ORCID Profile
0000-0001-9071-6296
Current Organisations
University of South Australia
,
University of Melbourne
,
Independent Researcher
,
Alfred Health
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Unpublished
Date: 1999
Publisher: Unpublished
Date: 2006
Publisher: Wiley
Date: 23-10-2022
DOI: 10.1002/CCD.30442
Abstract: Clinical factors favouring coronary angiography (CA) selection and variables associated with in‐hospital mortality among patients presenting with out‐of‐hospital cardiac arrest (OHCA) without ST‐segment elevation (STE) remain unclear. We evaluated clinical characteristics associated with CA selection and in‐hospital mortality in patients with OHCA, shockable rhythm and no STE. Between 2014 and 2018, 118 patients with OHCA and shockable rhythm without STE (mean age 59 males 75%) were stratified by whether CA was performed. Of 86 (73%) patients undergoing CA, 30 (35%) received percutaneous coronary intervention (PCI). CA patients had shorter return of spontaneous circulation (ROSC) time (17 vs. 25 min) and were more frequently between 50 and 60 years (29% vs. 6.5%), with initial Glasgow Coma Scale (GCS) score (24% vs. 6%) (all p 0.05). In‐hospital mortality was 33% ( n = 39) for overall cohort (CA 27% vs. no‐CA 50%, p = 0.02). Compared to late CA, early CA ( ≤ 2 h) was not associated with lower in‐hospital mortality (32% vs. 34%, p = 0.82). Predictors of in‐hospital mortality included longer defibrillation time (odds ratio 3.07, 95% confidence interval 1.44‒6.53 per 5‐min increase), lower pH (2.02, 1.33‒3.09 per 0.1 decrease), hypoalbuminemia (2.02, 1.03‒3.95 per 5 g/L decrease), and baseline renal dysfunction (1.33, 1.02‒1.72 per 10 ml/min/1.73 m 2 decrease), while PCI to lesion (0.11, 0.01‒0.79) and bystander defibrillation (0.06, 0.004‒0.80) were protective factors (all p 0.05). Among patients with OHCA and shockable rhythm without STE, younger age, shorter time to ROSC and GCS were associated with CA selection, while less effective resuscitation, greater burden of comorbidities and absence of treatable coronary lesion were key adverse prognostic predictors.
Publisher: Elsevier BV
Date: 10-2022
DOI: 10.1016/J.AMJCARD.2022.06.063
Abstract: Peri-procedural stroke (PPS) is an important complication in patients who underwent percutaneous coronary intervention (PCI). The extent to which PPS impacts mortality and outcomes remains to be defined. Consecutive patients who underwent PCI enrolled in the Victorian Cardiac Outcomes Registry (2014 to 2018) were categorized into PPS and no PPS groups. The primary outcome was 30-day major adverse cardiovascular events (MACEs) (composite of mortality, myocardial infarction, stent thrombosis, and unplanned revascularization). Of 50,300 patients, PPS occurred in 0.26% patients (n = 133) (71% ischemic, and 29% hemorrhagic etiology). Patients who developed PPS were older (69 vs 66 years) compared with patients with no PPS, and more likely to have pre-existing heart failure (59% vs 29%), chronic kidney disease (33% vs 20%), and previous cerebrovascular disease (13% vs 3.6%), p .01. Among those with PPS, there was a higher frequency of presentation with ST-elevation myocardial infarction (49% vs 18%) and out-of-hospital cardiac arrest (14% vs 2.2%), PCI by way of femoral access (59% vs 46%), and adjunctive thrombus aspiration (12% vs 3.6%), all p = .001. PPS was associated with incident 30-day MACE (odds ratio [OR] 2.97, 95% confidence intervals [CIs] 1.86 to 4.74, p .001) after multivariable adjustment. Utilizing inverse probability of treatment weighting analysis, PPS remained predictive of 30-day MACE (OR 1.91, 95% CI 1.31 to 2.80, p = 0.001) driven by higher 30-day mortality (OR 2.0, 95% CI 1.35 to 2.96, p = 0.001). In conclusion, in this large, multi-center registry, the incidence of PPS was low however, its clinical sequelae were significant, with a twofold increased risk of 30-day MACE and all-cause death.
