of acute coronary syndromes (ACSs). Evidence supporting the use of GPIs predates trials establishing the benefits of P2Y12 inhibitors, routine early invasive therapy, and thrombectomy devices in patients with ACS. Objective: The aim of this study was to determine trends in GPI use and their associated outcomes in contemporary practice. Methods: We assessed GPI use in patients with ACS undergoing percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry (2005-2013). The primary endpoint was the 30-day incidence of major adverse cardiovascular events (MACE). The safety endpoint was in-hospital major bleeding. Results: GPIs were used in 40.5% of 12 357 patients with ACS undergoing PCI. GPI use decreased over the study period (P for trend <0.0001). Patients were more likely to receive GPIs if they were younger, presented with a ST-elevation myocardial infarction (STEMI), had more complex (B2/C-type) lesions, and when thrombectomy devices were used (all P < 0.0001). MACE were higher in patients receiving GPI (4.9% vs 4.1%, P = 0.03). Propensity score matching revealed no difference in 30-day mortality and 30-day MACE (odds ratio [OR] = 1.00; 95% CI = 0.99-1.004 and OR = 1.01; 95% CI = 0.99-1.02, respectively). GPI use was associated with more bleeding complications (3.6% vs 1.8%, P < 0.0001). Conclusion and Relevance: GPI use in ACS patients undergoing PCI has declined, and use appears to be dictated by ACS type and lesion complexity, as opposed to high-risk comorbidities. GPI use was associated with a doubling in bleeding complications.
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Affiliation(s)
| | - Cia Connell
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | | | - Andrew E Ajani
- Monash University, Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Parkville, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | - Stephen J Duffy
- Alfred Hospital, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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14
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Biswas S, Andrianopoulos N, Dinh D, Duffy SJ, Lefkovits J, Brennan A, Noaman S, Ajani A, Clark DJ, Freeman M, Oqueli E, Hiew C, Reid CM, Stub D, Chan W. Association of Body Mass Index and Extreme Obesity With Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Heart Assoc 2019; 8:e012860. [PMID: 31648578 PMCID: PMC6898845 DOI: 10.1161/jaha.119.012860] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Previous studies have reported a protective effect of obesity compared with normal body mass index (BMI) in patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether this effect extends to the extremely obese. In this large multicenter registry‐based study, we sought to examine the relationship between BMI and long‐term clinical outcomes following PCI, and in particular to evaluate the association between extreme obesity and long‐term survival after PCI. Methods and Results This cohort study included 25 413 patients who underwent PCI between January 1, 2005 and June 30, 2017, who were prospectively enrolled in the Melbourne Interventional Group registry. Patients were stratified by World Health Organization–defined BMI categories. The primary end point was National Death Index–linked mortality. The median length of follow‐up was 4.4 years (interquartile range 2.0‐7.6 years). Of the study cohort, 24.8% had normal BMI (18.5‐24.9 kg/m2), and 3.3% were extremely obese (BMI ≥40 kg/m2). Patients with greater degrees of obesity were younger and included a higher proportion of diabetics (P<0.001). After adjustment for age and comorbidities, a J‐shaped association was observed between different BMI categories and adjusted hazard ratio (HR) for long‐term mortality (normal BMI, HR 1.00 [ref]; overweight, HR 0.85, 95% CI 0.78‐0.93, P<0.001; mild obesity, HR 0.85, 95% CI 0.76‐0.94, P=0.002; moderate obesity, HR 0.95, 95% CI 0.80‐1.12, P=0.54; extreme obesity HR 1.33, 95% CI 1.07‐1.65, P=0.01). Conclusions An obesity paradox is still apparent in contemporary practice, with elevated BMI up to 35 kg/m2 associated with reduced long‐term mortality after PCI. However, this protective effect appears not to extend to patients with extreme obesity.
