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BackgroundIn Thailand, access to specific pharmaceuticals and medical devices for ST-elevation myocardial infarction (STEMI) patients is restricted within certain healthcare systems, leading to inequalities in the quality of medical care among different healthcare systems. This study aims to compare mortality rates within one year of STEMI patients among the public health insurance schemes of Thailand.MethodologyThis study is a single-center retrospective analysis of patients with STEMI treated with primary percutaneous coronary intervention (pPCI). It involves patients utilizing various state health insurance schemes in Thailand from January 1, 2010, to December 31, 2020. Data collection occurred through the hospital's computerized management system and the registration administration office of the Department of Provincial Administration.ResultsThe study involved 1,077 patients, categorized into three groups based on their state health insurance: Universal Health Coverage (UC) (546 patients, 50.7%), Social Security System (SS) (199 patients, 18.5%), and Civil Service Reimbursement (CS) (332 patients, 30.8%). The one-year mortality rates in these groups were 10.57%, 4.21%, and 6.47%, respectively (p = 0.010). In the unadjusted model, the SS group showed a lower risk of one-year mortality [Hazard Ratio (HR) 0.38, 95% CI 0.18–0.80, p = 0.011], and the CS group also demonstrated a lower risk (HR 0.59, 95% CI 0.35–0.99, p = 0.047) compared to the UC group. In the adjusted model, only the CS group significantly reduced the risk of one-year mortality. Other factors that affected one-year mortality were age ≥65 years, prior coronary artery diseases, Killip class 3–4, pre-discharge prescription of angiotensin-converting enzyme inhibitors, occlusion in the left anterior descending artery, multivessel disease, in-hospital atrial fibrillation/flutter and in-hospital pericardial effusion.ConclusionHealthcare schemes play a significant role in influencing one-year mortality rates among STEMI patients treated with pPCI. This information would be crucial for developing strategies and programs to aid healthcare policymakers at both regional and international levels in reducing morbidity and mortality.

Introduction: Percutaneous mitral commissurotomy (PTMC) and mitral valve replacement(MVR) are treatments of choice for severe rheumatic mitral stenosis (MS). Data regarding the long-term outcomes of patients who underwent PTMC and MVR are limited. Methods: A retrospective cohort study was conducted to evaluate the long-term outcomes of patients with severe rheumatic MS who underwent PTMC or MVR between 2010 to 2020.The primary outcome comprised of all-cause death, stroke or systemic embolism, heart failure hospitalization and re-intervention. Cox regression was used to investigate predictors of the primary outcome. Results: 264 patients were included in analysis, 164 patients (62.1%) in PTMC group and 100patients in MVR group (37.9%). The majority were females (80.7%) and had atrial fibrillation(68.6%). The mean age was 49.52 (SD: 13.03) years old. MVR group had more age and AF,higher Wilkins’ score with smaller MVA. Primary outcome occurred significantly higher in PTMC group (37.2% vs 22%, p = 0.002), as well as, re-intervention (18.3% vs 0%, p < 0.001). However, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different. In multivariate Cox regression analysis, PTMC (HR 1.94; 95%CI1.14, 3.32; p = 0.015), older age (HR 1.03; 95%CI 1.01, 1.06; p = 0.009) and SPAP > 50 mmHg(HR 2.99; 95%CI 1.01, 8.84; p = 0.047) were the only predictors of primary outcome. Conclusion: Primary outcome occurred in PTMC group more than MVR group which was driven by re-intervention. However, all-cause mortality, stroke or systemic embolism and heart failure hospitalization were not significantly different.