Publisher: Unpublished
Date: 1999
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2023
Publisher: Wiley
Date: 07-11-2022
Abstract: Sex differences in patients presenting with out‐of‐hospital cardiac arrest (OHCA) and shockable rhythm might be associated with disparities in clinical outcomes. We conducted a retrospective cohort study and compared characteristics and short‐term outcomes between male and female adult patients who presented with OHCA and shockable rhythm at two large metropolitan health services in Melbourne, Australia between the period of 2014–2018. Logistic regression was used to assess the effect of sex on clinical outcomes. Of 212 patients, 166 (78%) were males and 46 (22%) were females. Both males and females presented with similar rates of ST‐elevation myocardial infarction (44% vs 36%, P = 0.29), although males were more likely to have a history of coronary artery disease (32% vs 13%) and a final diagnosis of a cardiac cause for their OHCA (89% vs 72%), both P = 0.01. Rates of coronary angiography (81% vs 71%, P = 0.23) and percutaneous coronary intervention (51% vs 42%, P = 0.37) were comparable among males and females. No differences in rates of in‐hospital mortality (38% vs 37%, P = 0.90) and 30‐day major adverse cardiac and cerebrovascular events (composite of all‐cause mortality, myocardial infarction, coronary revascularization and nonfatal stroke) (39% vs 41%, P = 0.79) were observed between males and females, respectively. Female sex was not associated with worse in‐hospital mortality when adjusted for other variables (odds ratio 0.66, 95% confidence interval 0.28–1.60, P = 0.36). Among patients presenting with OHCA and a shockable rhythm, baseline sex and sex differences were not associated with disparities in short‐term outcomes in contemporary systems of care.
Publisher: Unpublished
Date: 2006
Publisher: Elsevier BV
Date: 09-2023
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.ATHORACSUR.2021.02.011
Abstract: The Fontan procedure, the last of a series of palliative operations for patients born with single ventricles, is associated with a significant late burden of complications. There are other strategies for patients who are suboptimal candidates for Fontan completion however, the long-term outcomes of these different surgical options have not been clearly elucidated. We performed a systematic literature review to establish the current role of other treatment approaches besides the Fontan procedure. The MEDLINE and Embase databases were systematically searched for articles describing the long-term outcomes of patients with single ventricles who have not received the Fontan procedure. A total of 36 articles met all inclusion criteria. There is a scarcity of contemporary data on the non-Fontan cohort. Historical studies provided a significant contribution. Long-term survival of unoperated patients with single ventricles is possible under the rare conditions of having balanced hemodynamics. As many as half of patients may survive on only a systemic-to-pulmonary artery shunt or bidirectional cavopulmonary shunt for more than 20 years with reasonable functional status. In patients with a failing single ventricle, the bidirectional cavopulmonary shunt is an excellent bridge to heart transplantation and may provide better posttransplant survival than patients with a Fontan circulation. Currently, the Fontan procedure continues to be the best definitive palliation for patients born with single ventricle lesions. However, for those with borderline indications, other strategies should be carefully considered.
Publisher: Oxford University Press (OUP)
Date: 09-10-2023
Publisher: Elsevier BV
Date: 10-2023
Publisher: MDPI AG
Date: 07-07-2022
DOI: 10.3390/JCM11143955
Abstract: Objectives: Despite an increase in the use of mechanical circulatory support (MCS) devices for acute myocardial infarction cardiogenic shock (AMI-CS), there is currently no randomised data directly comparing the use of Impella and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO). Methods: Electronic databases of MEDLINE, EMBASE and CENTRAL were systematically searched in November 2021. Studies directly comparing the use of Impella (CP, 2.5 or 5.0) with VA-ECMO for AMI-CS were included. Studies examining other modalities of MCS, or other causes of cardiogenic shock, were excluded. The primary outcome was in-hospital mortality. Results: No randomised trials comparing VA-ECMO to Impella in patients with AMI-CS were identified. Six cohort studies (five retrospective and one prospective) were included for systematic review. All studies, including 7093 patients, were included in meta-analysis. Five studies reported in-hospital mortality, which, when pooled, was 42.4% in the Impella group versus 50.1% in the VA-ECMO group. Impella support for AMI-CS was associated with an 11% relative risk reduction in in-hospital mortality compared to VA-ECMO (risk ratio 0.89 95% CI 0.83–0.96, I2 0%). Of the six studies, three studies also adjusted outcome measures via propensity-score matching with reported reductions in in-hospital mortality with Impella compared to VA-ECMO (risk ratio 0.72 95% CI 0.59–0.86, I2 35%). Pooled analysis of five studies with 6- or 12-month mortality data reported a 14% risk reduction with Impella over the medium-to-long-term (risk ratio 0.86 95% CI 0.76–0.97, I2 0%). Conclusions: There is no high-level evidence comparing VA-ECMO and Impella in AMI-CS. In available observation studies, MCS with Impella was associated with a reduced risk of in-hospital and medium-term mortality as compared to VA-ECMO.