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Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of CardiologyThe Alfred HospitalMelbourneAustralia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Diem Dinh
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Stephen J. Duffy
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of CardiologyThe Alfred HospitalMelbourneAustralia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of CardiologyRoyal Melbourne HospitalMelbourneAustralia
| | - Angela Brennan
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Samer Noaman
- Department of CardiologyThe Alfred HospitalMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
| | - Andrew Ajani
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of CardiologyRoyal Melbourne HospitalMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
| | | | | | - Ernesto Oqueli
- Department of CardiologyBallarat Health ServicesBallaratAustralia
- School of MedicineDeakin UniversityBallaratAustralia
| | - Chin Hiew
- Department of CardiologyUniversity Hospital GeelongGeelongAustralia
| | - Christopher M. Reid
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- School of Public HealthCurtin UniversityPerthAustralia
| | - Dion Stub
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of CardiologyThe Alfred HospitalMelbourneAustralia
- Baker IDI Heart and Diabetes InstituteMelbourneAustralia
| | - William Chan
- Department of CardiologyThe Alfred HospitalMelbourneAustralia
- Department of MedicineUniversity of MelbourneMelbourneAustralia
- Baker IDI Heart and Diabetes InstituteMelbourneAustralia
- Department of MedicineMonash UniversityMelbourneAustralia
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15
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Murphy AC, Yudi MB, Farouque O, Dinh D, Duffy SJ, Brennan A, Reid CM, Andrianopoulos N, Koshy AN, Martin L, Dagan M, Freeman M, Blusztein D, Ajani AE, Clark DJ. Impact of Gender and Door-to-Balloon Times on Long-Term Mortality in Patients Presenting With ST-Elevation Myocardial Infarction. Am J Cardiol 2019; 124:833-841. [PMID: 31327488 DOI: 10.1016/j.amjcard.2019.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/27/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
Guidelines mandate emergent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of gender. We sought to compare the door-to-balloon times and the impact of timely reperfusion on clinical outcomes in women compared with men presenting with STEMI undergoing primary percutaneous coronary intervention (PPCI). We analyzed data from 6,179 consecutive patients presenting with STEMI undergoing PPCI from the Melbourne Interventional Group registry (2005 to 2017). The primary outcome was long-term mortality. Of the 6,179 patients included 1,258 (20.3%) were female. Female patients were older (69 ± 13 vs 62 ± 12 years; p < 0.001), had more co-morbidities and had longer median symptom-to-balloon times (204 [interquartile range {IQR} 154 to 294] vs 181 [IQR 139 to 258] minutes; p < 0.001) and longer median door-to-balloon times (81 [IQR 55 to 102] vs 75 [IQR 51 to 102)] minutes; p < 0.001), while receiving less drug-eluting stents (39% vs 43%; p = 0.01) and having less radial access for PPCI (15% vs 21%; p < 0.001). Furthermore, female patients received less guideline-directed medical therapy than men with less prescription of aspirin (93.4% vs 95.4%; p = 0.02), statins (96.5% vs 97.6%; p < 0.05), and beta blockers (84.3% vs 89.4%; p < 0.001). Unadjusted in-hospital and 30-day mortality rates were higher in women (8.8% vs 6.2%, 9.8% vs 6.9%; p < 0.001). However, on Cox-proportional hazards modeling, gender was not an independent predictor of long-term mortality (hazards ratio 0.99, 95% confidence interval 0.83 to 1.18; p = 0.92) at a mean follow-up of 4.8 ± 3.5 years. In conclusion, in this large multicenter registry of patients with STEMI, women had longer ischemic times, higher risk profiles, and differing interventional approaches compared with men. Addressing these gender inequalities with early identification of symptoms, adherence to guideline-directed medical therapy, as well as higher rates of radial access and use of drug-eluting stents has the potential to further improve outcomes in women with STEMI.
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Affiliation(s)
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Diem Dinh
- Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Stephen J Duffy
- Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Angela Brennan
- Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Christopher M Reid
- Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Nick Andrianopoulos
- Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Lorelle Martin
- Department of Cardiology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Misha Dagan
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Eastern Health, Victoria, Australia
| | - David Blusztein
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew E Ajani
- University of Melbourne, Melbourne, Australia; Center of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
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16
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Papapostolou S, Andrianopoulos N, Duffy SJ, Brennan AL, Ajani AE, Clark DJ, Reid CM, Freeman M, Sebastian M, Selkrig L, Yudi MB, Noaman SQ, Chan W. Long-term clinical outcomes of transient and persistent no-reflow following percutaneous coronary intervention (PCI): a multicentre Australian registry. EUROINTERVENTION 2019; 14:185-193. [PMID: 28966156 DOI: 10.4244/eij-d-17-00269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate long-term outcomes of transient versus persistent no-reflow. METHODS AND RESULTS A total of 17,547 patients with normal flow post percutaneous coronary intervention (PCI) were compared to 590 patients (3.2%) with transient no-reflow and 144 patients (0.8%) with persistent no-reflow. Long-term all-cause mortality was obtained by linkage with the National Death Index (NDI). No-reflow patients were more likely to have presented with ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA) or cardiogenic shock (all p<0.01). Long-term NDI-linked all-cause mortality was highest in patients with persistent no-reflow (31%) followed by transient no-reflow (22%) and normal flow (14%) over a median follow-up of 5.2, 5.5 and 4.5 years, respectively (all p<0.0001). Kaplan-Meier survival estimates demonstrated a graded increase in all-cause mortality from normal flow, to transient to persistent no-reflow (p<0.01), with the highest mortality occurring early (<30 days) in the persistent no-reflow group (p<0.0001). Multivariate Cox proportional hazards modelling identified glomerular filtration rate <30 mL/min, ejection fraction <30%, persistent no-reflow and transient no-reflow as independent predictors of increased hazard for all-cause mortality (all p<0.05). CONCLUSIONS Transient and persistent no-reflow were associated with a stepwise reduction in long-term survival. The presence of even transient no-reflow appears to be an important predictor of adverse long-term outcome.
