BACKGROUND:Cardiac rehabilitation is a key component of secondary prevention following percutaneous coronary intervention (PCI), yet participation remains suboptimal. Linked health datasets offer an opportunity to better understand attendance patterns and associated outcomes across the care continuum. METHODS:A retrospective, observational cohort study was conducted using linked health data from 13 public hospitals between 2019 and 2021. Cardiac rehabilitation attendance was defined as participation in ≥1 session. Predictors of cardiac rehabilitation attendance and 12-month outcomes were assessed. A dose-response analysis was also performed, categorizing participants by cardiac rehabilitation session frequency as non-attenders, low attendance (1-5 sessions) and high attendance (≥6 sessions). RESULTS:Adults undergoing PCI (n = 37,191) were identified, of whom 7126 were successfully linked to the Victorian Integrated Non-Admitted Health (VINAH) dataset. Cardiac rehabilitation attendance was observed in 19.3% of the cohort. Key predictors of attendance were STEMI (OR 1.59, 95% CI 1.32-1.93), NSTEMI (OR 1.24, 95% CI 1.05-1.46), rural/regional program location (OR 1.48, 95% CI 1.25-1.75), and length of stay >3 days (OR 1.04, 95% CI 1.02-1.07). At 12 months, cardiac rehabilitation attendees had lower mortality (1.0% vs 4.9%, p < 0.001) and fewer unplanned readmissions (p = 0.038). A dose-response relationship was found for 12-month mortality. A dose-response relationship was evident for mortality, with lowest rates among high-attendance participants (0.6%), compared with low-attendance (1.5%) and non-attenders (2.9%) (p < 0.001). CONCLUSIONS:Linking Victorian datasets is feasible and provides valuable insights. Cardiac rehabilitation attendance is low, yet participation, particularly at higher doses, is associated with significantly improved outcomes.

Abstract Introduction Percutaneous coronary intervention (PCI) is an important treatment for coronary artery disease, and coronary dominance may influence procedural risk. PCI to a left-sided posterior descending artery (L-PDA) occurs in the setting of left-dominant coronary anatomy and may involve greater anatomical complexity and a larger myocardial territory at risk than PCI to a right-sided PDA (R-PDA). We performed a retrospective analysis of a statewide registry to compare the characteristics and outcomes of R-PDA and L-PDA PCI. Methods The Victorian Cardiac Outcomes Registry is a state-wide quality registry with all PCI capable centres in Victoria, Australia contributing. We undertook a retrospective analysis of patients undergoing PCI for L-PDA and R-PDA lesions between 2013 and 2022. Results 2,880 patients were included over the 10-year study period, with 2,282 (79.2%) undergoing R-PDA PCI and 598 (20.8%) undergoing L-PDA PCI. Patient characteristics between groups were of similar age (66.3 years in both groups), gender (17.9% vs. 14.5%; p = 0.06) and had comparable rates of comorbidities including diabetes (25.8% vs. 24.9%; p = 0.66). There was no significant difference between groups with respect to 30-day mortality (1.1% vs. 0.5%; p = 0.21). 30-day MACE was also comparable (2.2% both groups; p = 0.93). Conclusions Data from a large contemporary cohort did not find any association between coronary dominance and clinical outcomes when undertaking PDA PCI.

Coronary artery complications following the arterial switch operation (ASO) for transposition of the great arteries have become increasingly relevant as those affected are exposed to the comorbidities of later years. A scoping review was undertaken to explore the incidence, clinical features, and management of the long-term coronary complications after the ASO. The selection criteria yielded 73 articles They recorded few long-term coronary artery complications following the ASO, which were difficult to recognize as most affected patients' symptoms were absent or nonspecific. In patients with suspected coronary artery involvement, coronary angiography or computed tomography provided confirmation, with significant stenosis generally managed by percutaneous trans-catheter interventions.

