Predicting severe multivessel coronary artery disease to guide access strategy in patients undergoing invasive coronary angiography.

Introduction: Given radial artery conduits are increasingly utilized for coronary artery bypass grafting (CABG), avoiding transradial access (TRA) for invasive coronary angiography (ICA) may benefit patients who ultimately undergo CABG. We sought to predict the likelihood of severe multivessel disease (MVD) before ICA to guide this decision.

Methods: This was a single-center study of 1485 patients with stable symptoms who underwent ICA.

PET/CT-derived coronary calcium score may predict cardiac complications in anthracycline-treated lymphoma patients.

Anthracycline-mediated cardiotoxicity is a common concern following lymphoma therapy, particularly in patients with high cardiovascular risk (CVR). In non-cancer populations, coronary artery calcium scoring (CACS) effectively identifies individuals who may benefit from aggressive CVR modification to lower the risk of cardiovascular events. Emerging evidence suggests that CACS can also predict cancer therapy-related cardiotoxicity, potentially identifying candidates for cardioprotective strategies.

Understanding long-term risk in Percutaneous Coronary Intervention (PCI) in the Australian contemporary era with a focus on defining Complex Revascularisation in High-Risk Indicated Patients (CHIP).

Background: Complex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures.

Outcomes After Percutaneous Coronary Intervention in Patients With Previous Coronary Artery Bypass Grafting.

In patients with previous coronary artery bypass graft surgery (CABG) requiring subsequent percutaneous coronary intervention (PCI), there is uncertainty whether bypass grafts or native coronary arteries should be targeted. We analyzed data from 2,764 patients with previous CABG in the Melbourne Interventional Group registry (2005 to 2018), divided into 2 groups: those who underwent PCI in a native vessel (n = 1,928) and those with PCI in a graft vessel (n = 836). Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (previous myocardial infarction, heart failure, ejection fraction <50%, renal impairment, peripheral and cerebrovascular disease), and had high-risk procedural features (American College of Cardiology and American Heart Association types B2/C lesions).

The impact of stress testing to guide PCI in patients with chronic coronary disease.

Background: Guidelines and international appropriate use criteria increasingly endorse non-invasive stress testing to evaluate patients with suspected chronic coronary disease (CCD). We sought to review the real-world utilisation of non-invasive stress testing and investigate whether their use prior to PCI associates with outcomes in patients with CCD.

Methods: Consecutive patients from a multicentre registry who underwent PCI for CCD between 2006 and 2018 were included.

Graft Patency and Clinical Outcomes in Patients With Radial Artery Grafts Previously Instrumented for Cardiac Catheterization.

Background: While transradial access is favored for cardiac catheterization, the radial artery (RA) is increasingly preferred for coronary artery bypass grafting. Whether the RA is suitable for use as a graft following instrumentation for transradial access remains uncertain.

Methods: Consecutive patients from 2015 to 2019 who underwent coronary artery bypass grafting using both the left and right RAs as grafts were included.

Real-world long-term survival after non-emergent percutaneous coronary intervention to unprotected left main coronary artery - From the Melbourne Interventional Group (MIG) registry.

Background: Current evidence suggests that percutaneous coronary intervention for unprotected left main coronary artery disease (LMPCI) in selected patients is a safe alternative to coronary artery bypass grafting. However, real-world long-term survival data is limited.

Methods: We analyzed 24,644 patients from the MIG (Melbourne Interventional Group) registry between 2005 and 2020.

Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention.

Background: When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft.

Trends and Real-World Safety of Patients Undergoing Percutaneous Coronary Intervention for Symptomatic Stable Ischaemic Heart Disease in Australia.

Background: Percutaneous coronary intervention (PCI) in stable ischaemic heart disease (SIHD) has not been shown to improve prognosis but can alleviate symptoms and improve quality of life. Appropriately selected patients with symptoms refractory to medical therapy therefore stand to benefit, provided safety is proven.

Methods: Consecutive patients undergoing PCI for SIHD between 2005-2018 in a prospective registry were included.

Reperfusion Times and Outcomes in Patients With ST-Elevation Myocardial Infarction Presenting Without Pre-Hospital Notification.

Background: Primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) is recommended within 90 min of first medical contact. Those without pre-hospital notification (PN) are less likely to meet reperfusion targets and are an understudied subset of the STEMI population.

Methods: An observational cohort study from a multicentre PCI registry of consecutive patients undergoing primary PCI for STEMI between 2012 and 2017.

Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic.

Objectives: To assess the efficacy of a pro-active, absolute cardiovascular risk-guided approach to opportunistically modifying cardiovascular risk factors in patients without coronary ischaemia attending a chest pain clinic.

Design: Prospective, randomised, open label, blinded endpoint study.

Setting: The rapid access chest pain clinic of Royal Hobart Hospital, a tertiary hospital.

Meta-analysis Comparing Valve-In-Valve Transcatheter Aortic Valve Implantation With Self-Expanding Versus Balloon-Expandable Valves.

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an alternative to redo-surgery in patients with failed surgical bioprostheses. It remains unclear whether outcomes vary when using either self-expanding (SE) or balloon-expandable (BE) valves. The aim of this study was to compare outcomes between SE and BE transcatheter heart valves when used for ViV TAVI.

Long-term outcomes following percutaneous coronary intervention to an unprotected left main coronary artery in cardiogenic shock.

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.

Postoperative Atrial Fibrillation Following Noncardiac Surgery Increases Risk of Stroke.

Background: New-onset postoperative atrial fibrillation is well recognized to be an adverse prognostic marker in patients undergoing noncardiac surgery. Whether postoperative atrial fibrillation confers an increased risk of stroke remains unclear.

Methods: A systematic review and meta-analysis was performed to assess the risk of stroke after postoperative atrial fibrillation in noncardiac surgery.

Prevalence of pre-existing dysglycaemia among inpatients with acute coronary syndrome and associations with outcomes.

Aims: We aimed to confirm the hypothesis that dysglycaemia including in the pre-diabetes range affects a majority of patients admitted with acute coronary syndrome (ACS) and is associated with worse outcomes.

Methods: In this prospective observational cohort study, consecutive inpatients aged ≥ 54 years with ACS were uniformly tested and categorised into diabetes (prior diagnosis/ HbA1c ≥ 6.5%, ≥48 mmol/mol), pre-diabetes (HbA1c 5.