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Affiliation(s)
- Stavroula Papapostolou
- Department of Cardiovascular Medicine, Alfred Health, The Alfred Hospital, Melbourne, VIC, Australia
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17
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Biswas S, Brennan A, Duffy SJ, Andrianopoulos N, Chan W, Walton A, Noaman S, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Lefkovits J, Reid CM, Stub D. The Impact of Out-of-Hours Presentation on Clinical Outcomes in ST-Elevation Myocardial Infarction. Heart Lung Circ 2019; 29:814-823. [PMID: 31262617 DOI: 10.1016/j.hlc.2019.05.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/13/2018] [Revised: 03/26/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Systems of care have been established to ensure patients with ST-elevation myocardial infarction (STEMI) get timely access to primary percutaneous coronary intervention (PPCI). In this study, we evaluated whether patients undergoing PPCI both in-hours and out-of-hours experience similar care and clinical outcomes. METHODS Of 9,865 patients who underwent PCI for STEMI from 2005 to 2016 and were enrolled in the multi-centre Melbourne Interventional Group registry, patients who had initially presented to a non-PCI capable hospital, received thrombolysis or presented >12hourspost-symptom onset were excluded. Our final study cohort of 4,590 patients were dichotomised by whether PPCI was performed in-hours or out-of-hours, and compared. The primary outcome was 30-day mortality. RESULTS The in-hours group included 1,865 patients (40.6%) while 2,725 patients (59.4%) had out-of-hours PPCI. Patients presenting out-of-hours had longer median door-to-balloon time (DTBT; 83 [IQR 61-109] vs. 60 [IQR 41-88] mins, p<0.01) and were more likely to receive a drug-eluting stent (p=0.001). Procedural characteristics were otherwise similar although rates of radial access were low overall (18.4%). No differences in in-hospital, 30-day or 12-month mortality were observed between the groups (p=NS). On Cox proportional hazards modelling, out-of-hours presentation was not an independent predictor of 30-day mortality (HR 0.94, 95% CI 0.71-1.22). A landmark analysis of data from 2012 did not change the primary outcome. CONCLUSION Despite a slightly longer DTBT, patients undergoing PPCI out-of-hours experienced similar care and clinical outcomes to the in-hours group. Given the majority of patients with STEMI present out-of-hours, these data have implications for STEMI systems of care.
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Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - William Chan
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - James A Shaw
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Vic, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Vic, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Geelong, Vic, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Vic, Australia; School of Medicine, Deakin University, Ballarat, Vic, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
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Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
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19
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Murphy A, Hamilton G, Andrianopoulos N, Yudi MB, Farouque O, Duffy SJ, Lefkovits J, Brennan A, Reid CM, Ajani AE, Clark DJ. One-Year Outcomes of Patients With Established Coronary Artery Disease Presenting With Acute Coronary Syndromes. Am J Cardiol 2019; 123:1387-1392. [PMID: 30797559 DOI: 10.1016/j.amjcard.2019.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 10/27/2022]
Abstract
The risk of major adverse cardiovascular events (MACE) remains high in patients with established coronary artery disease (CAD). The aim of this study was to assess the prognostic significance of established CAD in patients who present with acute coronary syndromes (ACS) using a large established multicenter registry. Consecutive patients from the Melbourne Interventional Group registry who presented with ACS and underwent percutaneous coronary intervention from 2005 to 2015 were included. Patients with a history of myocardial infarction, percutaneous coronary intervention, or coronary artery bypass graft surgery were included in the established CAD cohort. The primary end points were 12-month mortality and 12-month MACE. Of the 12,878 ACS patients included in our study, 3,542 (28%) patients had established CAD. Over the 10-year study period, the proportion of patients presenting with established CAD decreased (30.7% to 25.2%; p-for-overall-trend <0.001). Non-ST elevation myocardial infarction was the most prominent presentation in the established CAD cohort (45.1%) whereas ST-elevation myocardial infarction was the most prominent in the de novo CAD cohort (51%; p< 0.001). The patients in the established CAD cohort were older, had more co-morbidities and were more likely to present with high-risk features such as atrial fibrillation, left main disease, multivessel CAD and left ventricular dysfunction (all p < 0.001). Regarding revascularization in ST-elevation myocardial infarction presentations, symptom-to-door time was shorter, whereas door-to-balloon-time was longer in those with established CAD (p < 0.001). On multivariate analysis, established CAD was an independent risk factor for 12-month MACE (odds ratio 1.40, 95% confidence intervals 1.23 to 1.58, p < 0.001), but not for 12-month mortality (odds ratio 1.08, 95% confidence intervals 0.77 to 1.52, p = 0.66). In conclusion, patients with a history of myocardial infarction or previous revascularization have a higher rate of MACE at 12 months. Despite this they do not appear to suffer from higher mortality.
