35 results on '"Chee Yang Chin"'
Search Results
2. Trainee doctor clinics after 24-hour shifts: Effects on patient satisfaction and prescription errors
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Chee Yang Chin, Si Qi Tan, Swee Leng Kui, Kurugulasigamoney Gunasegaran, and Jill Cheng Sim Lee
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medical education ,sleep deprivation ,physician training ,outpatient clinics ,patient satisfaction ,patient safety ,Education (General) ,L7-991 ,Medicine (General) ,R5-920 - Abstract
Introduction: Sleep deprivation impacts clinical performance. However, literature is conflicting, with insufficient focus on patient outcomes. The aim of this study was to assess if patient satisfaction and prescription errors in outpatient clinics were adversely affected when consulting post-call versus non-post-call registrars. Methods: This prospective, quantitative study was set in a large teaching hospital in Singapore. Between November 2015 and February 2016, patients from clinics run by a registrar after 24-hour shift were recruited to post-call group. Patients from non-post-call clinics run by the same registrar were controls. Outcome measures were patient satisfaction, using 5-item 4-point Likert scale questionnaire, and prescribing error rate, defined as number of errors over number of orders. Differences were analysed using chi-squared test. Results: 103 of 106 (97%) patients in 9 post-call clinics and 93 of 105 (90%) patients in 9 non-post-call clinics were recruited. Questionnaire completion rate was 99%. 536 and 526 prescriptions were ordered in post-call and non-post-call groups, respectively. Percentage of top-box responses (greatest satisfaction) was higher in post-call group overall (79.3% versus 62.4%, p
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- 2021
- Full Text
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3. Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial
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Thu-Thao Le, Briana W. Y. Ang, Jennifer A. Bryant, Chee Yang Chin, Khung Keong Yeo, Philip E. H. Wong, Kay Woon Ho, Jack W. C. Tan, Phong Teck Lee, Calvin W. L. Chin, and Stuart A. Cook
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Exercise stress ,Supine cycle ergometer ,Coronary artery disease ,Cardiovascular magnetic resonance ,Fractional flow reserve ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. Methods In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. Results In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ 2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P
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- 2021
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4. Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method
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Jun-Mei Zhang, Huan Han, Ru-San Tan, Ping Chai, Jiang Ming Fam, Lynette Teo, Chee Yang Chin, Ching Ching Ong, Ris Low, Gaurav Chandola, Shuang Leng, Weimin Huang, John C. Allen, Lohendran Baskaran, Ghassan S. Kassab, Adrian Fatt Hoe Low, Mark Yan-Yee Chan, Koo Hui Chan, Poay Huan Loh, Aaron Sung Lung Wong, Swee Yaw Tan, Terrance Chua, Soo Teik Lim, and Liang Zhong
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coronary artery disease ,fractional flow reserve ,computed tomography coronary angiography ,analytical method ,non-invasive ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The aim of this study was to evaluate a new analytical method for calculating non-invasive fractional flow reserve (FFRAM) to diagnose ischemic coronary lesions. Patients with suspected or known coronary artery disease (CAD) who underwent computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) with FFR measurements from two sites were prospectively recruited. Obstructive CAD was defined as diameter stenosis (DS) ≥50% on CTCA or ICA. FFRAM was derived from CTCA images and anatomical features using analytical method and was compared with computational fluid dynamics (CFD)-based FFR (FFRB) and invasive ICA-based FFR. FFRAM, FFRB, and invasive FFR ≤ 0.80 defined ischemia. A total of 108 participants (mean age 60, range: 30–83 years, 75% men) with 169 stenosed coronary arteries were analyzed. The per-vessel accuracy, sensitivity, specificity, and positive predictive and negative predictive values were, respectively, 81, 75, 86, 81, and 82% for FFRAM and 87, 88, 86, 83, and 90% for FFRB. The area under the receiver operating characteristics curve for FFRAM (0.89 and 0.87) and FFRB (0.90 and 0.86) were higher than both CTCA- and ICA-derived DS (all p < 0.0001) on per-vessel and per-patient bases for discriminating ischemic lesions. The computational time for FFRAM was much shorter than FFRB (2.2 ± 0.9 min vs. 48 ± 36 min, excluding image acquisition and segmentation). FFRAM calculated from a novel and expeditious non-CFD approach possesses a comparable diagnostic performance to CFD-derived FFRB, with a significantly shorter computational time.
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- 2021
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5. Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention
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Gaurav Chandola, Jun-Mei Zhang, Ru-San Tan, Ping Chai, Lynette Teo, John C. Allen, Ris Low, Weimin Huang, Shuang Leng, Jiang Ming Fam, Chee Yang Chin, Ghassan S. Kassab, Adrian Fatt Hoe Low, Swee Yaw Tan, Terrance Chua, Soo Teik Lim, and Liang Zhong
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fractional flow reserve ,stents ,hemodynamics ,coronary angiography ,computed tomography angiography ,Biotechnology ,TP248.13-248.65 - Abstract
Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): −0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: −0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.
