Background: In many low- to middle-income countries in Asia, patients with NVAF usually received warfarin for thromboembolic prevention due to cost-effectiveness. The SAMe-TT2R2 score has been proposed to predict TTR in NVAF patients. However, the SAMe-TT2R2 score has not been much validated in Asian population. Interestingly, it may overestimate patients who had TTR < 65% due to regarding being Asians as a risk factor. Objectives: To determine the factors predicting poor anticoagulant control on warfarin, create new scoring system, and compare with the SAMe-TT2R2 score in a Thai population with NVAF. Methods: This is a retrospective study in a tertiary care hospital. We enrolled NVAF patients who received warfarin from January 2014 to December 2018. TTR was calculated based on Rosendaal method. Multiple logistic regression and AUC-ROC curve were used for analysis. Results: A total of 864 patients were enrolled with mean age of 73.6 ± 11.58 years. The mean TTR was 48.1 ± 25.2%. Using multivariate regression analysis, the predictive factors for TTR < 65% were antiplatelet use (OR 4.49, p ≤ 0.001), LVEF < 40% (OR 1.92, p = 0.037), chronic kidney disease (GFR < 50 ml/min/1.73 m²) (OR 1.68, p = 0.013), history of CHF (OR 1.7, p = 0.047), and age ≥ 75 years (OR 1.4, p = 0.037). Based on the regression coefficients, we developed the new scoring system called ACAChE score [A, antiplatelet use (4 points); C, chronic kidney disease, GFR < 50 ml/min/1.73 m² (2 points); A, age ≥ 75 years (1 point); Ch, history of CHF (2 points); E, LVEF < 40% (2 points)]. ROC curve showed discrimination performance of the ACAChE score and SAMe-TT2R2 score for prediction of TTR < 65% with the C-statistic of 0.62 (95%CI 0.57–0.65) and 0.54 (95%CI 0.50–0.58), respectively. Conclusion: In Thai NVAF patients, the ACAChE score (antiplatelet use, chronic kidney disease (GFR < 50 ml/min/1.73 m²), age ≥ 75 years, history of congestive heart failure, and LVEF < 40%) has better prediction for TTR < 65% than SAMe-TT2R2 score. Thus, it expected to guide the selection of oral anticoagulation in Asian patients with NVAF.

The current recommendation for bioprosthetic valve replacement in severe aortic stenosis (AS) is either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). We evaluated the performance of a machine learning-based predictive model using existing periprocedural variables for valve replacement modality selection. We analyzed 415 patients in a retrospective longitudinal cohort of adult patients undergoing aortic valve replacement for aortic stenosis. A total of 72 clinical variables including demographic data, patient comorbidities, and preoperative investigation characteristics were collected on each patient. We fit models using LASSO (least absolute shrinkage and selection operator) and decision tree techniques. The accuracy of the prediction on confusion matrix was used to assess model performance. The most predictive independent variable for valve selection by LASSO regression was frailty score. Variables that predict SAVR consisted of low frailty score (value at or below 2) and complex coronary artery diseases (DVD/TVD). Variables that predicted TAVR consisted of high frailty score (at or greater than 6), history of coronary artery bypass surgery (CABG), calcified aorta, and chronic kidney disease (CKD). The LASSO-generated predictive model achieved 98% accuracy on valve replacement modality selection from testing data. The decision tree model consisted of fewer important parameters, namely frailty score, CKD, STS score, age, and history of PCI. The most predictive factor for valve replacement selection was frailty score. The predictive models using different statistical learning methods achieved an excellent concordance predictive accuracy rate of between 93% and 98%.

Background: Nowadays, current evidence on the effects of the COVID-19 outbreak on ST-elevation myocardial infarction (STEMI) patients is discrepant. The aim of this study was to compare and identify any changes in STEMI patients between the pre-COVID-19 period and during the COVID-19 outbreak. Methods: We conducted a retrospective cohort study to evaluate consecutive STEMI patients admitted from 1 September 2018 to 30 September 2021. We designated 14 March 2020 as the commencement of the COVID-19 outbreak in Thailand. Results: A total of 513 consecutive STEMI patients were included in this study: 330 (64%) admitted during the pre-COVID-19 outbreak period and 183 (36%) admitted during the COVID-19 outbreak. There was a significant 45% decline in the number of STEMI cases admitted during the COVID-19 outbreak period. During the outbreak, STEMI patients had significantly increased intra-aortic balloon pump (IABP) insertion (23% vs. 15%, p-value = 0.004), higher high-sensitivity troponin T level (11,150 vs. 5213, p-value < 0.001), and lower pre- and post-PCI TIMI flow. The time-to-diagnosis (59 vs. 7 min, p-value < 0.001), pain-to-first medical contact (FMC) time (250 vs. 214 min, p-value = 0.020), FMC-to-wire-crossing time (39 vs. 23 min, p-value < 0.001), and pain-to-wire-crossing time (292 vs. 242 min, p-value = 0.005) were increased in STEMI patients during the outbreak compared with pre-outbreak. There was no statistical difference in in-hospital mortality between both periods (p-value = 0.639). Conclusions: During the COVID-19 outbreak, there was a significant decline in the total number of admitted STEMI cases. Unfortunately, the time-to-diagnosis, pain-to-FMC time, FMC-to-wire-crossing time, and pain-to-wire-crossing time were significantly delayed during the COVID-19 outbreak. However, in-hospital mortality showed no significant differences between these two time periods. Highlights: 45% decline in the number of STEMI cases admitted and a significant delay in the treatment timeline during the COVID-19 outbreak. In-hospital mortality showed no significant difference between these two periods. Our study will motivate healthcare professionals to optimize treatments, screenings, and infectious control protocols to reduce the time from the onset of chest pain to wire crossing in STEMI patients during the outbreak.

