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  • 1
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    Online Resource
    Association between proton pump inhibitors after percutaneous coronary intervention and risk of gastric cancer
    BMJ ; 2021
    In:  BMJ Open Gastroenterology Vol. 8, No. 1 ( 2021-08), p. e000719-
    Details
    In: BMJ Open Gastroenterology, BMJ, Vol. 8, No. 1 ( 2021-08), p. e000719-
    Abstract: Previous studies showing an association between chronic use of proton pump inhibitor (PPI) and gastric cancer are limited by confounding by indication. This relationship has not been studied in patients receiving PPI for prophylaxis, such as those undergoing percutaneous coronary intervention (PCI). Method This was a retrospective cohort study including 14 hospitals under the Hospital Authority of Hong Kong between 1 January 2004 and 31 December 2017. Participants were patients who underwent first-ever PCI, were not on PPI prescription within 30 days before admission for PCI, had no known malignancy and survived for 365 days after PCI. Propensity score matching was used to balance baseline characteristics and other prescription patterns. The primary outcome was diagnosis of gastric cancer made 〉 365 days after PCI as a time-to-first-event analysis. The secondary outcome was death from gastric cancer. Results Among the 13 476 patients (6738 pairs) matched by propensity score, gastric cancer developed in 17 (0.25%) PPI users and 7 (0.10%) PPI non-users after a median follow-up of 7.1 years. PPI users had a higher risk of gastric cancer (HR 3.55; 95% CI 1.46 to 8.66, p=0.005) and death from gastric cancer (HR 4.18; 95% CI 1.09 to 16.08, p=0.037), compared with non-users. The association was duration-dependent and patients who took PPI for ≥365 days were at increased risk. Conclusions Chronic use of PPI was significantly associated with increased risk of gastric cancer and death from gastric cancer in patients for whom it was prescribed as prophylaxis. Physicians should judiciously assess the relevant risks and benefits of chronic PPI use before prescription.
    Type of Medium: Online Resource
    ISSN: 2054-4774
    URL: Article
    DOI: 10.1136/bmjgast-2021-000719
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2884818-4
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  • 2
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    Sensitivity of ventricular systolic function to afterload during veno‐arterial extracorporeal membrane oxygenation
    Wiley ; 2022
    In:  ESC Heart Failure Vol. 9, No. 5 ( 2022-10), p. 3241-3253
    Details
    In: ESC Heart Failure, Wiley, Vol. 9, No. 5 ( 2022-10), p. 3241-3253
    Abstract: Veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) increases afterload to the injured heart and may hinder myocardial recovery. We aimed to compare the sensitivity of left ventricular (LV) systolic function to the afterload effects of peripheral V‐A ECMO during the acute and delayed stages of acute myocardial dysfunction. Methods and results A total of 46 adult patients who were supported by peripheral V‐A ECMO between April 2019 and June 2021 were analysed. Serial cardiac performance parameters were measured by transthoracic echocardiography (TTE) on mean day 1 ± 1 of V‐A ECMO initiation ( n  = 45, ‘acute phase’) and mean day 4 ± 2 of V‐A ECMO initiation ( n  = 36, ‘delayed phase’). Measurements were obtained at 100%, 120%, and 50% of ECMO target blood flow (TBF). LV global longitudinal strain (GLS) significantly improved from −6.1 (−8.9 to −4.0)% during 120% TBF to −8.8 (−11.5 to −6.0)% during 50% TBF ( P   〈  0.001). The sensitivity of LV GLS to changes in ECMO flow was significantly greater in the acute phase of myocardial injury compared with the delayed phase [median (IQR) percentage change: 72.7 (26.8–100.0)% vs. 22.5 (14.9–43.8)%, P   〈  0.001]. Findings from other echocardiographic parameters including LV ejection fraction [43.0 (29.1–56.8)% vs. 22.8 (9.2–42.2)%, P  = 0.012] and LV outflow tract velocity‐time integral [45.8 (18.6–58.7)% vs. 24.2 (12.6–34.0)%, P  = 0.001] were similar. A total of 24 (52.2%) patients were weaned off ECMO successfully. Conclusions We demonstrated that LV systolic function was significantly more sensitive to the afterload effects of V‐A ECMO during the acute stage of myocardial dysfunction compared with the delayed phase. Understanding the evolution of the heart–ECMO interaction over the course of acute myocardial dysfunction informs the clinical utility of echocardiographic assessment in patients on V‐A ECMO.