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- 2021
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6. Effect of Cangrelor on Infarct Size in ST-Segment–Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention: A Randomized Controlled Trial (The PITRI Trial)
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Bulluck, Heerajnarain, Chong, Jun Hua, Bryant, Jennifer, Annathurai, Annitha, Chai, Ping, Chan, Mervyn, Chawla, Ashish, Chin, Chee Yang, Chung, Yiu-Cho, Gao, Fei, Ho, Hee Hwa, Ho, Andrew Fu Wah, Hoe, John, Imran, Syed Saqib, Lee, Chi-Hang, Lim, Benji, Lim, Soo Teik, Lim, Swee Han, Liew, Boon Wah, Zhan Yun, Patrick Lim, Ong, Marcus Eng Hock, Paradies, Valeria, Pung, Xuan Ming, Tay, Julian Cheong Kiat, Teo, Lynette, Ting, Boon Ping, Wong, Aaron, Wong, Evelyn, Watson, Timothy, Chan, Mark Y., Keong, Yeo Khung, Tan, Jack W.C., Hausenloy, Derek J., Tan, Jack W.C., Hausenloy, Derek J., Chi, Chee-Tang, Tay, Julian, Xuan Ming, Pung, Anbalakan, Kamalesh, Yann San, Keh, Chew, Kenneth, Chan, Michelle, Rilong, Hong, Swee Leng, Kui, Soo Teik, Lim, Lee, Audry, Maverick Rubillar, Felix, Cai, James, Yap, Jonathan, Ning Yan, Wong, Kay Woon, Ho, Fang Yi, Lim, Xia Yen, Shen, Xucong, Ruan, Khung Keong, Yeo, Hua Chong, Jun, Bryant, Jennifer, Chua, Terrance, Yang Chin, Chee, Paradies, Valeria, Wong, Aaron, Bahru, Leong, Teo, Tina, Ru San, Tan, Hak Chiaw, Tang, Chin, Calvin, Ang, Florence, Kyaw, Min-Tun, Priyalatha, S., Chua, Jia-Mei, Yip, Deborah, Lee, Rosalind, Oh, Katherina, Pei Yi, Ho, Wanshan, Leow, Atiqa Binte Rahmat, Syamimi, Yar Chze, Gan, Hausenloy, Derek J., Gao, Fei, Yan Tan, Shi, Chan, Mervyn, Fatimah, Lateef, Ho, Andrew, Choon Peng Jeffrey, Wee, Han Lim, Swee, Ong Eng Hock, Marcus, Wong, Evelyn, Tan Boon Kiat, Kenneth, Venkataraman, Anantharaman, Chan, Mark Y., Lee, Chi-Hang, Ping, Chai, Fatt Hoe Adrian, Low, Koo Hui, Chan, Poay Huan, Loh, Yi-Ting Laureen, Wang, Zhengfeng Jason, Chen, Dalakoti, Mayank, Ng, Perryn, Ching Hui, Sia, Chook, Shaun, Yip, Alfred, Zhe Yan, Ng, Hartanto Djohan, Andie, Houdmont, Marie, Chew, Nicholas, Jiamin, Siew, Ng, Faclin, Teo, Lynette, Ching Ong, Ching, Song, Junda, Kuang Low, Choong, Shalini, Nair, Francis Prabath, Joseph, Ho, Hee-Hwa, Mahadi, Tasha, Watson, Timothy, Ong, Paul, Xin Ni, Koo, Chai Jun Hui, Tony, Yue Ting, Ho, Zhi Lin Deanna, Khoo, Lee Jin Hyun, Deborah, Ki Fung Cliff, Li, Low Jun Bang, Randal, Joo Hor, Tan, Ke Xuan Jessica, Ng, Jia Min, Chua, Wei Sheng Jonathan, Ong, Xuyan, Teoh, Shu Qi Benita, Chiang, Sim Wen Jun, Eran, An Shing, Ang, Jia-ling Stephanie, Quek, Rui Yi, Pang, Ahmad Hatib Muhammad Alimi, Bin, Jin Hyun, Lee, Shiane, Lim, Chong Keat, Tan, Shonda, Ng, Hoe, John, Tan, Jack, Chee Yang, Chin, Jian Ming, Fam, Raudha, Siti, Annathurai, Annitha, Ping Ting, Boon, Chawla, Ashish, Saqib Imran, Syed, Lim Zhan Yun, Patrick, Tan, Alvin, Lim, Benji, Wah Liew, Boon, and Thon Hon, Yong
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- 2024
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7. Effective scene change detection in complex environments.
