ORCID Profile
0000-0002-6785-3185
Current Organisation
Alfred Health
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Publisher: Elsevier BV
Date: 10-2020
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: Wiley
Date: 04-09-2018
DOI: 10.1111/APT.14955
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.CARDFAIL.2021.11.020
Abstract: Patients undergoing heart transplant are at high risk for postoperative vasoplegia. Despite its frequency and association with poor clinical outcomes, there remains no consensus definition for vasoplegia, and the predisposing risk factors for vasoplegia remain unclear. Accordingly, the aim of this study was to evaluate the prevalence, predictors, and clinical outcomes associated with vasoplegia in a contemporary cohort of patients undergoing heart transplantation. This was a retrospective cohort study of patients undergoing heart transplantation from January 2015 to December 2019. A binary definition of vasoplegia of a cardiac index of 2.5 L/min/m After exclusion of patients with primary cardiogenic shock, major bleeding, or overt sepsis, data were collected on 95 eligible patients. By binary definition, vasoplegia incidence was 66.3%. We separately stratified by actual vasopressor requirement tertile (high, intermediate, low). Stratified by tertile, patients with vasoplegia were older (52.7 ± 10.2 vs 46.8 ± 12.7 vs 44.4 ± 11.3 years, P = .02), with higher rates of chronic kidney disease (18.8% vs 32.3% vs 3.1%, P = .01) and were more likely to have been transplanted from left ventricular assist device support (n = 42) (62.5% vs 32.3% vs 37.5%, P = .03). Cardiopulmonary bypass time was prolonged in those that developed vasoplegia (155 min [interquartile range 135-193] vs 131 min [interquartile range 117-152] vs 116 min [interquartile range 102-155], P = .003). Intubation time and length of intensive care unit and hospital stay were significantly increased in those that developed vasoplegia however, this difference did not translate to a significant increase in all-cause mortality at 30 days or 1 year. Vasoplegia occurs at a high rate after heart transplantation. Older age, chronic kidney disease, mechanical circulatory support, and prolonged bypass time are all associated with vasoplegia however, this study did not demonstrate an associated increase in all-cause mortality LAY SUMMARY: Patients undergoing heart transplantation are at high risk of vasoplegia, a condition defined by low blood pressure despite normal heart function. We found that vasoplegia was common after heart transplant, occurring in 60%-70% of patients after heart transplant after excluding those with other causes for low blood pressure. Factors implicated included age, poor kidney function, prolonged cardiopulmonary bypass time and preoperative left ventricular assist device support. We found no increased risk of death in patients with vasoplegia despite longer lengths of stay in intensive care and in hospital.
Publisher: Oxford University Press (OUP)
Date: 09-10-2023
Publisher: Oxford University Press (OUP)
Date: 26-12-2022
Abstract: Experimental studies demonstrate protective effects of doxycycline on myocardial ischaemia-reperfusion injury. The trial investigated whether doxycycline administered prior to reperfusion in patients presenting with ST-elevation myocardial infarction (STEMI) reduces infarct size (IS) and ameliorates adverse left ventricular (LV) remodelling. In this randomized, double-blind, placebo-controlled trial, patients presenting with STEMI undergoing primary percutaneous coronary intervention (PPCI) were randomized to either intravenous doxycycline or placebo prior to reperfusion followed by 7 days of oral doxycycline or placebo. The primary outcome was final IS adjusted for area-at-risk (fIS/AAR) measured on two cardiac magnetic resonance scans ∼6 months apart. Of 103 participants, 50 were randomized to doxycycline and 53 to placebo and were matched for age (59 ± 12 vs. 60 ± 10 years), male sex (92% vs. 79%), diabetes mellitus (26% vs. 11%) and left anterior descending artery occlusion (50% vs. 49%), all P & 0.05. Patients treated with doxycycline had a trend for larger fIS/AAR [0.79 (0.5–0.9) vs. 0.61 (0.47–0.76), P = 0.06], larger fIS at 6 months [18.8% (12–26) vs. 13.6% (11–21), P = 0.08], but similar acute IS [21.7% (17–34) vs. 19.4% (14–27), P = 0.19] and AAR [26% (20–36) vs. 24.7% (16–31), P = 0.22] compared with placebo. Doxycycline did not ameliorate adverse LV remodelling [%Δend-diastolic volume index, 1.1% (−3.8–8.4) vs. −1.34% (−6.1–5.8), P = 0.42] and was independently associated with larger fIS (regression coefficient = 0.175, P = 0.03). Doxycycline prior to PPCI neither reduced IS acutely or at six months nor attenuated adverse LV remodelling. These data raise safety concerns regarding doxycycline use in STEMI for infarct modulation and healing.