    Type of Medium: Online Resource
    ISSN: 2055-5822 , 2055-5822
    URL: Issue
    URL: Article
    DOI: 10.1002/ehf2.v9.5
    DOI: 10.1002/ehf2.13959
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2814355-3
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  • 3
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    Trade-off of major bleeding versus myocardial infarction on mortality after percutaneous coronary intervention
    BMJ ; 2022
    In:  Open Heart Vol. 9, No. 1 ( 2022-01), p. e001861-
    Details
    In: Open Heart, BMJ, Vol. 9, No. 1 ( 2022-01), p. e001861-
    Abstract: The choice of antithrombotic therapy after percutaneous coronary intervention (PCI) is heavily dependent on the relative trade-off between major bleeding (MB) and myocardial infarction (MI). However, the mortality trade-off was mostly described in Western populations and remained unknown in East Asians. Method This was a retrospective cohort study from 14 hospitals under the Hospital Authority of Hong Kong between 2004 and 2017. Participants were patients undergoing first-time PCI and survived for the first year. Patients were stratified by the presence of MB and MI during the first year. The primary endpoint was all-cause mortality between 1 and 5 years after PCI. The secondary endpoint was cardiovascular mortality. Results A total of 32 180 patients were analysed. After adjustment for baseline characteristics and using patients with neither events as reference, the risks of all-cause mortality were increased in patients with MI only (HR, 1.63; 95% CI 1.45 to 1.84; p 〈 0.001), further increased in those with MB only (HR, 2.11, 95% CI 1.86 to 2.39; p 〈 0.001) and highest in those with both (HR, 2.92; 95% CI 2.39 to 3.56; p 〈 0.001). In both Cox regression and propensity score analyses, MB had a stronger impact on all-cause mortality than MI, but similar impact on cardiovascular mortality. Conclusions Both MB and MI within the first year after PCI were associated with increase in all-cause and cardiovascular mortality in Chinese patients, but the impact was stronger with MB.
    Type of Medium: Online Resource
    ISSN: 2053-3624
    URL: Article
    DOI: 10.1136/openhrt-2021-001861
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2747269-3
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  • 4
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    Incidence, Prediction, and Outcomes of Major Bleeding After Percutaneous Coronary Intervention in Chinese Patients
    Elsevier BV ; 2022
    In:  JACC: Asia Vol. 2, No. 3 ( 2022-06), p. 341-350
    Details
    In: JACC: Asia, Elsevier BV, Vol. 2, No. 3 ( 2022-06), p. 341-350
    Type of Medium: Online Resource
    ISSN: 2772-3747
    URL: Article
    DOI: 10.1016/j.jacasi.2021.12.009
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 3096596-2
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  • 5
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    Risk of ICU Admission and Related Mortality in Patients With Sodium-Glucose Cotransporter 2 Inhibitors and Dipeptidyl Peptidase-4 Inhibitors: A Territory-Wide Retrospective Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Critical Care Medicine Vol. 51, No. 8 ( 2023-08), p. 1074-1085
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 8 ( 2023-08), p. 1074-1085
    Abstract: The benefit of sodium-glucose cotransporter 2 (SGLT2) inhibitors in reducing the occurrence rate of adverse cardiac and renal outcomes in patients with type 2 diabetes has been well described in randomized trials. Whether this benefit extends to patients at the most severe end of the disease spectrum requiring admission to the ICU remains to be examined. DESIGN: Retrospective observational study. SETTING: Data were obtained from a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System). PATIENTS: All adult patients (age ≥ 18 yr) with type 2 diabetes and newly prescribed SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP-4) inhibitors between January 1, 2015, and December 31, 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After 1:2 propensity score matching, a total of 27,972 patients (10,308 SGLT2 inhibitors vs 17,664 DPP-4 inhibitors) were included in the final analysis. The mean age was 59 ± 11 years, and 17,416 (62.3%) were male. The median follow-up period was 2.9 years. The use of SGLT2 inhibitors was associated with decreased ICU admission (286 [2.8%] vs 645 [3.7%] ; hazard ratio [HR], 0.79; 95% CI, 0.69–0.91; p = 0.001) and lower risks of all-cause mortality (315 [3.1%] vs 1,327 [7.5%] ; HR, 0.44; 95% CI, 0.38–0.49; p 〈 0.001), compared with DPP-4 inhibitors. The severity of illness upon ICU admission by Acute Physiology and Chronic Health Evaluation IV-predicted risk of death was also lower in SGLT2 inhibitors users. Admissions and mortality due to sepsis were lower in SGLT2 inhibitor users compared with DPP-4 inhibitor users (admissions for sepsis: 45 [0.4%] vs 134 [0.8%] ; p = 0.001 and mortality: 59 [0.6%] vs 414 [2.3%] ; p 〈 0.001, respectively). CONCLUSIONS: In patients with type 2 diabetes, SGLT2 inhibitors were independently associated with lower rates of ICU admission and all-cause mortality across various disease categories.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000005869