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20
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Ramzy J, Andrianopoulos N, Roberts L, Duffy SJ, Clark D, Teh AW, Ajani AE, Reid CM, Brennan A, Freeman M. Outcomes in patients with peripheral vascular disease following percutaneous coronary intervention. Catheter Cardiovasc Interv 2019; 94:588-597. [DOI: 10.1002/ccd.28145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/21/2018] [Revised: 01/14/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Affiliation(s)
- John Ramzy
- Department of CardiologyThe Royal Melbourne Hospital Melbourne Victoria Australia
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventative MedicineMonash University Melbourne Victoria Australia
| | - Louise Roberts
- Department of CardiologyBox Hill Hospital Melbourne Victoria Australia
- Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
| | - Stephen J. Duffy
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventative MedicineMonash University Melbourne Victoria Australia
- Department of Cardiovascular MedicineAlfred Hospital Melbourne Victoria Australia
| | - David Clark
- Department of CardiologyAustin Hospital Melbourne Victoria Australia
| | - Andrew W. Teh
- Department of CardiologyBox Hill Hospital Melbourne Victoria Australia
- Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
| | - Andrew E. Ajani
- Department of CardiologyThe Royal Melbourne Hospital Melbourne Victoria Australia
| | - Christopher M. Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventative MedicineMonash University Melbourne Victoria Australia
- School of Public HealthCurtin University Perth Western Australia Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Department of Epidemiology and Preventative MedicineMonash University Melbourne Victoria Australia
| | - Melanie Freeman
- Department of CardiologyBox Hill Hospital Melbourne Victoria Australia
- Eastern Health Clinical SchoolMonash University Melbourne Victoria Australia
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21
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Murphy A, Dinh D, Duffy S, Brennan A, Andrianopoulos N, Freeman M, Reid C, Ajani A, Farouque O, Martin L, Dagan M, Blusztein D, Eccleston D, Yudi M, Clark D. Impact of Gender and Door-to-Balloon Times on Long-Term Mortality in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI). Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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Omair M, Dinh D, Brennan A, Farouque O, Duffy S, Ajani A, Reid C, Oqueli E, Hutchinson A, Andrianopoulos N, Koshy A, Yudi M, Clark D. Impact of Single-Vessel vs Multi-vessel CAD on Long-Term Mortality in Patients with Diabetes Mellitus Undergoing PCI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Dawson L, Dinh D, Duffy S, Brennan A, Clark D, Reid C, Blusztein D, Stub D, Andrianopoulos N, Freeman M, O’Queli E, Hutchison A, Ajani A. Percutaneous Coronary Intervention Outcomes Following Out-of-Hospital Cardiac Arrest For Patients With and Without ST-Elevation Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Segan L, Andrianopoulos N, Brennan A, Hiew C, Reid C, Freeman M, Oqueli E, Ajani A, Clarke D, Duffy S, Yip T. Impact of Lunar Phase on Outcomes following ST-Elevation Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.396] [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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25
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Biswas S, Andrianopoulos N, Duffy SJ, Lefkovits J, Brennan A, Walton A, Chan W, Noaman S, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D. Impact of Socioeconomic Status on Clinical Outcomes in Patients With ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 12:e004979. [DOI: 10.1161/circoutcomes.118.004979] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
| | - Stephen J. Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (J.L., A.A.)
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
| | - Antony Walton
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia (W.C., D.S.)
| | - Samer Noaman
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - James A. Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (J.L., A.A.)
| | - David J. Clark
- Department of Cardiology, Austin Health, Melbourne, Australia (D.J.C.)
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia (M.F.)
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Australia (C.H.)
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Australia (E.O.)
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- School of Public Health, Curtin University, Perth, Australia (C.M.R.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia (W.C., D.S.)
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26
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Noaman S, Goh CY, Vogrin S, Brennan AL, Andrianopoulos N, Dinh DT, Lefkovits J, Reid CM, Walton A, Al-Mukhtar O, Biswas S, Stub D, Duffy SJ, Cox N, Chan W. Comparison of short-term clinical outcomes of proximal versus nonproximal lesion location in patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction: The PROXIMITI study. Catheter Cardiovasc Interv 2019; 93:32-40. [PMID: 30019827 DOI: 10.1002/ccd.27665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/07/2018] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The objective of this study was to investigate the association of proximal and nonproximal location of culprit coronary lesions with clinical outcomes of patients presenting with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI). BACKGROUND Proximal culprit lesion location in patients presenting with STEMI is associated with increased mortality when compared to distal culprit lesions in the thrombolytic era. The impact of lesion location on clinical outcomes in the era of PCI remains unclear. METHODS We analyzed 3,283 patients with STEMI who enrolled in the Victorian Cardiac Outcomes Registry. We compared outcomes in those with proximal lesion location versus patients with nonproximal location. RESULTS Of 3,283 participants, 1,376 (41.9%) had a proximal lesion location. Patients with proximal lesion location presented with greater rates of cardiogenic shock and out-of-hospital cardiac arrest, and left ventricular systolic dysfunction, all P < .01. Procedural success rates were similar (96% vs. 95%, P = .08). Patients with proximal lesion location had higher rates of in-hospital and 30-day mortality, major adverse cardiac events (MACE; mortality, myocardial infarction, stent thrombosis, and unplanned revascularization) and major adverse cardiac and cerebrovascular events (MACCE; MACE, and stroke) compared to the nonproximal group, all P < .001. However, on multivariable regression analysis, proximal lesion location was not independently associated with MACE during in-hospital stay or at 30-days (OR 1.32, 95% CI 0.95-1.83, P = .09 and OR 1.23, 95% CI 0.92-1.65, P = .15) respectively. CONCLUSIONS Patients with proximal lesion location had greater hemodynamic instability and higher-risk features; however, proximal lesions per se were not independently associated with worse clinical outcomes compared to nonproximal lesions.