Publisher: Elsevier BV
Date: 02-2023
Publisher: Wiley
Date: 28-07-2017
DOI: 10.1111/JGH.13750
Publisher: Wiley
Date: 31-07-2021
DOI: 10.1002/CCD.29886
Abstract: To examine predictors and outcomes of unsuccessful percutaneous coronary intervention (PCI) cases in a contemporary Australian registry cohort. With improvements in techniques and pharmacotherapy in PCI, more complex lesions in older patients are now being attempted. In the context of PCI performance assessment, there are limited data regarding the characteristics and outcomes of unsuccessful PCI. We prospectively collected data on patients undergoing single‐lesion PCI between 2013 and 2017 who were enrolled in the multi‐center Victorian Cardiac Outcomes Registry. Procedures were ided into two groups by whether or not PCI was deemed successful at the end of the procedure using a pre‐specified definition. There were 34,383 single‐lesion PCI performed, of which 18,644 (54.2%) were for acute coronary syndromes. Of the study cohort, 2080 patients (6.0%) had an unsuccessful PCI – these patients were older, more likely to have previous stroke, PCI, severe left ventricular dysfunction and chronic kidney disease (all p 0.001). The procedure was also more likely to be performed for stable angina ( p 0.001). Chronic total occlusion PCI made up 31% of unsuccessful PCI cases. Unsuccessful PCI was itself associated with higher in‐hospital and 30‐day mortality and MACE (all p 0.001). 4.9% of unsuccessful PCIs led to unplanned in‐hospital bypass surgery (compared to 0.2% in successful PCIs, p 0.001). Our study highlights that even in contemporary PCI practice, more than 1 in 20 PCI attempts are unsuccessful. Lack of procedural success has a strong influence on patient outcomes. Monitoring rates of unsuccessful cases is an important quality assurance tool.
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: Wiley
Date: 26-10-2019
DOI: 10.1002/CCD.28561
Abstract: To conduct a systematic review and meta-analysis of studies examining the impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Morphine analgesia may reduce the absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of periprocedural intravenous morphine on clinical outcomes in patients undergoing PCI for STEMI is not well defined. Analysis of the electronic databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI intravenous morphine use with in-hospital or 30-day myocardial infarction (MI) (primary outcome) and in-hospital or 30-day mortality. A total of 11 studies were included for systematic review. One study was a randomized controlled trial, 10 were observational studies. Five studies including 3,748 patients were included in meta-analysis of in-hospital or 30-day MI. Within this group, patients were treated concurrently with ticagrelor (n = 2,239), clopidogrel (n = 1,256) and prasugrel (n = 253). There was no significant association of in-hospital or 30-day MI with intravenous morphine (odds ratio 1.88 95% confidence interval [CI] 0.87-4.09 I Periprocedural intravenous morphine administration was not associated with adverse short-term clinical outcomes in patients undergoing primary PCI for STEMI. Further randomized trial data are needed to evaluate the pharmacologic interaction between morphine and P2Y12 antagonists with clinical outcomes.
Publisher: Oxford University Press (OUP)
Date: 17-02-2023
Abstract: The relationship between lower socioeconomic status (SES) and poor cardiovascular outcomes is well described however, there exists a paucity of data exploring this association in cardiogenic shock (CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality of care or outcomes of CS patients attended by emergency medical services (EMS). This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 and 30 June 2019 in Victoria, Australia. Data were collected from in idually linked ambulance, hospital, and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australian Bureau of Statistics. A total of 2628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8 [95% confidence interval (95% CI), 11.4–12.3] per 100 000 person-years, with a stepwise increase from the highest to lowest SES quintile (lowest quintile 17.0 vs. highest quintile 9.7 per 100 000 person-years, P-trend & 0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centres without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest three SES quintiles when compared with the highest quintile. This population-based study demonstrated discrepancies between SES status in the incidence, care metrics, and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.
Publisher: Oxford University Press (OUP)
Date: 08-03-2021
DOI: 10.1093/OFID/OFAB113
Abstract: Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal hotericin B (L-AMB) prophylaxis in a heterogenous group of hematology patients. A retrospective cohort of all hematology patients who received a course of intravenous L-AMB, defined as 1 mg/kg thrice weekly from July 1, 2013 to June 30, 2018, were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation, and acute kidney injury. There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n = 19 of 198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable roven BIFD occurred in 13 patients (6.6%, 13 of 198), including molds in 54% (n = 7) and non-albicans Candidemia in 46% (n = 6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukemia (6.8%) followed by acute lymphoblastic leukemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy, or anticancer drug-azole interactions (75% of courses) dominated by vincristine, or acute myeloid leukemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury, using a modified international definition, complicated 27% of courses but was not clinically significant, accounting for only 3.3% (9 of 273) of discontinuations. Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help researchers find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios in which azoles are unsuitable, especially as targeted anticancer drugs increase in use.
No related grants have been discovered for Riley Batchelor.