BACKGROUND:Contemporary guidelines lack support for the performance of complex percutaneous coronary intervention (PCI) in hospitals with no on-site cardiac surgery (NOSCS). We compared safety and efficacy of complex PCI performed at sites with and without on-site cardiac surgery. METHODS:Data from the Victorian Cardiac Outcomes Registry from 2014 and 2022 was retrospectively analysed. Complex PCI was defined as PCI to unprotected left main, bifurcations, rotational atherectomy or intravascular lithotripsy use, severe left ventricular systolic dysfunction, chronic total occlusion, or vein grafts. The primary outcome was 30-day MACCE comprising all-cause mortality, stroke, MI, target vessel revascularisation, and definite/probable stent thrombosis. The secondary outcome was long-term all-cause mortality. Risk ratio was estimated using propensity score analysis. RESULTS:81,869 PCI procedures were analysed, including 11,710 complex PCI cases (29.0 % at NOSCS). Patients from NOSCS presented more frequently with acute coronary syndromes (NSTE-ACS 35.2 % vs 30.6 %, STEMI 30.0 % vs 19.6 %, p < 0.001). After propensity score adjustment, patients treated at NOSCS centres had equivalent risk of MACCE at 30-days in all-comers PCI (RR 0.95, 95 % CI 0.88-1.03, p = 0.16) and complex PCI (RR 0.97, 95 % CI 0.86-1.10, p = 0.65). There was no difference in propensity-weighted mortality following all-comers or complex at median follow up of 3.5 years. CONCLUSIONS:Patients undergoing PCI and complex PCI at NOSCS centres had comparable risk-adjusted 30-day outcomes and long-term mortality to those treated at OSCS centres. These data underscore the safety of contemporary complex PCI at NOSCS and support health policy changes to increase equitable PCI access for more patients.

BACKGROUND:The occurrence and sequelae of acute myocardial infarction (AMI) in major trauma patients is underexplored across both trauma and cardiology specialties. Coronary reperfusion greatly reduces the risk of significant morbidity and mortality in AMI. However, in patients presenting with significant injuries, concurrent AMI presents a competing management priority given the increase in risk of bleeding with standard anticoagulation and antiplatelet therapy, which may be contraindicated. This study aimed to evaluate the epidemiology and clinical outcomes associated with AMI in a contemporary major trauma cohort. METHODS:This study used data from the Victorian State Trauma Registry (VSTR). All adult patients with major trauma from 1 January 2013 to 31 December 2022 were included. Patients that died prior to hospital arrival were excluded. AMI was identified by ICD-10-AM diagnosis codes recorded against the first hospital admission. Clinical outcomes included in-hospital mortality, length of stay, and discharge destination. RESULTS:28,928 patients were identified over the 10-year study period. AMI occurred in 401 patients (1.4 %). AMI patients were older, had more comorbidities and were more frequently on anticoagulation or antiplatelet therapy. Low impact fall was the most common trauma mechanism in AMI patients. Patients with AMI experienced longer hospital stays (12 [7-20] versus 7 [4-12] days, p < 0.001) and higher rates of in-hospital mortality (adjusted RR 1.45, 95 % CI 1.25-1.65). CONCLUSION:AMI in the setting of major trauma occurs in an older, more comorbid, and vulnerable group of patients. AMI is associated with an increased risk of in-hospital mortality and prolonged hospital stay in the setting of major trauma, underscoring the importance of identifying and treating major trauma associated AMI in a timely and effective manner.

BACKGROUND:Dual antiplatelet therapy (DAPT) is standard following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Preloading is the practice of administering both aspirin and a P2Y12 inhibitor before PCI. DAPT preloading is common practice, however clinical trial evidence demonstrating benefit is lacking. AIMS:This study aimed to examine the prevalence and associated clinical outcomes of DAPT before PCI for ACS in a contemporary population of Australian patients. METHODS:Data on consecutive PCI procedures from patients included in the Victorian Cardiac Outcomes Registry (VCOR) from 2014 to 2021 was collected and stratified by administration of DAPT before PCI versus single, or no, antiplatelet therapy. RESULTS:In total, 42,453 consecutive PCI procedures for ACS were included. Of these, 33,520 (79%) patients were either preloaded or already on DAPT before PCI. Patients on DAPT were younger (63.9 vs. 65.1, p < 0.001) and generally had fewer comorbidities. Unadjusted outcomes were more favorable with pre-loading with lower in-hospital mortality with DAPT (2.6% vs. 5.6%, p < 0.001), and 30-day cardiovascular mortality (0.3% vs. 0.4%, p = 0.039). 30-day major adverse cardiovascular events (MACE) (5.5% vs. 8.8%, p < 0.001) was similarly lower in the preloaded group. Major bleeding in hospital was less common in patients on DAPT (1.0% vs. 1.7%, p < 0.001). However, following adjustment for covariates, there was no difference in in-hospital or 30-day all-cause mortality, MACE or stent thrombosis between groups. CONCLUSIONS:DAPT before PCI is common in ACS but not independently associated with improvements in in-hospital mortality, MACE, or stent thrombosis.

BackgroundClinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated.MethodBetween 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m2) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)—composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke.ResultsRT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality.ConclusionsRT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.

BackgroundAn uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included.MethodsData on patients aged 18–50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients.ResultsOHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p = 0.015), non-obesity (p = 0.004), ST-elevation myocardial infarction (p < 0.0001) and left main (p < 0.0002) or left anterior descending (LAD) coronary artery (p < 0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p < 0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p = 0.029).ConclusionOHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.