Publications by authors named "Poay-Huan Loh"
Background: Pathological Q waves at presentation in ST segment elevation myocardial infarction (STEMI) have been associated with poorer clinical outcomes including heart failure. This observational study highlights the prognostic value of pathological Q waves at presentation in the Southeast Asian population.
Methods: Multiethnic Asian patients presenting with STEMI and treated with primary coronary intervention were recruited from 2015 to 2019.
Background And Aim: Diabetes has been shown in last decades to be associated with a significantly higher mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI (PPCI). Therefore, the aim of current study was to evaluate the impact of diabetes on times delays, reperfusion and mortality in a contemporary STEMI population undergoing PPCI, including treatment during the COVID pandemic.
Methods And Results: The ISACS-STEMI COVID-19 is a large-scale retrospective multicenter registry involving PPCI centers from Europe, Latin America, South-East Asia and North-Africa, including patients treated from 1st of March until June 30, 2019 and 2020.
Article Synopsis
- This study investigates how metabolic dysfunction-associated steatotic liver disease (MASLD) affects long-term survival in patients who have suffered an acute myocardial infarction (AMI) across different body weight categories.
- The four patient groups analyzed were obesity MASLD, non-obesity MASLD, obesity non-MASLD, and non-obesity non-MASLD, with findings showing that non-obesity MASLD had the highest risk of heart failure and long-term mortality.
- The results indicate that both obesity and non-obesity MASLD are significant predictors of all-cause mortality post-AMI, particularly highlighting the greater risk associated with non-obesity MASLD.
Background: Hypertension is the most prevalent cardiovascular risk factor, with several detrimental effects on the cardiovascular system. Contrasting results have been reported so far on its prognostic role in patients admitted for ST-segment elevation myocardial infarction (STEMI). Therefore, we investigated the impact of hypertension on short-term mortality in a large multicenter contemporary registry of STEMI patients, including patients treated during COVID-19 pandemic.
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- Cardiogenic shock (CS) after a heart attack (STEMI) in Asian patients is linked to significantly worse long-term outcomes compared to those without CS.
- In a study of 1,791 patients who underwent emergency heart procedures, about 12% developed CS, leading to much higher mortality and major cardiac events.
- Key factors influencing survival include higher left ventricular ejection fraction (LVEF) at admission, better arterial pH levels, and lower serum lactate concentrations, with the latter indicating a worse prognosis.
The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis for East Asia, South Asia, South-East Asia, Central Asia, and high-income Asia Pacific regions.
Lancet Reg Health West Pac
August 2024
Article Synopsis
- A study forecasts a 91.2% increase in crude cardiovascular disease (CVD) mortality in Asia from 2025 to 2050, despite a 23.0% decrease in the age-standardized mortality rate.
- Ischaemic heart disease and stroke will remain the top causes of mortality, with Central Asia experiencing the highest mortality rates while high systolic blood pressure is identified as the leading risk factor across most of Asia.
- The research highlights the need for targeted health interventions due to the significant variations in CVD burden across different regions in Asia.
Background: Door-to-balloon time (DTBT) for ST-elevation myocardial infarction (STEMI) is a performance metric by which primary percutaneous coronary intervention (PPCI) services are assessed.
Methods: Consecutive patients presenting with STEMI undergoing PPCI between January 2007 to December 2019 from the Singapore Myocardial Infarction Registry were included. Patients were stratified based on DTBT (≤60 min, 61-90 min, 91-180 min) and Killip status (I-III vs.
Article Synopsis
- INOCA, or ischaemia with no obstructive coronary arteries, poses a diagnostic and treatment challenge, linked to higher risks of death and cardiovascular issues, along with increased healthcare costs.
- While awareness of INOCA is growing in Western populations, its prevalence and recognition in Asian populations are still unclear.
- The review highlights barriers to diagnosing and managing INOCA, offering strategies to improve the situation.
Article Synopsis
- Malnutrition is linked to worse outcomes for patients with acute coronary syndrome (ACS), impacting their prognosis and survival rates.
- The study reviewed various nutritional assessment tools and analyzed data from 30 studies with over 37,000 patients, revealing that about one-third were malnourished, leading to a mortality rate of 20.59% among them.
- Results showed that malnutrition significantly increased the risk of all-cause mortality, regardless of ACS type, ethnicity, or income, highlighting the importance of addressing nutritional status in these patients.
Incorporating AI into cardiovascular diseases prevention-insights from Singapore.
Lancet Reg Health West Pac
July 2024
Improved upstream primary prevention of cardiovascular disease (CVD) would enable more individuals to lead lives free of CVD. However, there remain limitations in the current provision of CVD primary prevention, where artificial intelligence (AI) may help to fill the gaps. Using the data informatics capabilities at the National University Health System (NUHS), Singapore, empowered by the Endeavour AI system, and combined large language model (LLM) tools, our team has created a real-time dashboard able to capture and showcase information on cardiovascular risk factors at both individual and geographical level- CardioSight.
View Article and Find Full Text PDFAim: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) are at increased risk of incident cardiovascular disease. However, the clinical characteristics and prognostic importance of MASLD in patients presenting with acute myocardial infarction (AMI) have yet to be examined.