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Affiliation(s)
- Samer Noaman
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Cheng Yee Goh
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sara Vogrin
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Victoria, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Nick Andrianopoulos
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Diem T Dinh
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Antony Walton
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Omar Al-Mukhtar
- Department of Cardiology, Western Health, Victoria, Australia
| | - Sinjini Biswas
- Department of Cardiology, Alfred Health, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Health, Victoria, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - William Chan
- Department of Cardiology, Western Health, Victoria, Australia.,Department of Cardiology, Alfred Health, Victoria, Australia.,Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, Victoria, Australia.,Monash University, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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27
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Dagan M, Dinh D, Murphy A, Tan C, Brennan A, Warren J, Ajani A, Freeman M, Shaw J, Chan W, Reid C, Andrianopoulos N, Clark D, Duffy S. Gender Disparity in Secondary Prevention Medication and Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndrome. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.624] [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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28
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Dawson L, Dinh D, Duffy S, Clark D, Reid C, Brennan A, Andrianopoulos N, Hiew C, Freeman M, O’Queli E, Chan W, Ajani A. An Overview of the Melbourne Interventional Group Registry: Results from 34,797 Percutaneous Coronary Intervention Procedures 2005–2017. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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O'Brien J, Reid CM, Andrianopoulos N, Ajani AE, Clark DJ, Krum H, Loane P, Freeman M, Sebastian M, Brennan AL, Shaw J, Dart AM, Duffy SJ. Heart Rate as a Predictor of Outcome Following Percutaneous Coronary Intervention. Am J Cardiol 2018; 122:1113-1120. [PMID: 30107905 DOI: 10.1016/j.amjcard.2018.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
Data from previous studies of patients with heart failure and coronary artery disease suggest that those with higher resting heart rates (HRs) have worse cardiovascular outcomes. We sought to evaluate whether HR immediately before percutaneous coronary intervention (PCI) is an independent predictor for 30-day outcome. We analyzed the outcome of 3,720 patients who had HR recorded before PCI from the Melbourne Interventional Group registry. HR and outcomes were analyzed by quintiles, and secondarily by dichotomizing into <70 or ≥70 beats/min. Patients with cardiogenic shock, intra-aortic balloon pump or inotropic support, and out-of-hospital arrest were excluded. The mean ± SD HR was 70.9 ± 14.7 beats/min. HR by quintile was 55 ± 5, 64 ± 2, 70 ± 1, 77 ± 3, and 93 ± 13 beats/min, respectively. Patients with higher HR were more likely to be women, current smokers, have higher systolic and diastolic blood pressure, atrial fibrillation, recent heart failure, lower ejection fraction, and ST-elevation myocardial infarction as the indication for the PCI (all p ≤0.002). However, rates of treated hypertension, multivessel disease, previous myocardial infarction, PCI, and coronary bypass surgery were lower (all p ≤0.004). Increased HR was associated with higher 30-day mortality (p for trend = 0.04), target vessel revascularization (p for trend = 0.003), and 30-day major adverse cardiac events (MACE) (p for trend = 0.004). In a multivariable analysis, HR was an independent predictor of 30-day MACE (OR 1.21 per quintile; 95% confidence interval (CI): 1.06 to 1.39, p = 0.004). When dichotomized into <70 or ≥70 beats/min, HR independently predicted both 30-day MACE (OR 1.59, 95% CI 1.08 to 2.36, p = 0.02) and 30-day mortality (OR 2.80, 95% CI 1.10 to 7.08, p = 0.03). In conclusion, HR immediately before PCI is an independent predictor of adverse 30-day cardiovascular outcomes.