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2034247-0
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  • 6
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    Predictors of Favorable Neurologic Outcomes in a Territory-First Extracorporeal Cardiopulmonary Resuscitation Program
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  ASAIO Journal Vol. 68, No. 9 ( 2022-09), p. 1158-1164
    Details
    In: ASAIO Journal, Ovid Technologies (Wolters Kluwer Health), Vol. 68, No. 9 ( 2022-09), p. 1158-1164
    Abstract: Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced resuscitation method that has been associated with better outcomes after cardiac arrest compared with conventional cardiopulmonary resuscitation. This is a retrospective analysis of all patients who received ECPR for cardiac arrest in Hong Kong’s first ECPR program from 2012 to 2020. The primary outcome was favorable neurologic outcome at 3 months. A new risk prediction model was developed and its performance was compared with published risk scores. One-hundred two patients received ECPR and 19 (18.6%) patients survived with favorable neurologic outcome. Having a shockable rhythm was the strongest predictor of favorable neurologic outcome in multivariate analysis (odds ratio, 9.64; 95% confidence interval [CI], 1.49 to 62.30; P = 0.017). We developed a simple model with three parameters for the prediction of favorable neurologic outcomes – presence of shockable rhythm, mean arterial pressure after extracorporeal membrane oxygenation, and the Acute Physiology And Chronic Health Evaluation IV score, with an area under receiver operating characteristic curve of 0.85 (95% CI, 0.77 to 0.94). In Hong Kong’s first ECPR program, 18.6% patients survived with favorable neurologic outcomes, and having a shockable rhythm at presentation was the strongest predictor. Risk scores are useful in predicting important patient outcomes and should be included in clinical decision-making for patients who received ECPR.
    Type of Medium: Online Resource
    ISSN: 1058-2916
    URL: Article
    DOI: 10.1097/MAT.0000000000001620
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2083312-X
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  • 7
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    Clinical Outcomes of Left Atrial Appendage Occlusion Versus Switch of Direct Oral Antcoagulant in Atrial Fibrillation: A Territory‐Wide Retrospective Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Journal of the American Heart Association
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health)
    Abstract: Left atrial appendage occlusion (LAAO) has emerged as an alternative to oral anticoagulation therapy for stroke prevention in atrial fibrillation, but data comparing LAAO with direct oral anticoagulant (DOAC) are sparse. Methods and Results This cohort study compared LAAO (with or without prior anticoagulation) with a switch of one DOAC to another DOAC by 1:2 propensity score matching. The primary outcome was a composite of all‐cause mortality, ischemic stroke, and major bleeding. A total of 2350 patients (874 in the LAAO group and 1476 in the DOAC switch group) were included. After a mean follow‐up of 1052±694 days, the primary outcome developed in 215 (24.6%) patients in the LAAO group and in 335 (22.7%) patients in the DOAC switch group (hazard ratio [HR], 0.94 [95% CI, 0.80–1.12] ; P =0.516). The LAAO group had a lower all‐cause mortality (HR, 0.49 [95% CI, 0.39–0.60]; P 〈 0.001) and cardiovascular mortality (HR, 0.49 [95% CI, 0.32–0.73]; P 〈 0.001) but similar risk of ischemic stroke (HR, 0.83 [95% CI, 0.63–1.10]; P =0.194). The major bleeding risk was similar overall (HR, 1.18 [95% CI, 0.94–1.48], P =0.150) but was lower in the LAAO group after 6 months (HR, 0.71 [95% CI, 0.51–0.97]; P =0.032). Conclusions LAAO conferred a similar risk of composite outcome of all‐cause mortality, ischemic stroke, and major bleeding, as compared with DOAC switch. The risks of all‐cause mortality and cardiovascular mortality were lower with LAAO.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.123.029421
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2653953-6
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  • 8
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    Abstract 10117: Reactivity Of Myocardial Contractility To Afterload Effects During Peripheral Veno-arterial Extracorporeal Membrane Oxygenation
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_1 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