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Hui-Fuang Ng and Chee Yang Chin
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- 2019
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8. A Flexible and Reliable Internet-of-Things Solution for Real-Time Production Tracking With High Performance and Secure Communication
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Boon-Yaik Ooi, Wai-Kong Lee, Martin J. W. Shubert, Yu-Wei Ooi, Chee-Yang Chin, and Wing-Hon Woo
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Control and Systems Engineering ,Electrical and Electronic Engineering ,Industrial and Manufacturing Engineering - Published
- 2023
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9. Trainee doctor clinics after 24-hour shifts: Effects on patient satisfaction and prescription errors
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Si Qi Tan, Chee Yang Chin, Kurugulasigamoney Gunasegaran, Swee Leng Kui, and Jill Cheng Sim Lee
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Medicine (General) ,medicine.medical_specialty ,patient satisfaction ,business.industry ,Medicine (miscellaneous) ,Education (General) ,sleep deprivation ,Health Professions (miscellaneous) ,Education ,outpatient clinics ,R5-920 ,Patient satisfaction ,Family medicine ,Reviews and References (medical) ,patient safety ,medicine ,L7-991 ,Medical prescription ,medical education ,business ,physician training - Abstract
Introduction: Sleep deprivation impacts clinical performance. However, literature is conflicting, with insufficient focus on patient outcomes. The aim of this study was to assess if patient satisfaction and prescription errors in outpatient clinics were adversely affected when consulting post-call versus non-post-call registrars. Methods: This prospective, quantitative study was set in a large teaching hospital in Singapore. Between November 2015 and February 2016, patients from clinics run by a registrar after 24-hour shift were recruited to post-call group. Patients from non-post-call clinics run by the same registrar were controls. Outcome measures were patient satisfaction, using 5-item 4-point Likert scale questionnaire, and prescribing error rate, defined as number of errors over number of orders. Differences were analysed using chi-squared test. Results: 103 of 106 (97%) patients in 9 post-call clinics and 93 of 105 (90%) patients in 9 non-post-call clinics were recruited. Questionnaire completion rate was 99%. 536 and 526 prescriptions were ordered in post-call and non-post-call groups, respectively. Percentage of top-box responses (greatest satisfaction) was higher in post-call group overall (79.3% versus 62.4%, p
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- 2021
- Full Text
- View/download PDF
10. Multiparametric exercise stress cardiovascular magnetic resonance in the diagnosis of coronary artery disease: the EMPIRE trial
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Jennifer A. Bryant, Chee Yang Chin, Philip Wong, Thu-Thao Le, Khung Keong Yeo, Stuart A. Cook, Calvin W. L. Chin, Kay Woon Ho, Jack Wei Chieh Tan, Phong Teck Lee, and Briana Ang
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Cardiac & Cardiovascular Systems ,Cardiac index ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,030218 nuclear medicine & medical imaging ,Angina ,0302 clinical medicine ,Medicine ,Prospective Studies ,1102 Cardiorespiratory Medicine and Haematology ,Singapore ,Ejection fraction ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Radiology, Nuclear Medicine & Medical Imaging ,Exercise stress ,Middle Aged ,Fractional Flow Reserve, Myocardial ,Nuclear Medicine & Medical Imaging ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Life Sciences & Biomedicine ,medicine.medical_specialty ,Perfusion Imaging ,Magnetic Resonance Imaging, Cine ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Supine cycle ergometer ,Aged ,Angiology ,Science & Technology ,business.industry ,Research ,Reproducibility of Results ,Magnetic resonance imaging ,medicine.disease ,Bicycling ,lcsh:RC666-701 ,Angiography ,Cardiovascular System & Cardiology ,Exercise Test ,Cardiovascular magnetic resonance ,business - Abstract
Background Stress cardiovascular magnetic resonance (CMR) offers assessment of ventricular function, myocardial perfusion and viability in a single examination to detect coronary artery disease (CAD). We developed an in-scanner exercise stress CMR (ExCMR) protocol using supine cycle ergometer and aimed to examine the diagnostic value of a multiparametric approach in patients with suspected CAD, compared with invasive fractional flow reserve (FFR) as the reference gold standard. Methods In this single-centre prospective study, patients who had symptoms of angina and at least one cardiovascular disease risk factor underwent both ExCMR and invasive angiography with FFR. Rest-based left ventricular function (ejection fraction, regional wall motion abnormalities), tissue characteristics and exercise stress-derived (perfusion defects, inducible regional wall motion abnormalities and peak exercise cardiac index percentile-rank) CMR parameters were evaluated in the study. Results In the 60 recruited patients with intermediate CAD risk, 50% had haemodynamically significant CAD based on FFR. Of all the CMR parameters assessed, the late gadolinium enhancement, stress-inducible regional wall motion abnormalities, perfusion defects and peak exercise cardiac index percentile-rank were independently associated with FFR-positive CAD. Indeed, this multiparametric approach offered the highest incremental diagnostic value compared to a clinical risk model (χ2 for the diagnosis of FFR-positive increased from 7.6 to 55.9; P Conclusion The study demonstrates the clinical potential of using in-scanner multiparametric ExCMR to accurately diagnose CAD. Trial registration: ClinicalTrials.gov, NCT03217227, Registered 11 July 2017–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03217227?id=NCT03217227&draw=2&rank=1&load=cart
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- 2021
11. OCT and IVUS Appearance of a Neointimal Dissection Within a Recently Implanted Left Main Stent
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Adrian F. Low, Chee Yang Chin, Yann Shan Keh, and Khung Keong Yeo
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Dissection ,medicine.medical_treatment ,Stent ,Coronary Artery Disease ,Dissection (medical) ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,Optical coherence tomography ,Neointima ,medicine ,Humans ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence ,Ultrasonography, Interventional - Published
- 2021
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12. Quantification of effects of mean blood pressure and left ventricular mass on noninvasive fast fractional flow reserve
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Gaurav Chandola, Aaron Sung Lung Wong, Swee Yaw Tan, Terrance Chua, Soo Teik Lim, Chee Yang Chin, Ris Low, John Carson Allen, Adrian F. Low, Jiang Ming Fam, Ghassan S. Kassab, Lynette Teo, Jun-Mei Zhang, Liang Zhong, Ping Chai, Ru San Tan, and Weimin Huang
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Male ,Patient-Specific Modeling ,Cfd simulation ,medicine.medical_specialty ,Brachial Artery ,Computed Tomography Angiography ,Physiology ,Heart Ventricles ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Coronary artery disease ,Left ventricular mass ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Physiology (medical) ,Internal medicine ,Multidetector Computed Tomography ,medicine ,Humans ,Arterial Pressure ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Observer Variation ,business.industry ,Models, Cardiovascular ,Reproducibility of Results ,Middle Aged ,medicine.disease ,Coronary Vessels ,Fractional Flow Reserve, Myocardial ,Blood pressure ,Mean blood pressure ,Hydrodynamics ,Cardiology ,Radiographic Image Interpretation, Computer-Assisted ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis.