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Brennan AL, Bayles T, Andrianopoulos N, Reid CM, Selkrig L, Noaman S, Dihn D, Ajani AE, Clark DJ, Duffy SJ. P3577Trends and clinical outcomes of percutaneous coronary intervention for chronic total occlusions - Results from an Australian multi-centre interventional registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3577] [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: 11/13/2022] Open
Affiliation(s)
- A L Brennan
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - T Bayles
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - N Andrianopoulos
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - C M Reid
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - L Selkrig
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - S Noaman
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
| | - D Dihn
- Monash University, Department of Epidemiology & Preventive Medicine, Melbourne, Australia
| | - A E Ajani
- Royal Melbourne Hospital, Department of Cardiology, Melbourne, Australia
| | - D J Clark
- Austin Hospital, Melbourne, Australia
| | - S J Duffy
- The Alfred Hospital, Department of Cardiology, Melbourne, Australia
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31
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Yudi MB, Farouque O, Andrianopoulos N, Ajani AE, Brennan A, Lefkovits J, Reid CM, Chan W, Duffy SJ, Clark DJ. Pretreatment with dual antiplatelet therapy in patients with ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2018; 92:E98-E105. [PMID: 28963757 DOI: 10.1002/ccd.27325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/14/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND The optimal time to administer P2Y12 inhibitors in patients with ST-elevation myocardial infarction (STEMI) remains to be defined. We sought to assess whether a pretreatment strategy was associated with improved coronary reperfusion and clinical outcomes. METHODS Consecutive patients from the Melbourne Interventional Group registry (2005-2014) who presented with STEMI and underwent primary PCI were included. Those who received any P2Y12 inhibitor prior to arrival in the cardiac catheterisation laboratory were included in the pretreatment group. The primary endpoints were the proportion of patients with initial TIMI flow grade <3 and in-hospital bleeding. The secondary endpoints were 12-month mortality and major adverse cardiovascular events (MACE). RESULTS Of the 2,807 patients included, 892(31.8%) received pretreatment. Clopidogrel was the most common P2Y12 inhibitor used (79.6%). Pretreatment was associated with less thromboaspiration and GPIIb/IIIa inhibitor use (both P < 0.01). Pretreatment was not associated with lower rates of TIMI flow <3 on initial angiogram (78.0% vs. 80.7%, P = 0.18) nor with increased in-hospital bleeding (3.6% vs. 3.9%, P = 0.67). Pretreatment was associated with lower 12-month mortality (4.7% vs. 7.0%, P = 0.02) but similar MACE rate (13.0% vs. 14.1%, P = 0.43). Multivariate analysis revealed pretreatment was not an independent predictor of 12-month mortality (OR 0.79; 95% CI 0.5-1.3, P = 0.32). CONCLUSION Pretreatment with a P2Y12 inhibitor in patients with STEMI was not routine practice in our Australian cohort and was not associated with improved coronary reperfusion or clinical outcomes. Larger studies are required to definitively ascertain the risk/benefit ratio of dual antiplatelet therapy pretreatment in STEMI.
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Affiliation(s)
- Matias B Yudi
- 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
| | - Nick Andrianopoulos
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Andrew E Ajani
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Perth, Western Australia
| | - William Chan
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia
| | - Stephen J Duffy
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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Dinh DT, Tacey M, Brennan AL, Andrianopoulos N, Liew D, Reid C, Lefkovits J. P2643Risk-adjusting key outcome measures in a clinical quality registry of PCI: development of a highly predictive model without the need to exclude very high risk conditions. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2643] [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: 11/14/2022] Open
Affiliation(s)
- D T Dinh
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - M Tacey
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A L Brennan
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - N Andrianopoulos
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - D Liew
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - C Reid
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Lefkovits
- Monash University, Epidemiology and Preventive Medicine, Melbourne, Australia
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Noaman S, Andrianopoulos N, Reid C, Sharma A, Chan W, O'Brien J, Clark D, Ajani A, Freeman M, Brennan A, Yip T, Duffy SJ, Oqueli E. P812Clinical outcomes of ST-elevation myocardial infarction secondary to stent thrombosis treated by percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p812] [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: 11/14/2022] Open
Affiliation(s)
- S Noaman
- Western Hospital, Cardiology, Melbourne, Australia
| | | | - C Reid
- Monash University, Melbourne, Australia
| | - A Sharma
- University of Melbourne, Melbourne, Australia
| | - W Chan
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - J O'Brien
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - D Clark
- Austin Health Hospital, Melbourne, Australia
| | - A Ajani
- University of Melbourne, Melbourne, Australia
| | - M Freeman
- Box Hill Hospital, Melbourne, Australia
| | - A Brennan
- Monash University, Melbourne, Australia
| | - T Yip
- Geelong Hospital, Geelong, Australia
| | - S J Duffy
- The Alfred Hospital, Cardiology, Melbourne, Australia
| | - E Oqueli
- University of Melbourne, Melbourne, Australia
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34
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Chin KL, Tacey M, Reid CM, Tonkin A, Hopper I, Brennan A, Andrianopoulos N, Duffy SJ, Clark D, Ajani AE, Liew D. Temporal Changes in Characteristics, Treatment and Outcomes of Heart Failure Patients Undergoing Percutaneous Coronary Intervention Findings From Melbourne Interventional Group Registry. Heart Lung Circ 2018; 28:1018-1026. [PMID: 29960835 DOI: 10.1016/j.hlc.2018.03.030] [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: 10/04/2017] [Revised: 01/24/2018] [Accepted: 03/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limited data exist on whether outcomes of patients with heart failure (HF) undergoing percutaneous coronary intervention (PCI) have improved over time. The purpose of this study was to assess temporal trends in patient characteristics, treatment and outcomes of patients with HF undergoing PCI. METHODS Using data from the Melbourne Interventional Group (MIG), we evaluated temporal trends of procedure volume, major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction and target vessel revascularisation) and rates of cardiovascular readmission, all-cause death and cardiovascular death in consecutive patients with HF undergoing PCI. Change over time was assessed by Box-Jenkins autoregressive integrated moving average (ARIMA) models. RESULTS Data from 1,604 patients were analysed. In our cohort, there were no significant changes in the number of procedures performed annually and patient characteristics between January 2005 and December 2014. Optimal use of HF therapy has improved over the study period. Planned clopidogrel therapy of more than 12 months increased in tandem with increasing use of drug-eluting stents (DES). Procedural success was high (≥90%). However, the rates of MACE, cardiovascular readmission, all-cause death and cardiovascular death remained unchanged throughout the study period. CONCLUSIONS Clinical outcomes in HF patients undergoing PCI have remained unchanged despite improvement in medical technology and contemporary therapeutic measures.