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. While invasive coronary angiography is the gold standard for diagnosing obstructive CAD, contemporary guidelines advocate for initial evaluation using resting transthoracic echocardiography. The role of left ventricular global longitudinal strain (LV GLS) as a screening tool in the diagnosis of obstructive CAD remains unclear. To evaluate the diagnostic utility of LV GLS in predicting physiologically significant CAD as confirmed by intracoronary physiological tests such as fractional flow reserve (FFR) and/or non-hyperemic pressure ratios (NHPRs). We conducted a retrospective cohort study at the Cardiac Center, Chulabhorn Hospital, Thailand, enrolling patients with suspected CAD who underwent coronary angiography with FFR and/or NHPRs between August 2018 and September 2024. Resting echocardiograms were reevaluated for LV GLS. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of LV GLS for physiologically significant CAD. A multivariate model incorporating LV GLS patterns and clinical parameters was also developed. Of the 207 patients analyzed, 99 (47 %) had positive physiological test results (FFR ≤0.80 and/or NHPR ≤0.89). The average LV GLS was lower in the physiologically positive group (-15.6 %) compared to the negative group (-16.8 %), though this difference was not statistically significant. ROC analysis of average LV GLS yielded an area under the curve (AUC) of 0.56 (95 % CI: 0.48-0.64, p = 0.130). However, the ischemic Bull's-eye pattern derived from LV GLS demonstrated high sensitivity (93 %) and negative predictive value (87 %). Multivariate analysis identified central aortic pulse pressure (OR 1.02, 95 % CI = 1.00-1.04, p = 0.042) and the ischemic Bull's-eye pattern (OR 16.33, 95 % CI = 5.16-51.72, p < 0.001) as independent predictors of physiologically significant CAD. The combined model achieved an AUC of 0.76, outperforming both the average LV GLS alone and 2024 ESC clinical risk factor-based likelihood. While the average LV GLS is not a robust predictor of physiologically significant CAD, the ischemic Bull's-eye pattern derived from LV GLS offers high sensitivity and negative predictive value. When combined with central aortic pulse pressure, this approach enhances the diagnostic accuracy for physiologically significant CAD. These findings support the integration of ischemic Bull's-eye patterns derived from LV GLS and central aortic pulse pressure into initial CAD screening protocols.

Background: Primary percutaneous coronary intervention (PPCI) is now a standard treatment procedure for ST elevation myocardial infraction (STEMI) patients. Because of the many STEMI patients, there is a space constraint in coronary care unit, especially in Southeast Asian countries. Therefore, we practitioners should be evaluating if the patients could be safely discharged earlier. The current European Society of Cardiology STEMI 2017 guideline recommended early discharge in stable patients; however, the data are limited, especially in the Asian countries. Objective: To determine the rate of 30-day, 1-year mortality, and readmission of STEMI patients that underwent PPCI and were discharged early within three days of admission, compared with the late discharge of more than three days after admission. Materials and Methods: The present study was a retrospective cohort study at King Chulalongkorn Memorial Hospital. The authors collected consecutive cases of STEMI patients that underwent PPCI and were discharged between January 1999 and December 2015.The patients were divided into two groups as group 1 with early discharge within three days of admission and group 2 with late discharge more than three days of admission. The follow up on the mortality and readmission rates were collected at 30-day and 1-year after discharge. Results: Out of 1,242 STEMI patients, 691 patients (55.6%) were classified in group 1 and 551 patients (44.4%) were in group 2. The 30-day mortality was 0.4% in group 1 compared with 1.3% in group 2 (HR 2.93, p=0.12) and 1-year mortality was 3.9% in group 1 compared with 8.0% in group 2 (HR 2.09, p=0.003). There was no difference in 30-day readmission between both groups at 1.3% versus 2.5% (OR 1.98, p=0.113), but there was a difference in 1-year readmission between the two groups at 4.5% versus 10.6% (OR 2.51, p<0.001). In multivariate analysis, the predictive factors for early discharged STEMI patients were male (adjusted OR 1.78, p=0.007), Killip classification 1, 2, and 3 (adjusted OR 5.85, p=0.001), EF greater than 40% (adjusted OR 2.51, p=0.001), and TIMI flow after PPCI 3 (adjusted OR 1.48, p=0.016). Conclusion: Early discharge in STEMI patients within three days after PPCI is safe in terms of mortality and readmission compared to late discharge, especially in STEMI patients with Killip class I. Early discharge can provide more space for coronary care. Keywords: STEMI; PPCI; Early discharge; Late discharge; Mortality; Readmission; Killip class