Abstract Background Despite numerous studies supporting the outperformance of ultrathin-strut bioresorbable polymer sirolimus-eluting stent (Orsiro SES, Biotronik AG), the generalizability of the study results remains unclear in the Asian population. We sought to evaluate the clinical outcomes of the Orsiro SES in unselected Thai population. Methods The Thailand Orsiro registry was a prospective, open-label clinical study evaluating all patients with obstructive coronary artery disease implanted with Orsiro SES. The primary endpoint was target lesion failure (TLF) at 12 months. TLF is defined as a composite of cardiac death, target vessel myocardial infarction (TVMI), emergent coronary artery bypass graft (CABG), and clinically driven target lesion revascularization (CD-TLR). Patients with diabetes, small vessels (≤ 2.75 mm), chronic total occlusions (CTOs), and acute myocardial infarction (AMI) were pre-specified subgroups for statistical analysis. Result A total of 150 patients with 235 lesions were included in the analysis. Half of the patients (53.3%) presented with AMI, and 24% had diabetes. Among 235 lesions, 93(39.4%) were small vessels, and 24(10.2%) were chronic total occlusions. The primary endpoint, TLF at 12 months, occurred in eight patients (5.3%), predominately caused by cardiac death. By contrast, the incidences of TVMI and CD-TLR were null. The outcomes in pre-specified subgroup were not different from the overall population (all p > 0.05). One definite late stent thrombosis(0.7%) was incidentally observed during primary percutaneous coronary intervention to the non-target vessel. Conclusion The safety and efficacy of the ultrathin strut sirolimus-eluting stent in unselected cases are confirmed in the Thailand Orsiro registry. Despite the high proportion of pre-specified high-risk subgroups, the excellent stent performance was consistent with the overall population. Trial Registration TCTR20190325001.

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.

Background. Several interventions have been proposed to improve hypertension control with various outcomes. The home blood pressure (HBP) measurement is widely accepted for assessing the response to medications. However, the enhancement of blood pressure (BP) control with HBP telemonitoring technology has yet to be studied in Thailand. Objective. To evaluate the attainment of HBP control and drug prescription patterns in Thai hypertensives at one year after initiating the TeleHealth Assisted Instrument in Home Blood Pressure Monitoring (THAI HBPM) nationwide pilot project. Methods. A multicenter, prospective study enrolled treated hypertensive adults without prior regular HBPM to obtain monthly self-measured HBP using the same validated, oscillometric telemonitoring devices. The HBP reading was transferred to the clinic via a cloud-based system, so the physicians can adjust the medications at each follow-up visit on a real-life basis. Controlled HBP is defined as having HBP data at one year of follow-up within the defined target range (

Background. White-coat hypertension (HT), masked HT, HT with white-coat effect, and masked uncontrolled HT are well-recognized problems of over- and undertreatment of high blood pressure in real-life practice. However, little is known about the true prevalence in Thailand. Objectives. To examine the prevalence and characteristics of each HT subtype defined by mean home blood pressure (HBP) and clinic blood pressure (CBP) using telemonitoring technology in Thai hypertensives. Methods. A multicenter, observational study included adult hypertensives who had been diagnosed for at least 3 months based on CBP without the adoption of HBP monitoring. All patients were instructed to manually measure their HBP twice a day for the duration of at least one week using the same validated automated, oscillometric telemonitoring devices (Uright model TD-3128, TaiDoc Corporation, Taiwan). The HBP, CBP, and baseline demographic data were recorded on the web-based system. HT subtypes were classified according to the treatment status, CBP (≥or

Background: The transfemoral approach (TF) is the access of choice for transcatheter aortic valve implantation (TAVI). However, approximately 10% of patients have anatomy or comorbidity unsuitable for TF. Objective: To analyze the outcomes of an alternative approach compared with TF in the authors' institute. Materials and Methods: A retrospective analysis of patients undergoing TAVI in King Chulalongkorn Memorial Hospital between December 2010 and 2021 was conducted. The present study compared the baseline characteristics, outcomes, and complications of TAVI procedures, including one-year mortality, according to whether they were performed through a TF or alternative approach. Results: Among 210 patients that underwent TAVI, 188 (89.6%) were in the TF group and 22 (10.4%) were in the alternative group with seven in the trans-subclavian, nine in the transapical, and six in the transaortic. The mean age of the population was 81 years. Patients in the alternative group had more severe disease (median logistic EuroSCORE-II 19.67 versus 10.01, p<0.001). Other baseline characteristics were not different between groups. According to the Valve Academic Research Consortium 3 (VARC-3) criteria, there were higher mortality and complication rates in the alternative group but no statistical differences regarding 30-day mortality of TF at 2.1% versus alternative at 9.1% (p=0.121) and 1-year mortality of TF at 5.3% versus alternative at 13.6% (p=0.143). Hospitalization times were significantly longer in the alternative group (median hospital stay in days of TF 4 versus alternative 10, p=0.013). Although no statistical significance was found, there were trends towards a higher rate of valve malposition for TF at 3.7% versus alternative at 13.6%, and major vascular complications for TF at 1.6% versus alternative at 9.1%. Conclusion: The authors' institute data demonstrates alternative approach TAVI was associated with a similar mortality rate and post-procedural complication rate compared with transfemoral TAVI, except for a trend toward a higher rate of valve malposition and major vascular complications. The alternative approach TAVI may be favored in patients with high or prohibitive surgical risk unsuitable for transfemoral TAVI. [ABSTRACT FROM AUTHOR]