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Affiliation(s)
- Ken Lee Chin
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Mark Tacey
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Christopher M Reid
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew Tonkin
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Ingrid Hopper
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - Angela Brennan
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Nick Andrianopoulos
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephen J Duffy
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Vic, Australia
| | - David Clark
- Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia
| | - Andrew E Ajani
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Danny Liew
- CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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35
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Stub D, Lefkovits J, Brennan AL, Dinh D, Brien R, Duffy SJ, Cox N, Nadurata V, Clark DJ, Andrianopoulos N, Harper R, McNeil J, Reid CM. The Establishment of the Victorian Cardiac Outcomes Registry (VCOR): Monitoring and Optimising Outcomes for Cardiac Patients in Victoria. Heart Lung Circ 2018; 27:451-463. [DOI: 10.1016/j.hlc.2017.07.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 05/11/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
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36
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Biswas S, Andrianopoulos N, Papapostolou S, Noaman S, Duffy SJ, Lefkovits J, Brennan A, Walton A, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D, Chan W. Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes? European Heart Journal - Quality of Care and Clinical Outcomes 2018; 4:318-327. [DOI: 10.1093/ehjqcco/qcy009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/20/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stavroula Papapostolou
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antony Walton
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Australia
- School of Medicine, Deakin University, Ballarat, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
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37
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Cohen MM, Ben-Meir M, Andrianopoulos N. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. Med J Aust 2018; 208:189. [PMID: 29553695 DOI: 10.5694/mja17.00735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Nick Andrianopoulos
- Centre for Cardiovascular Research and Education and Therapeutics, Monash University, Melbourne, VIC
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38
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Aubron C, Kandane-Rathnayake RK, Andrianopoulos N, Westbrook A, Engelbrecht S, Ozolins I, Bailey M, Murray L, Cooper DJ, Wood EM, McQuilten ZK. Day or overnight transfusion in critically ill patients: does it matter? Vox Sang 2018; 113:275-282. [PMID: 29392786 DOI: 10.1111/vox.12635] [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: 07/19/2017] [Revised: 12/02/2017] [Accepted: 01/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES The timing of blood administration in critically ill patients is first driven by patients' needs. This study aimed to define the epidemiology and significance of overnight transfusion in critically ill patients. MATERIALS AND METHODS This is a post hoc analysis of a prospective multicentre observational study including 874 critically ill patients receiving red blood cells, platelets, fresh frozen plasma (FFP) or cryoprecipitate. Characteristics of patients receiving blood only during the day (8 am up until 8 pm) were compared to those receiving blood only overnight (8 pm up until 8 am). Characteristics of transfusion were compared, and factors independently associated with major bleeding were analysed. RESULTS The 287 patients transfused during the day only had similar severity and mortality to the 258 receiving blood products overnight only. Although bleeding-related admission diagnoses were similar, major bleeding was the indication for transfusion in 12% of patients transfused in daytime only versus 30% of patients transfused at night only (P < 0·001). Similar total amount of blood products were transfused at day and night (2856 versus 2927); however, patients were more likely to receive FFP and cryoprecipitate at night compared with daytime. Overnight transfusion was independently associated with increased odds of major bleeding (odds ratio, 3·16, 95% confidence interval, 2·00-5·01). CONCLUSION Transfusion occurs evenly across day and night in ICU; nonetheless, there are differences in type of blood products administered that reflect differences in indication. Critically ill patients were more likely to receive blood for major bleeding at night irrespective of admission diagnosis.
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Affiliation(s)
- C Aubron
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Médecine Intensive Réanimation, Brest University Hospital - Université de Bretagne Occidentale, Brest, France
| | - R K Kandane-Rathnayake
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - N Andrianopoulos
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - A Westbrook
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - S Engelbrecht
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - I Ozolins
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - M Bailey
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - L Murray
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D J Cooper
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - E M Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Z K McQuilten
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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39
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Biswas S, Duffy SJ, Lefkovits J, Andrianopoulos N, Brennan A, Walton A, Chan W, Noaman S, Shaw JA, Dawson L, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D. Australian Trends in Procedural Characteristics and Outcomes in Patients Undergoing Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction. Am J Cardiol 2018; 121:279-288. [PMID: 29198986 DOI: 10.1016/j.amjcard.2017.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
Over the last decade, systems of care for ST-elevation myocardial infarction (STEMI) have evolved to try to improve outcomes and timely access to percutaneous coronary intervention (PCI). There have also been advances in PCI techniques and adjunctive pharmacotherapies. In this study, we sought to determine temporal changes in practices and clinical outcomes of PCI in patients with STEMI. We prospectively collected data on 8,412 consecutive patients undergoing PCI for STEMI between 2005 and 2016 in the multicenter Melbourne Interventional Group registry. Data were divided by procedure year for trends analysis. The primary end point was 30-day mortality. Patient demographics and comorbidities including smoking and diabetes have remained stable. The volume of primary PCI performed within 12 hours of symptom onset has significantly risen (65.7% to 80.1%, p < 0.01). The proportion of patients achieving the recommended door-to-balloon time ≤90 minutes has also risen (37.6% to 59.0%, p < 0.01). Patient complexity has also increased with more patients after out-of-hospital cardiac arrest with STEMI now being treated with PCI (2.6% to 9.1%, p < 0.01). A shift from mainly femoral to radial access and from bare-metal to drug-eluting stent use was seen. Glycoprotein IIb/IIIa inhibitors are being used less frequently with increasing use of newer antiplatelet agents. Thirty-day mortality has remained low throughout the study period at 6.5% overall. In conclusion, although timely access to primary PCI has improved, mortality rates have remained unchanged, but remain low and compare favorably with international data. Australian PCI practice has overall evolved in response to evidence and emergence of new adjunctive device and pharmacotherapies.