    Abstract: Introduction: Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) poses increased afterload to the injured heart. The reactivity of myocardial contractility to ECMO blood flow during various phases of acute myocardial dysfunction has not been examined. Hypothesis: We hypothesized that myocardial contractility is more reactive to the afterload effects of peripheral V-A ECMO during the acute stage of myocardial dysfunction. Methods: Adult patients who were supported by peripheral V-A ECMO between April 2019 and October 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by TTE within 48 hours after initiation of V-A ECMO (“acute phase”) and upon weaning (“delayed phase”). Measurements were obtained at 100%, 120%, and 50% of ECMO target blood flow. Results: A total of 30 patients were included, 22 (71%) were male, and the mean±SD age was 54±13 years. The main indications of ECMO were myocardial infarction (19 patients, 63%) and myocarditis (5, 17%). TTE was performed on a median of day 1 (1-1) (n=30, “acute phase”) and day 4.5 (3-6) (n=24, “delayed phase”) after initiation of ECMO. Left ventricular contractility was reactive to afterload effects from V-A ECMO in both the acute and delayed phases, with an improvement in LVEF during ECMO flow reduction from 21.5 to 30.9% (p 〈 0.001) and 34.5 to 41.7% (p=0.002), respectively. The change in LVEF was similar in the acute phase compared with the delayed phase when considering the whole cohort [median (IQR) change in LVEF: 8.88 (5.26 - 13.7)% vs 6.12 (0.64 - 15.60)%, p=0.38]. Of the 24 patients who had a TTE during the delayed phase, 16 (66.7%) had myocardial recovery and were weanable from ECMO support. The reactivity of LVEF to ECMO blood flow was similar in the patients who were weanable compared with patients who were not weanable [median (IQR) change in LVEF: 10.21 (2.61 - 16.21)% vs 3.20 (-2.13 - 6.79)%, p=0.14]. Conclusions: In conclusion, we demonstrated that the reactivity of left ventricular contractility to afterload effects of V-A ECMO was not significantly different at different stages of acute myocardial dysfunction. Future studies should examine the predictive value and clinical utility of these echocardiographic measurements in patients on V-A ECMO.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_1.10117
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 1466401-X
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  • 9
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    Association Between Radial Versus Femoral Access for Percutaneous Coronary Intervention and Long‐Term Mortality
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Journal of the American Heart Association Vol. 10, No. 15 ( 2021-08-03)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 10, No. 15 ( 2021-08-03)
    Abstract: Percutaneous coronary intervention with radial arterial access has been associated with fewer occurrences of major bleeding. However, published data on the long‐term mortality and major adverse cardiac events after percutaneous coronary intervention with radial or femoral arterial access are inconclusive. Method and Results This was a territory‐wide retrospective cohort study including 26 022 patients who underwent first‐ever percutaneous coronary intervention between January 1, 2010 and December 31, 2017 in Hong Kong. Among the 14 614 patients matched by propensity score (7307 patients in each group), 558 (7.6%) and 787 (10.8%) patients died during the observation period in the radial group and femoral group, respectively, resulting in annualized all‐cause mortality rates of 2.69% and 3.87%, respectively. The radial group had a lower risk of all‐cause mortality compared with the femoral group up to 3 years after percutaneous coronary intervention (hazard ratio [HR], 0.70; 95% CI, 0.63–0.78; P 〈 0.001). Radial access was associated with a lower risk of major adverse cardiac events (HR, 0.78; 95% CI, 0.73–0.83, P 〈 0.001), myocardial infarction after hospital discharge (HR, 0.78; 95% CI, 0.70–0.87, P 〈 0.001), and unplanned revascularization (HR, 0.76; 95% CI, 0.68–0.85, P 〈 0.001). The risks of stroke were similar across the 2 groups (HR, 0.96; 95% CI, 0.82–1.13, P =0.655). Conclusions Radial access was associated with a significant reduction in all‐cause mortality at 3 years compared with femoral access. Radial access was associated with reduced risks of myocardial infarction and unplanned revascularization, but not stroke. The benefits were sustained beyond the early postoperative period.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.121.021256
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2653953-6
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  • 10
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    Effect of hospital case volume on clinical outcomes of patients requiring extracorporeal membrane oxygenation: a territory-wide longitudinal observational study
    AME Publishing Company ; 2022
    In:  Journal of Thoracic Disease Vol. 14, No. 6 ( 2022-6), p. 1802-1814
    Details
    In: Journal of Thoracic Disease, AME Publishing Company, Vol. 14, No. 6 ( 2022-6), p. 1802-1814
    Type of Medium: Online Resource
    ISSN: 2072-1439 , 2077-6624
    URL: Journal
    URL: Article
    DOI: 10.21037/jtd
    DOI: 10.21037/jtd-21-1512
    Language: Unknown
    Publisher: AME Publishing Company
    Publication Date: 2022
    detail.hit.zdb_id: 2573571-8
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