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- 2020
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13. A Flexible and Reliable Internet-of-Things Solution for Real-Time Production Tracking
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Boon-Yaik Ooi, Wai-Kong Lee, Martin Schubert, Yu-Wei Ooi, Chee-Yang Chin, and Wing-Hon Woo
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- 2021
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14. What drives attrition amongst obstetrics and gynaecology residents in Singapore?
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Xiang Lee Jamie Kee, Bernard Chern, Jill Cheng Sim Lee, Chee Yang Chin, and Sharon Wiener-Ogilvie
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medicine.medical_specialty ,lcsh:R5-920 ,Work Experience ,business.industry ,Medicine (miscellaneous) ,medicine.disease ,Health Professions (miscellaneous) ,lcsh:Education (General) ,Education ,Obstetrics and gynaecology ,Family medicine ,Reviews and References (medical) ,Obstetrics and Gynaecology ,Medicine ,Attrition ,business ,Resident Attrition ,lcsh:L7-991 ,lcsh:Medicine (General) - Abstract
Background: Resident attrition is costly but literature studying the motivations behind it in obstetrics and gynaecology (OBGYN) is lacking. Objectives: We aimed to study the relationship between prior specialty-appropriate work experience and risk of attrition amongst OBGYN residents in Singapore, and identify factors placing residents at greater risk of attrition. Methods: This nationwide mixed methods case control study studied all OBGYN residents in Singapore for the 2011 and 2012 intakes. A pre-piloted questionnaire was used to identify work experience and risk factors related to resident attrition. Structured interviews were conducted with a subgroup of participants chosen for diversity of educational background, work experience, and position towards residency. Results: 28 of 33 (84.8%) eligible residents participated in this study. Female (40.9% vs. 0%), married (50.0% vs. 22.2%) and Singaporean (38.1% vs.14.3%) residents more often considered attrition from training. Those accepted into residency after graduation were 33% less likely to have considered leaving. No statistical difference was observed between residents with prior work experience and those without (38.9% vs. 20.0%, p=0.417). All interviewees believed that prior experience informs expectations and eases initial learning. Low job satisfaction related to mismatched expectations was the most quoted reason for considering attrition. 85.7% of interviewed residents were concerned about competing work and family demands. Conclusions: Lack of specialty-appropriate work experience contributes to misinformed training expectations and increased attrition risk. Residents who have considered attrition may still desire career longevity in their specialty. Reduction in mismatched expectations promises to improve job satisfaction and translate to career longevity.
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- 2019
15. Coronary Intravascular Lithotripsy Versus Rotational Atherectomy in an Asian Population: Clinical Outcomes in Real-World Patients
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Jie Jun Wong, Sridharan Umapathy, Yann Shan Keh, Yee How Lau, Jonathan Yap, Muhammad Idu, Chee Yang Chin, Jiang Ming Fam, Boon Wah Liew, Chee Tang Chin, Philip En Hou Wong, Tian Hai Koh, and Khung Keong Yeo
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Internal Medicine ,Cardiology and Cardiovascular Medicine - Abstract
We compared real-world clinical outcomes of patients receiving intravascular lithotripsy (IVL) versus rotational atherectomy (RA) for heavily calcified coronary lesions.Fifty-three patients who received IVL from January 2017 to July 2020 were retrospectively compared to 271 patients who received RA from January 2017 to December 2018. Primary endpoints were in-hospital and 30-day major adverse cardiovascular events (MACE).IVL patients had a higher prevalence of acute coronary syndrome (56.6% vs 24.4, p0.001), multivessel disease (96.2% vs 73.3%, p0.001) and emergency procedures (17.0% vs 2.2%, p0.001) compared to RA. In-hospital MACE (11.3% vs 5.9%, p=0.152), MI (7.5% vs 3.3%, p=0.152), and mortality (5.7% vs 3.0%, p=0.319) were not statistically significant. 30-day MACE was higher in the IVL cohort vs RA (17.0% vs 7.4%, p=0.035). Propensity score adjusted regression using IVL was also performed on in-hospital MACE (odds ratio [OR], 1.677; 95% confidence interval [CI], 0.588-4.779) and 30-day MACE (OR, 1.910; 95% CI, 0.774-4.718).These findings represent our initial IVL experience in a high-risk, real-world cohort. Although the event rate in the IVL arm was numerically higher compared to RA, the small numbers and retrospective nature of this study preclude definitive conclusions. These clinical outcomes are likely to improve with greater experience and better case selection, allowing IVL to effectively treat complex calcified coronary lesions.