Publisher: MDPI AG
Date: 21-06-2018
Publisher: Architectural Science Association
Date: 2006
Publisher: Wiley
Date: 16-12-2020
DOI: 10.1002/CCD.29436
Abstract: We aimed to assess the impact of the severity of chronic kidney disease (CKD) with long‐term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). We analyzed data on consecutive patients undergoing PCI enrolled in the Victorian Cardiac Outcomes Registry (VCOR) from January 2014 to December 2018. Patients were stratified into tertiles of renal function estimated glomerular filtration (eGFR) ≥60, 30–59 and 30 ml/min/1.73 m 2 (including dialysis). The primary outcome was long‐term all‐cause mortality obtained from linkage with the Australian National Death Index (NDI). The secondary endpoint was a composite of 30 day major adverse cardiac and cerebrovascular events. We identified a total of 51,480 patients (eGFR ≥60, n = 40,534 eGFR 30–59, n = 9,521 eGFR , n = 1,425). Compared with patients whose eGFR was ≥60, those with eGFR 30–59 and eGFR were on average older (77 and 78 vs. 63 years) and had a greater burden of cardiovascular risk factors. Worsening CKD severity was independently associated with greater adjusted risk of long‐term NDI mortality: eGFR hazard ratio 4.21 (CI 3.7–4.8) and eGFR 30–59 1.8 (CI 1.7–2.0), when compared to eGFR ≥60, all p .001. In this large, multicentre PCI registry, severity of CKD was associated with increased risk of all‐cause mortality underscoring the high‐risk nature of this patient cohort.
Publisher: Elsevier BV
Date: 05-2022
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.AMJCARD.2021.12.051
Abstract: Unprotected left main (LM) percutaneous coronary intervention (PCI) at centers without onsite cardiac surgery remains controversial. We aimed to evaluate the effect of onsite cardiac surgery on short-term and long-term outcomes in patients who had unprotected LM PCI. We analyzed Victorian Cardiac Outcomes Registry data on consecutive patients who had unprotected LM PCI at cardiac surgical centers (SCs) and non-SCs (NSCs) between January 2014 to December 2018. Compared with the SC group (n = 594, 81%), the NSC group (n = 136) were younger (69 vs 72 years) and presented with more ST-elevation myocardial infarction (35% vs 16%) and cardiogenic shock (25% vs 15%), with higher rates of preprocedural intubation (17% vs 11%) and mechanical circulatory support (20% vs 9.3%), all p <0.01. Unadjusted in-hospital mortality (23% vs 11.4%), and 30-day major adverse cardiac events (composite of mortality, myocardial infarction, stent thrombosis, or unplanned revascularization) (26% vs 16%) were higher in NSC patients, all p <0.01. However, following multivariable adjustment, SC was neither a predictor of in-hospital mortality (odds ratio 0.68, 95% confidence interval [CI] 0.32 to 1.43, p = 0.31), 30-day mortality (odds ratio 0.70, 95% CI 0.33 to 1.48, p = 0.35) nor long-term survival at 60 months (hazard ratio 0.88, 95% CI 0.62 to 1.27, p = 0.51). Propensity score analysis confirmed the neutral effect of onsite cardiac surgery on long-term survival (hazard ratio 0.99, 95% CI 0.66 to 1.50, p = 0.97). In conclusion, patients who underwent unprotected LM PCI at NSCs presented with greater acuity of illness. Despite this, the availability of onsite cardiac surgical support was not associated with in-hospital, 30-day, or long-term outcomes underscoring the safety of LM PCI in NSCs.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Wayne Zheng.