Methods: This study compared the characteristics and outcomes of patients with and without MASLD presenting with AMI at a tertiary centre in Singapore.
Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for over one-third of all deaths in Singapore. An analysis of age-standardized mortality rates (ASMR) for CVD in Singapore revealed a deceleration in the initial rapid decline in ASMR. A decrease in smoking prevalence may have contributed to the initial rapid decline in ASMR.
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- * Overweight/obesity is forecasted to not only be the most rapidly growing risk factor but also the leading cause of AMI-related deaths, with a staggering 294.7% increase in mortality associated with it.
- * Disparities exist among ethnic groups, with Indian and Malay populations facing a higher burden of obesity and AMI-related mortality compared to Chinese individuals.
Background: Electrocardiogram (ECG) is the first diagnostic tool physicians use in diagnosing acute myocardial infarction (MI). In this case report, we present a case where the initial ECG diagnosis was that of an acute anteroseptal MI but emergency coronary angiography showed that the infarct-related artery was a small non-dominant right coronary artery (RCA) instead of the anticipated left anterior descending artery (LAD). Isolated right ventricular (RV) infarction from a non-dominant RCA is rarely seen in clinical practice, and it may exhibit ECG changes that can be confused with an acute anteroseptal MI.
View Article and Find Full Text PDFUnlabelled: Intracranial stenosis is prevalent among Asians and constitutes a common cause of cerebral ischemia. While the best medical therapy carries stroke recurrence rates in excess of 10% per year, trials with intracranial stenting have been associated with unacceptable peri-procedural ischemic events. Cerebral ischemic events are strongly related to the severity of intracranial stenosis, which is high in patients with severe intracranial stenosis with poor vasodilatory reserve.
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- Health literacy and illness perception significantly impact the management of cardiometabolic diseases, with this study examining the differences in attitudes and knowledge between individuals with and without metabolic risk factors (MFs).
- A survey of 345 participants revealed that those with MFs tended to have lower knowledge scores but higher perceived risks regarding cardiometabolic diseases like hypertension and diabetes.
- Despite their heightened awareness of risks, individuals with MFs showed only slight increases in taking preventive actions, highlighting a critical need to bridge the gap between knowledge and actual health behaviors.
The COVID -19 pandemic impacted acute myocardial infarction (AMI) attendances, ST-elevation myocardial infarction (STEMI) treatments, and outcomes. We collated data from majority of primary percutaneous coronary intervention (PPCI)-capable public healthcare centres in Singapore to understand the initial impact COVID-19 had on essential time-critical emergency services. We present data comparisons from 'Before Disease Outbreak Response System Condition (DORSCON) Orange', 'DORSCON Orange to start of circuit breaker (CB)', and during the first month of 'CB'.
View Article and Find Full Text PDFBackground: Low socioeconomic status (SES) is an important prognosticator amongst patients with acute coronary syndrome (ACS). This paper analysed the effects of SES on ACS outcomes.
Methods: Medline and Embase were searched for articles reporting outcomes of ACS patients stratified by SES using a multidimensional index, comprising at least 2 of the following components: Income, Education and Employment.
Although most of the current evidence on myocardial infarction focuses on obesity, there is growing evidence that patients who are underweight have unfavorable prognosis. This study aimed to explore the prevalence, clinical characteristics, and prognosis of this population at risk. Embase and Medline were searched for studies reporting outcomes in populations who were underweight with myocardial infarction.
View Article and Find Full Text PDFClinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE.
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- * A study involving over 16,600 STEMI patients found a 16% reduction in PPCI procedures in 2020 compared to 2019, with the elderly experiencing the most significant delays.
- * Consequently, there was a notable increase in 30-day mortality rates during the pandemic, particularly among older patients, attributed to longer ischemia times and treatment delays.
Background: The double burden of malnutrition, described as the coexistence of malnutrition and obesity, is a growing global health issue. This study examines the combined effects of obesity and malnutrition on patients with acute myocardial infarction (AMI).
Methods: Patients presenting with AMI to a percutaneous coronary intervention-capable hospital in Singapore between January 2014 and March 2021 were retrospectively studied.
Article Synopsis
- The COVID-19 pandemic significantly reduced the number of primary percutaneous coronary interventions (PPCIs) for ST-segment elevation myocardial infarction (STEMI) patients by 16% in 2020 compared to 2019.
- Despite this reduction affecting both genders equally, 30-day mortality rates increased notably for female patients during the pandemic, while male patients did not show a significant change.
- The analysis highlights the importance of addressing gender-specific outcomes in cardiac care during public health crises.
Article Synopsis
- The study investigates how common hepatic steatosis (fatty liver) and fibrosis are in patients who have experienced an acute myocardial infarction (heart attack) and looks at their impact on mortality.
- Among 5,765 patients studied, about 24.8% had hepatic steatosis, with 41.7% of those also having advanced fibrosis, which was linked to higher death rates over an average follow-up of 2.7 years.
- The research concludes that hepatic steatosis and fibrosis are prevalent in post-AMI patients and significantly increase the risk of mortality, suggesting they could be important factors for assessing patient risk alongside traditional factors.