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- 2022
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16. Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study
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Chee Yang Chin, Mitsuaki Matsumura, Ziad A. Ali, Dong Yin, Richard Shlofmitz, Gary S. Mintz, Jeffrey W. Moses, Ajay J. Kirtane, Lei Song, Akiko Maehara, Manish Parikh, and Myong Hwa Yamamoto
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Lumen (anatomy) ,Target vessel ,030204 cardiovascular system & hematology ,Coronary Restenosis ,Late presentation ,03 medical and health sciences ,0302 clinical medicine ,Restenosis ,Optical coherence tomography ,Neointima ,medicine ,Humans ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Aged ,medicine.diagnostic_test ,business.industry ,Stent ,Drug-Eluting Stents ,Middle Aged ,Statin treatment ,medicine.disease ,Coronary Vessels ,Female ,Radiology ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - Abstract
In-stent restenosis (ISR) is an important cause of drug-eluting stent (DES) failure and target vessel revascularisation. In this study we aimed to evaluate differences between early and late-presenting restenosis in second-generation DES using optical coherence tomography (OCT).Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area3.0 mm2 were included: 33.3% of patients (n=57) had early ISR, and 66.7% (n=114) had late ISR (duration from stent implantation1 year). Minimum stent area (MSA)4.0 mm2, neointimal thickness100 µm, and heterogeneous neointimal hyperplasia (NIH) were more prevalent in early ISR, whereas NIH with neoatherosclerosis trended towards being more frequent for late ISR (28.9% vs. 15.8%, p=0.06). Multivariable analysis revealed that duration from implantation2 years, absence of statin use, and NIH50% were independent predictors for neoatherosclerosis (all p0.05).OCT morphological characteristics of second-generation DES ISR differ between early and late presentation. Early ISR was associated with MSA4.0 mm2, while neoatherosclerosis contributed more commonly to late ISR.
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- 2017
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17. Cardiac resynchronisation therapy in paediatric patients with pacing induced cardiomyopathy – A single centre experience
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Chee Yang Chin, Swee Leng Kui, and Chi Keong Ching
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medicine.medical_specialty ,Pacing induced cardiomyopathy ,Cardiomyopathy ,business.industry ,MEDLINE ,Case Report ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,Single centre ,0302 clinical medicine ,Paediatric ,Physiology (medical) ,Internal medicine ,Cardiac resynchronisation therapy ,medicine ,Cardiology ,Pacing ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Paediatric patients - Published
- 2018
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18. COVID-19 in Singapore: Graduate Medical Education in The Face of a Global Pandemic
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Caroline Yu Ming Ong, Hak Koon Tan, Xiaoqi Yong, Jill Cheng Sim Lee, Chee Yang Chin, and Chia Wee Chew
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Medical education ,Coronavirus disease 2019 (COVID-19) ,Political science ,Pandemic ,Graduate medical education ,Face (sociological concept) - Abstract
This article was migrated. The article was not marked as recommended. The 2019 novel coronavirus disease (COVID-19) spreads outside China rapidly and became a global pandemic. Recognising its severity and with experiences from the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) outbreak in 2003, the Singapore government promptly and decisively implemented measures to contain the disease. Many of them have direct effects on our healthcare workers (HCW), and our graduate medical education, which is modelled after the US residency training system, has invariably been impacted to a large degree. Strategies aimed at minimising unnecessary contact between HCW, and directives to step up on human resources as healthcare institutions prepare to cope with a disease outbreak called for modifications to residents' training routine. Residents are affected by curtailment of leave and reallocation of manpower to meet the demands at various frontlines and have to cope with significant physical and emotional stress from anxiety and even pessimism as the situation unfolds with unpredictability. Nevertheless, the pandemic also presents a rare opportunity for residents to learn about healthcare in an international and interdisciplinary context, and develop qualities like resilience, adaptability and solidarity in the face of a medical crisis.
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- 2020
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19. ‘Balanced ischaemia’ on ECG in dual territory STEMI
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Iswaree Balakrishnan, Louis L. Y. Teo, Khung Keong Yeo, Chee Yang Chin, and Boon Yew Tan
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medicine.medical_specialty ,Coronary artery occlusion ,medicine.diagnostic_test ,business.industry ,Ischemia ,Case Report ,030204 cardiovascular system & hematology ,medicine.disease ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,St elevation myocardial infarction ,030220 oncology & carcinogenesis ,Internal medicine ,Culprit lesion ,medicine ,Cardiology ,Parasitology ,cardiovascular diseases ,business ,Electrocardiography - Abstract
Culprit lesion identification in ST elevation myocardial infarction (STEMI) is often guided by electrocardiogram (ECG) changes. However, in the setting of multi-vessel coronary artery occlusion, this can be challenging. We describe an interesting case of dual territory STEMI with unanticipated ECG changes that bring forth the concept of ‘balanced ischaemia’. These seemingly bizarre findings are well explained using the fundamentals of electrocardiography reinstating its relevance in modern day cardiology.