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Yeoh J, Andrianopoulos N, Yudi M, Brennan A, Picardo S, Horrigan M, Duffy S, Freeman M, Fernando D, Sebastian M, Murphy A, O’Brien J, Oqueli E, Ajani A, Farouque O, Clark D. Outcomes After Percutaneous Coronary Intervention in Stable Coronary Artery Disease: A Multi-Centre Australian Registry Review. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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41
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Leong K, Andrianopoulos N, Sharma A, Noaman S, Yudi M, Freeman M, Brennan A, Fernando H, Reid C, Clark D, Sebastian M, Ajani A, Duffy S, Oqueli E. Are Current Bare-Metal Stents Still an Option in Selected Patient Populations? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.889] [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: 11/30/2022]
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42
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Stehli J, Zaman S, Martin C, Brennan A, Lefkovits J, Dinh D, Andrianopoulos N. Impact of Gender on Radial Access Use and Bleeding Risk in Patients Presenting With Acute Coronary Syndromes to Victorian Hospitals. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Fernando H, Andrianopoulos N, Sharma A, Leong K, Ajani A, Clark D, Freeman M, Sebastian M, Brennan A, Selkrig L, Reid C, Kaye D, Duffy S, Oqueli E. Prevalence, Predictors and Outcomes of Patients With Totally Occluded Culprit Artery in Non-ST-Elevation Myocardial Infarction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1033] [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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44
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Biswas S, Andrianopoulos N, Noaman S, Duffy S, Lefkovits J, Brennan A, Ajani A, Clark D, Freeman M, Oqueli E, Reid C, Stub D, Chan W. Impact of Extreme Obesity on Outcomes Following Percutaneous Coronary Intervention: Insights From a Large Multi-Centre Registry. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Yeoh J, Andrianopoulos N, Yudi M, Brennan A, Picardo S, Horrigan M, Fernando D, Duffy S, Freeman M, Sebastian M, Murphy A, O’Brien J, Oqueli E, Ajani A, Farouque O, Clark D. Long-Term Mortality Following Percutaneous Coronary Intervention to the Proximal Left Anterior Descending Artery: A Multi-Centre Australian Registry Review. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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46
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Rajakariar K, Andrianopoulos N, Roberts L, Ajani A, Clark D, Parfrey S, Peck K, Duffy S, Oqueli E, Brennan A, Sebastian M, Reid C, Teh A, Freeman M. Influence of Circadian, Seasonal and Climatic Variables in ST-Elevation Myocardial Infarction Onset and Outcomes. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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47
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Khialani B, Andrianopoulos N, Yip T, Ajani A, Yudi M, Freeman M, Jaworski C, Oqueli E, Brennan A, Duffy S, Hutchison A, Hiew C, Sebastian M, Stub D. Trends in Vascular Access for Patients Undergoing Percutaneous Coronary Intervention in Australia: A Report From the Melbourne Interventional Group Cohort. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1048] [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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48
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Nanayakkara S, Chang H, Bergmeir C, Brennan A, Andrianopoulos N, Ajani A, Clark D, Duffy S, Kaye D. Phenomapping Patients After Percutaneous Coronary Intervention Using Novel Machine Learning Techniques: Insights Into the Melbourne Interventional Group Registry. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Tacey M, Dinh D, Brennan A, Andrianopoulos N, Zomer E, Gutman J, MacIsaac A, Hiew C, Rowe M, Senior J, Amerena J, Liew D, Wilson A, Reid C, Stub D, Lefkovits J. Establishment of a Data Linkage Process Between the Victorian Cardiac Outcomes Registry and Victorian Hospital Admission and Emergency Presentation Administrative Datasets. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Peck K, Andrianopoulos N, Parfrey S, Roberts L, Duffy S, Sebastian M, Clark D, Brennan A, Oqueli E, Ajani A, Reid C, Freeman M, Teh A. Role of Routine Use of Beta Blockers After Percutaneous Coronary Intervention for Acute Coronary Syndrome. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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