Publications by authors named "Chun S Kwok"
Purpose: Congenital diaphragmatic hernia (CDH) is associated with congenital heart disease (CHD) and index newborns reportedly may experience cardiac arrhythmia disorders [Tella et al.-Pediatric Critical Care Medicine 2022]. This study analyses, details and reports contemporary outcome metrics of CHD and cardiac rhythm disease (CRD) in CDH babies attending a university surgical centre.
View Article and Find Full Text PDFHow frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation.
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- The study investigates how the number of mechanical thrombectomy (MT) procedures performed annually at hospitals affects patient outcomes for acute ischemic stroke in the U.S. from 2016 to 2020.
- It found that as MT procedural volume increases, patients had lower rates of being discharged home/self-cared and higher odds of in-hospital mortality and post-treatment intracranial hemorrhage (ICH).
- The results suggest a paradox where higher procedural volume at hospitals correlates with worse outcomes, likely due to treating more severe cases at these high-volume centers.
Article Synopsis
- The study investigates the effects of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) on patients' symptoms, quality of life, and mortality based on a retrospective analysis in Austria.
- Out of 300 patients, 84% had successful CTO-PCI, showing improved angina scores and quality of life metrics for those who had successful procedures, while there was no significant difference in mortality or major complications between successful and failed cases.
- The results suggest that while CTO-PCI does not impact overall mortality, successful interventions can significantly reduce angina symptoms and decrease the need for medication.
Article Synopsis
- A systematic review analyzed 31 studies with nearly 32,000 patients undergoing coronary angiography, revealing that 13.4% had significant RAS, with some having severe or bilateral cases.
- Key risk factors for RAS included older age, diabetes, hypertension, chronic kidney disease, and severe CAD, while smoking did not significantly affect the risk of developing RAS.
Background: Severe early graft dysfunction (EGD) is defined by mechanical circulatory support (MCS) <24 hours of heart transplantation (HT). We classified severe EGD based on timing of post-HT MCS: ''Immediate'' intra-operative vs ''Delayed'' post-operative MCS (after admission into intensive care unit (ICU) from operating theater). We hypothesized that (1) risk factors and clinical course differ between ''Immediate'' and ''Delayed'' MCS; and (2) diastolic perfusion pressure (DPP=diastolic blood pressure-central venous pressure) and Norepinephrine equivalents (NE=sum of vasopressor doses), as measures of vasoplegia are related to ''Delayed'' MCS.
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- Cerebral infarction is a major concern for patients with aneurysmal subarachnoid hemorrhage (SAH), affecting over half of these patients as observed in a study of national data from 2016 to 2021.* -
- There has been a significant increase in the occurrence of cerebral infarction among patients with SAH over the study period, impacting outcomes such as lower chances of routine discharge and worse overall outcomes, although in-hospital mortality rates remained unchanged.* -
- Patients who developed cerebral infarction experienced longer hospital stays and higher hospitalization costs compared to those without cerebral infarction, indicating a substantial economic impact on healthcare resources.*
Objectives: The value of thrombectomy in patients with acute ischemic stroke cannot be understated. As such, whether these patients get access to this treatment can significantly impact their disease outcomes. We analyzed the trends in thrombectomy adoption between teaching and non-teaching hospitals in the United States, and their impact on overall patient care.
View Article and Find Full Text PDFBackground: This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM).
Methods: This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined.
Background: The influence of different viral infections in patients with myocarditis is unknown. Myocarditis is an inflammatory disease of heart muscle that is commonly caused by viruses. The impact of different viral infections in patients with myocarditis is unknown.
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- The RoPE score is a tool used to find a heart condition called patent foramen ovale (PFO) in people who have had a stroke without a clear cause.
- A study looked at over 3 million hospital admissions for strokes, finding that 3% of those patients had PFOs, and those with PFOs were generally younger.
- The RoPE score helps predict PFOs, but it's not super accurate; a score of 4 or higher can suggest a PFO, but it misses some cases while identifying others.
Article Synopsis
- The study investigates the role of beta-blockers in improving survival for patients with cardiac amyloidosis (CA), highlighting unclear efficacy and concerns about worsening heart failure symptoms.
- A systematic review and meta-analysis of 13 studies involving 4,215 CA patients concluded that beta-blocker therapy may be associated with reduced mortality, particularly in mixed ATTR-CM and AL-CM cases.
- However, the study notes significant limitations, such as a lack of information on the staging of CA, which may affect the findings' applicability.
Article Synopsis
- Physician transfer can be a faster alternative to patient transfer for performing mechanical thrombectomy in acute ischemic stroke patients, leading to quicker treatment.
- A systematic review of 12 studies (involving 1,894 patients) showed that physician transfer significantly reduced the time from stroke onset to recanalization by approximately 62 minutes and increased the chances of functional independence after 90 days.