- Published
- 2018
20. Answer to June 2018 Photo Quiz
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Chee Yang Chin, James Heng Chiak Sim, Boon Yew Tan, and Zijuan Huang
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Microbiology (medical) ,medicine.medical_specialty ,business.industry ,General surgery ,medicine ,Bacteriology ,Endocarditis ,Photo Quiz ,medicine.disease ,business ,Clinical method - Published
- 2018
21. Photo Quiz: A Fishy Tale of Endocarditis
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Boon Yew Tan, Chee Yang Chin, Zijuan Huang, and James Heng Chiak Sim
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Microbiology (medical) ,medicine.medical_specialty ,business.industry ,General surgery ,Medicine ,Endocarditis ,Photo Quiz ,business ,medicine.disease ,Clinical method - Published
- 2018
22. Optical Coherence Tomography Assessment of Morphological Characteristics in Suspected Coronary Artery Disease, but Angiographically Nonobstructive Lesions
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Monica Losquadro, Mitsuaki Matsumura, Richard Shlofmitz, Akiko Maehara, Fernando Sosa, Chee Yang Chin, Myong Hwa Yamamoto, Gary S. Mintz, and Lei Song
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,New York ,Lumen (anatomy) ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Culprit ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Thrombus ,Acute Coronary Syndrome ,Aged ,Retrospective Studies ,Unstable angina ,business.industry ,Coronary Stenosis ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Stenosis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - Abstract
Background/purpose We sought to evaluate the morphological characteristics of nonobstructive coronary lesions in patients with ischemic symptoms and/or signs. Materials/methods We used optical coherence tomography (OCT) to assess the presumed culprit lesion in 142 patients with suspected coronary artery disease in whom coronary angiography showed no lesion with a diameter stenosis ≥50%. Patients with a clinical diagnosis of acute coronary syndrome (ACS, n = 31, including 2 ST-elevation myocardial infarction, 9 non-ST-elevation myocardial infarction, and 20 unstable angina pectoris) were compared to those with stable coronary artery disease (CAD) (n = 111) including 79 patients with stable angina and 32 patients with silent ischemia (positive non-invasive stress test only). Results The overall prevalence of thrombus, plaque rupture, intimal laceration, or calcified nodule in the combined groups was 23.2% (33/142) including 15 thrombus, 12 plaque rupture, 9 calcified nodule, and 8 intimal laceration (not mutually exclusive) without differences between ACS and stable CAD patients. Also the prevalence of thin-cap fibroatheroma was not significantly different between ACS and stable patients (12.9% vs 6.3%, p = 0.22). Minimum lumen area (3.1 mm2 [2.3, 4.1] versus 3.2 mm2 [2.4, 4.7], p = 0.7) and area stenosis (49.9% [37.1, 56.4] versus 48.1% [37.8, 55.8], p = 0.9) were similar between ACS and stable CAD patients. Conclusion In patients presenting with ischemic symptoms and/or signs, but angiographically nonobstructive culprit lesions, approximately 25% had abnormal findings by OCT—whether patients presented with acute/unstable or stable CAD.
- Published
- 2018
23. Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions
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Boyang Su, Aileen Mae Lomarda, Jack Wei Chieh Tan, Xiaodan Zhao, Nasrul Bin Ismail, Tian Hai Koh, Ris Low, Aaron Sung Lung Wong, Hua Zou, Khung Keong Yeo, Soo Teik Lim, Terrance Chua, Like Gobeawan, Swee Yaw Tan, Chee Yang Chin, Kay Woon Ho, Yi Su, Jun-Mei Zhang, Philip Wong, Xi Su, Soo-Kng Teo, John Carson Allen, Jonathan Yap, Felix Keng, Yanling Chi, Min Wan, Lohendran Baskaran, Chee Tang Chin, Liang Zhong, Dongsi Shuang, Jiang Ming Fam, Ghassan S. Kassab, Jiayin Zhou, Ru San Tan, Weimin Huang, and Weijun Wu
- Subjects
Coronary angiography ,Male ,China ,Computed Tomography Angiography ,Increased AUC ,Ischemia ,Hemodynamics ,Computed tomography ,Fractional flow reserve ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Singapore ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,Coronary Vessels ,Plaque, Atherosclerotic ,Fractional Flow Reserve, Myocardial ,Stenosis ,Dimensional Measurement Accuracy ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
Background Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia. Methods 49 (61 lesions) patients underwent CTCA and invasive FFR. Lesions with diameter stenosis (DS) ≥ 50% were considered obstructive. CTCA image processing incorporating analytical and numerical methods were used to quantify anatomical parameters of lesion length (LL) and minimum lumen area (MLA); plaque characteristic parameters of plaque volume, low attenuation plaque (LAP) volume, dense calcium volume (DCV), normalized plaque volume (NP Vol), plaque burden, eccentricity index and napkin-ring (NR) sign; and hemodynamic parameters of resistance index, stenosis flow reserve (SFR) and FFR B . Ischemia was defined as FFR ≤ 0.8. Results Plaque burden and plaque volume were inversely related to FFR. Multivariable logistic regression analysis identified the best anatomical, plaque and hemodynamic predictors, respectively, as DS (≥50% vs B (≤0.8 vs >0.8; OR: 44.4; 95% CI: 8.8–224.8). AUC increased from 0.70 with DS as the sole predictor to 0.81 after adding NP Vol and NR Sign; further addition of FFR B increased AUC to 0.93. Conclusion Normalized plaque volume, napkin-ring derived from plaque analysis, and FFR B from numerical simulations on CTCA images substantially improved discrimination of ischemic lesions, compared to assessment by DS alone.
- Published
- 2018
24. Quantification of effects of mean blood pressure and left ventricular mass on noninvasive fast fractional flow reserve.
