Clinical characteristics and outcomes of South-East Asian patients with Takotsubo (stress-induced) cardiomyopathy.

BACKGROUND: There is limited data on the natural history of Takotsubo (stress-induced) cardiomyopathy in South-East Asian patients. We aim to evaluate the clinical characteristics, predisposing factors and outcomes of patients diagnosed with Takotsubo cardiomyopathy in our region. METHODS: From January 2010 to March 2017, 98 patients were diagnosed with Takotsubo cardiomyopathy in our institution. Data were collected retrospectively on baseline clinical characteristics, presenting symptoms, precipitating factors, clinical investigations and in-hospital clinical outcomes. RESULTS: 82% of the patients were female. An antecedent physical stressor was more common than emotional trigger with 35% of patients having no identifiable stressor. The most common presenting symptoms were chest pain (53.1%), dyspnea (45%) and diaphoresis (18.5%).The apical variant (89%) was the most common form of Takotsubo cardiomyopathy followed by the mid-ventricular type (5.1%). The mean left ventricular ejection fraction was 35 ±â€¯11%.In-hospital mortality due to cardiovascular causes was 4.1%. 38% of patients developed in-hospital complications. By multi-variable analysis, lower left ventricular function was an independent predictor of in-hospital complication. CONCLUSION: South-East Asian patients with Takotsubo cardiomyopathy are characterised by female predominance, higher incidence of physical triggers and low cardiovascular mortality. Lower left ventricular function was an independent predictor of adverse outcomes.

Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention.

OBJECTIVE: To evaluate causes and impact of delay in the door-to-balloon (D2B) time for patients undergoing primary percutaneous coronary intervention (PPCI). SUBJECTS AND METHODS: From January 2009 to December 2012, 1268 patients (86% male, mean age of 58 ± 12 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: Non-delay defined as D2B time ≤ 90 mins and delay group defined as D2B time > 90 mins. Data were collected retrospectively on baseline clinical characteristics, mode of presentation, angiographic findings, therapeutic modality and inhospital outcome. RESULTS: 202 patients had delay in D2B time. There were more female patients in the delay group. They were older and tend to self-present to hospital. They were less likely to be smokers and have a higher prevalence of prior MI. The incidence of posterior MI was higher in the delay group. They also had a higher incidence of triple vessel disease. The 3 most common reasons for D2B delay was delay in the emergency department (39%), atypical clinical presentation (37.6%) and unstable medical condition requiring stabilisation/computed tomographic imaging (26.7%). The inhospital mortality was numerically higher in the delay group (7.4% versus 4.8%, p = 0.12). CONCLUSIONS: Delay in D2B occurred in 16% of our patients undergoing PPCI. Several key factors for delay were identified and warrant further intervention.

Clinical characteristics, risk factors and outcomes of South-East Asian patients with acute pulmonary embolism.

BACKGROUND: The clinical features of acute PE have not been well studied in South-East Asia. We therefore sought to evaluate the clinical characteristics, risk factors and outcomes of patients diagnosed with acute pulmonary embolism (PE) in our region. METHODS: From January 2008 to March 2013, 343 patients were admitted to our tertiary institution with acute PE. Data were collected retrospectively on baseline clinical characteristics, presenting signs and symptoms, results of electrocardiographic and imaging studies, therapeutic modality and hospital course. RESULTS: 91% of the patients presented with submassive PE. 6.1% of patients had saddle PE. The most common presenting symptom was dyspnea (72.3%) followed by chest pain (12.8%), hemoptysis (2.6%), syncope (2.6%) and cardiovascular collapse (1.2%). Risk factors for PE were idiopathic cause (33.5%), immobilization (21%), malignancy (6.1%) and hypercoagulable state (2.9%). The overall in-hospital mortality was 5%. Factors associated with mortality were massive PE, tachycardia at presentation, right ventricular dysfunction and cardiogenic shock. Bleeding complications occurred in 10.2% of patients (major bleeding in 3.5%). CONCLUSION: Acute PE in the South-East Asian patients is associated with an overall mortality rate of 5%. The bleeding complications from treatment are also high.

Drug-Coated Balloons: A Safe and Effective Alternative to Drug-Eluting Stents in Small Vessel Coronary Artery Disease.

BACKGROUND: Drug-coated balloons (DCB) have been used to treat de novo small vessel coronary disease (SVD), with promising results and shorter dual antiplatelet therapy (DAPT) duration compared to drug-eluting stents (DES). We compared safety and effectiveness of the two treatments at 1 year. METHODS: We reviewed 3,613 angioplasty cases retrospectively from 2011 to 2013 and identified 335 patients with SVD treated with device diameter of ≤2.5 mm. DCB-only angioplasty was performed in 172 patients, whereas 163 patients were treated with second-generation DES. RESULTS: DCB patients had smaller reference vessel diameter (2.22 ± 0.30 vs. 2.44 ± 0.19 mm, P < 0.001) and received smaller devices (median diameter 2.25 vs. 2.50 mm, P < 0.001) compared to the DES group. DES-treated vessels had larger acute lumen gain (1.71 ± 0.48 mm) than DCB (1.00 ± 0.53 mm, P < 0.001). Half the patients had diabetes mellitus. While there were more patients presenting with acute coronary syndrome (ACS) in the DCB group (77.9% vs. 62.2%, P = 0.013), they received shorter DAPT (7.4 ± 4.7 vs. 11.8 ± 1.4 months, P < 0.001) than the DES group. The 1-year composite major adverse cardiac event rate was 11.6% in the DCB arm and 11.7% in the DES arm (P = 1.000), with target lesion revascularization rate of 5.2% and 3.7%, respectively, (P = 0.601). CONCLUSIONS: In this high-risk cohort of patients, DCB-only angioplasty delivered good clinical outcome at 1 year. The results were comparable with DES-treated patients, but had the added benefit of a shorter DAPT regime.