- However, physician transfer did not show a significant increase in the odds of achieving complete or near-complete recanalization compared to patient transfer.
Background: Excimer laser atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI). Despite this there are a lack of contemporary outcome data, particulary longer-term, forpatients treated with ELCA PCI.
Aims: To evaluate the contemporary use ofELCA in PCI, the frequency of periprocedural complications and the longer-term outcomes associated with ELCA PCI.
Enteral nutrition (EN) is one method of nutrition support for children and adolescents receiving extracorporeal membrane oxygenation (ECMO) therapy, and there are no guidelines for its use in this population. We conducted a systematic review to determine whether EN is effective and safe in children supported by ECMO. We searched the Cochrane Library database, MEDLINE, and Embase on Ovid in March 2023 to identify studies that evaluated children and adolescents who received ECMO and were treated with EN.
View Article and Find Full Text PDFBackground: Coronary artery disease (CAD) is a common finding in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). However, the impact on prognosis of chronic total occlusions (CTOs), a drastic expression of CAD, remains unclear.
Methods And Results: We retrospectively reviewed 1,487 consecutive TAVR cases performed at a single tertiary care medical center.
ST-elevation myocardial infarction (STEMI) is a life-threatening emergency that can result in cardiac structural complications without timely revascularization. A retrospective study from the National Inpatient Sample included all patients with a diagnosis of STEMI between 2016 and 2020. Primary outcomes of interest were in-hospital mortality, length of stay (LoS), and healthcare costs for patients with and without structural complications.
View Article and Find Full Text PDFBackground: The territory and vessel involved in ST-elevation myocardial infarction (STEMI) is an important and there are limited contemporary studies from the national perspective.
Methods: A retrospective cohort study was undertaken of national representative hospital admission in the National Inpatient Sample with a diagnosis of anterior or non-anterior STEMI between 2017 and 2020. Multiple logistic regression and multiple linear regressions were used to determine if there are any differences in in-hospital mortality, length of stay (LOS) and cost for anterior and non-anterior STEMI.
Background: Type 2 diabetes mellitus (T2DM) is a significant health problem around the world.
Objective: This review aims to define missed opportunities and how they apply to patients with T2DM.
Method: This narrative review describes the natural history of T2DM and also describes where missed opportunities may arise.
Background And Purpose: There are limited data regarding the comparison of balloon expandable stents (BES) and self-expanding stents (SES) for the treatment of intracranial arterial stenosis.
Methods: We conducted a systematic review to identify studies that compared SES and BES in patients with symptomatic intracranial arterial stenosis. Data were extracted from relevant studies found through a search of PubMed, Scopus, and Web of Science until from January 1, 2010 to September 28, 2023.
Background: Rotational atherectomy (RA) during percutaneous coronary intervention may cause transient bradycardia or a higher-degree heart block. Traditionally, some operators use prophylactic transvenous pacing wire (TPW) to avoid haemodynamic complications associated with bradycardia.
Objective: We sought to establish the frequency of bail-out need for emergency TPW insertion in patients undergoing RA that have received no upfront TPW insertion.
The importance of pathways to facilitate early diagnosis and treatment of patients with cardiac amyloidosis.
Ther Adv Cardiovasc Dis
December 2023
Cardiac amyloidosis (CA) is a condition caused by extracellular deposition of amyloid fibrils in the heart. It is an underdiagnosed disease entity which can present with a variety of cardiac and non-cardiac manifestations. Diagnosis usually follows an initial suspicion based on clinical evaluation or imaging findings before confirmation with subsequent imaging (echocardiography, cardiac magnetic resonance imaging, 3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy) in combination with biochemical screening for monoclonal dyscrasia (serum free light chains and serum and urine electrophoresis) and/or histology (bone marrow trephine, fat or endomyocardial biopsy).
View Article and Find Full Text PDFBackground: It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA.
Methods: We analyzed the data from National Inpatient Sample from 2016 to 2020 and assessed the impact of COVID-19 infection and the COVID-19 pandemic (year 2020) on in-hospital mortality, length of stay (LOS) and hospitalization costs.P.
Gastrointestinal bleeding (GIB) is a major cause of mortality in patients with renal failure. We conducted a systematic review of the literature to evaluate the rates, predictors, and outcomes of GIB in patients with chronic kidney disease (CKD). A search of MEDLINE and EMBASE databases was performed, and data were extracted from relevant studies.
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- The study examined how mechanical thrombectomy (MT) impacts acute ischemic stroke patients in U.S. hospitals that also perform coronary interventions like PCI for heart attacks.
- Data from 2017 to 2020 showed that over a million stroke patients were treated at different hospital types, and patients at hospitals performing both PCI and MT had lower in-hospital mortality rates compared to those that only performed PCI or neither procedure.
- The findings suggest that nearly 37% of stroke patients are admitted to hospitals that only perform PCI, highlighting the need to increase MT access in these facilities to improve patient outcomes.