- Author
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Jun-Mei Zhang, Chandola, Gaurav, Ru-San Tan, Ping Chai, Teo, Lynette L. S., Low, Ris, Allen, John Carson, Weimin Huang, Jiang Ming Fam, Chee Yang Chin, Lung Wong, Aaron Sung, Low, Adrian F., Kassab, Ghassan S., Chua, Terrance, Tan, Swee Yaw, Soo Teik Lim, and Liang Zhong
- Abstract
Proper inlet boundary conditions are essential for accurate computational fluid dynamics (CFD) modeling. We developed methodology to derive noninvasive FFR
B using CFD and computed tomography coronary angiography (CTCA) images. This study aims to assess the influence of brachial mean blood pressure (MBP) and total coronary inflow on FFRB computation. Twenty-two patients underwent both CTCA and FFR measurements. Total coronary flow was computed from left ventricular mass (LVM) measured from CTCA. A total of 286 CFD simulations were run by varying MBP and LVM at 70, 80, 90, 100, 110, 120, and 130% of the measured values. FFRB increased with incrementally higher input values of MBP: 0.78 ± 0.12, 0.80 ± 0.11, 0.82 ± 0.10, 0.84 ± 0.09, 0.85 ± 0.08, 0.86 ± 0.08, and 0.87 ± 0.07, respectively. Conversely, FFRB decreased with incrementally higher inputs value of LVM: 0.86 ± 0.08, 0.85 ± 0.08, 0.84 ± 0.09, 0.84 ± 0.09, 0.83 ± 0.10, 0.83 ± 0.10, and 0.82 ± 0.10, respectively. Noninvasive FFRB calculated using measured MBP and LVM on a total of 30 vessels was 0.84 ± 0.09 and correlated well with invasive FFR (0.83 ± 0.09) (r = 0.92, P < 0.001). Positive association was observed between FFRB and MBP input values (mmHg) and negative association between FFRB and LVM values (g). Respective slopes were 0.0016 and −0.005, respectively, suggesting potential application of FFRB in a clinical setting. Inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. NEW & NOTEWORTHY While brachial mean blood pressure (MBP) and left ventricular mass (LVM) measured from CTCA are the two CFD simulation input parameters, their effects on noninvasive fractional flow reserve (FFRB ) have not been systematically investigated. We demonstrate that inaccurate MBP and LVM inputs differing from patient-specific values could result in misclassification of borderline ischemic lesions. This is important in the clinical application of noninvasive FFR in coronary artery disease diagnosis. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
25. Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents
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Akiko Maehara, Ajay J. Kirtane, Khady Fall, Gary S. Mintz, Mitsuaki Matsumura, Richard Shlofmitz, Chee Yang Chin, Myong Hwa Yamamoto, Lei Song, Jeffrey W. Moses, Manish Parikh, Ziad A. Ali, and Dong Yin
- Subjects
Bare-metal stent ,Male ,Time Factors ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,0302 clinical medicine ,Restenosis ,Risk Factors ,Odds Ratio ,030212 general & internal medicine ,media_common ,Aged, 80 and over ,medicine.diagnostic_test ,Fibrous cap ,Drug-Eluting Stents ,Middle Aged ,Coronary Vessels ,Plaque, Atherosclerotic ,Prosthesis Failure ,medicine.anatomical_structure ,Treatment Outcome ,Drug-eluting stent ,Metals ,Cardiology ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,Tomography, Optical Coherence ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,New York ,Prosthesis Design ,Coronary Restenosis ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Thrombus ,Aged ,Retrospective Studies ,Chi-Square Distribution ,business.industry ,Stent ,medicine.disease ,Logistic Models ,Multivariate Analysis ,business - Abstract
Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9 ± 47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n = 106), more stent underexpansion or fracture/deformation was observed in second-generation DES, whereas thrombus, without plaque rupture, or evagination was more common in first-generation DES. In multivariable analyses, duration from implantation >1 year (OR: 2.44, 95% CI 1.12–5.31; p = 0.03), absence of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (OR 1.95, 95% CI 1.10–3.44; p = 0.02) or statins at the time of ISR (OR 3.12, 95% CI 1.42–6.84; p = 0.01), and first-generation vs first-generation DES (OR 5.32, 95% CI 2.82–10.10; p
- Published
- 2016
26. Utility of near-infrared spectroscopy for detection of thin-cap neoatherosclerosis
- Author
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Wojciech Wojakowski, Emmanouil S. Brilakis, Gary S. Mintz, Gregg W. Stone, Akiko Maehara, Martin B. Leon, Ziad A. Ali, Ajay J. Kirtane, Tomasz Roleder, Keyvan Karimi Galougahi, Navdeep Bhatti, Tamim Nazif, Chee Yang Chin, and Dimitri Karmpaliotis
- Subjects
Male ,Pathology ,genetic structures ,Treatment outcome ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Cohort Studies ,0302 clinical medicine ,Restenosis ,030212 general & internal medicine ,Angioplasty, Balloon, Coronary ,Observer Variation ,Spectroscopy, Near-Infrared ,medicine.diagnostic_test ,Fibrous cap ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,Prognosis ,surgical procedures, operative ,medicine.anatomical_structure ,Treatment Outcome ,Female ,Cardiology and Cardiovascular Medicine ,Observer variation ,Tomography, Optical Coherence ,medicine.medical_specialty ,Risk Assessment ,03 medical and health sciences ,Optical coherence tomography ,Predictive Value of Tests ,Neointima ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Analysis of Variance ,business.industry ,Near-infrared spectroscopy ,technology, industry, and agriculture ,Original Articles ,equipment and supplies ,medicine.disease ,Survival Analysis ,Coronary arteries ,Logistic Models ,ROC Curve ,sense organs ,In stent restenosis ,business ,Nuclear medicine - Abstract
Near-infrared spectroscopy (NIRS) has been employed to assess the composition of the atherosclerotic plaques in native coronary arteries. However, little is known about the detection of neoatherosclerosis by NIRS in in-stent restenosis (ISR). The aim of the study was to assess the relationship between the distribution of lipid determined by NIRS and morphology of ISR on optical coherence tomography (OCT).We performed both NIRS and OCT in 39 drug-eluting stents with ISR. Values of lipid-core burden index (LCBI) derived by NIRS were compared with the OCT-derived thickness of the fibrous cap covering neoatherosclerotic lesions. A total of 22 (49%) in-stent neointimas were identified as lipid rich by both NIRS and OCT. There was good agreement between OCT and NIRS in identifying lipid within in-stent neointima (kappa = 0.60, 95% CI: 0.34-0.86). OCT identified thin-cap neoatheromas (TCNA) (65 µm) in 12 stents (23%). The minimal cap thickness of in-stent neoatherosclerotic plaque measured by OCT correlated with the maxLCBI4mm (maximal LCBI per 4 mm) within the stent (r = -0.77, P0.01). Moreover, maxLCBI4mm was able to accurately predict TCNA with a cut-off value of144.NIRS correlates with OCT identification of lipids in stented vessels and is able to predict the presence of thin fibrous cap neoatheroma.