Thai Guidelines for Transcatheter Aortic Valve Implantation (TAVI) were initiated by the Thai Heart Association, Society of Thoracic Surgeons of Thailand, and Cardiovascular Intervention Association of Thailand. There are several factors in Thailand that differ from western countries, such as patient life expectancy, the types of available TAVI valves, socio-economic status, and experiences in TAVI. Therefore, Thailand-specific guidelines would be of great benefit for Thai patients. The objectives of the guidelines are to provide update recommendations regarding best practice in patients undergoing TAVI in Thailand, to emphasize the importance of a multidisciplinary heart valve team, and to emphasize the importance of data collection and follow up in patients undergoing TAVI for quality improvement. Classes of recommendation were based on standard classification and level of evidence. Recommendations were categorized into recommendation for multidisciplinary heart valve team, for perioperative risk assessment, for patient selection, for antithrombotic treatment after TAVI, for hospital and operator requirement, and for TAVI data collection. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Dyslipidemia is one of the risk factor of coronary artery disease but there have been reports showing paradoxical effect of LDL cholesterol (LDL-C) level which lower LDL-C level at the time of diagnosis of patients with acute coronary syndrome was associated with higher 1-year mortality. However, this relationship has not been established in Thai patients. Objective: To evaluate LDL-C and 1-year all-cause mortality rate after acute ST-elevation myocardial infarction (STEMI) in Thailand. Materials and Methods: The present study was a retrospective study of 1,542 consecutive patients with STEMI from 1999 to 2015 whom underwent percutaneous coronary intervention (PCI) either primary PCI or rescue PCI at a tertiary care hospital in Thailand. Patients were classified into 4 groups according to their initial LDL-C level: <70 (group 1), 70-99 (group 2), 100-129 (group 3) and ≥130 mg/dl (group 4). The primary end point was a 1-year all-cause mortality rate. T-test, Chi-square and survival time analysis were used to analyze. Results: The rates of 1-year all-cause mortality were 23.0%, 21.2%, 12.3% and 9.2% in group 1, group 2, group 3 and group 4, respectively. Comparing with group 4, the hazard ratio (HR) was 2.72 (95 % confidence interval [CI] 1.62-4.57; P<0.001) for group 1, HR 2.45 (95% CI 1.64-3.66; p<0.001) for group 2 and HR 1.35 (95% CI 0.89-2.06; p=0.153) for group 3. In multivariate analysis, the predictors of 1-year all-cause mortality were Killip class IV (HR 2.40, 95% CI 1.78-3.25; p<0.001), cardiopulmonary resuscitation (HR 2.25, CI 1.64-3.09; p<0.001), left ventricular ejection fraction ≤40% (HR 2.07, 95% CI 1.57-2.72; p<0.001), culprit lesion at left main (HR 1.78, 95% CI 1.13-2.81; p=0.024), creatinine >1.5 mg/dl (HR 1.77, 95% CI 1.32-2.38; p<0.001), but not the LDL-C level (p=0.732) Conclusion: In this single center experience, lower LDL-C level at time of diagnosis of STEMI was associated with higher 1-year allcause mortality but the effect was not shown after multivariate analysis. This represent LDL-C was not the risk factor to predict 1-year all-cause mortality in STEMI but there were other factors that associated with the outcome. LDL-C was independent risk marker. [ABSTRACT FROM AUTHOR]