- Published
- 2016
27. Relation Between Renal Function and Coronary Plaque Morphology (from the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Virtual Histology-Intravascular Ultrasound Substudy)
- Author
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Claire Litherland, Ernest L. Mazzaferri, Bernhard Witzenbichler, Ajay J. Kirtane, Giora Weisz, Gregg W. Stone, Shigeo Saito, Chee Yang Chin, Akiko Maehara, Michael J. Rinaldi, Bruce R. Brodie, Thomas Stuckey, D. Christopher Metzger, Peter L. Duffy, and Gary S. Mintz
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,030232 urology & nephrology ,Lumen (anatomy) ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,Kidney Function Tests ,Culprit ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Myocardial infarction ,Prospective Studies ,Registries ,Prospective cohort study ,Ultrasonography, Interventional ,Aged ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Middle Aged ,medicine.disease ,Plaque, Atherosclerotic ,Creatinine ,Coronary vessel ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors - Abstract
We sought to examine the relation between various degrees of renal function and coronary plaque morphology by grayscale and virtual histology intravascular ultrasound (IVUS). ADAPT-DES was a prospective, multicenter registry of 8,582 consecutive patients treated using coronary drug-eluting stents with a prespecified grayscale and virtual histology-IVUS substudy. A lesion-level analysis of study participants was performed by comparing IVUS parameters of culprit and nonculprit lesions across tertiles of estimated creatinine clearance (CrCl). Preintervention IVUS imaging of 762 patients identified 898 culprit and 752 nonculprit native coronary artery lesions. Patients in the lowest CrCl tertile were older, more often women, and more often presented with stable angina. Compared with the middle and upper tertiles, the lowest tertile was significantly associated with culprit lesion smaller mean external elastic membrane cross-sectional area (12.9 vs 14.2 mm 3 /mm vs 14.9 mm 3 /mm, p 3 /mm vs 5.8 mm 3 /mm vs 6.1 mm 3 /mm, p = 0.002), and more dense calcium volume (11.5% vs 10.2% vs 9.7%, p = 0.02). Similar trends were found in the nonculprit lesions. Plaque rupture was least common in patients in the lowest tertile. On multivariable analysis, independent predictors of greater dense calcium volume were lower CrCl, hyperlipidemia, female gender, and presentation without ST-segment elevation myocardial infarction. In conclusion, in the present large-scale IVUS study diminishing renal function was associated with increased coronary calcification and decreased coronary vessel and lumen sizes, with a graded response according to the reduction in CrCl. In addition, these patients were more likely to present with stable angina versus patients with normal renal function who were more likely to present with an acute coronary syndrome.
- Published
- 2016
28. Imaging Comparisons of Coregistered Native and Stented Coronary Segments by High-Definition 60-MHz Intravascular Ultrasound and Optical Coherence Tomography
- Author
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Akiko Maehara, Khady N. Fall, Ziad A. Ali, Chee Yang Chin, and Gary S. Mintz
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Vessels ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Optical coherence tomography ,Predictive Value of Tests ,Intravascular ultrasound ,medicine ,Image acquisition ,High definition ,Humans ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Image resolution ,Tomography, Optical Coherence ,Ultrasonography, Interventional ,Biomedical engineering - Abstract
High-definition 60-MHz intravascular ultrasound (IVUS) represents the current state of the art in IVUS imaging, offering superior spatial resolution of
- Published
- 2016
29. USE OF OPTICAL COHERENCE TOMOGRAPHY TO DETERMINE THE PATHOGENESIS OF VERY LATE STENT THROMBOSIS IN A NON-COMPLIANT PATIENT WITH PRIOR CORONARY STENTING AND LEFT VENTRICULAR THROMBUS
- Author
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Chee Yang Chin, Swee Leng Kui, and Khung Keong Yeo
- Subjects
Pathogenesis ,medicine.medical_specialty ,Optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Internal medicine ,medicine ,Cardiology ,Coronary stenting ,Stent thrombosis ,Left ventricular thrombus ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
- Full Text
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30. What drives attrition amongst obstetrics and gynaecology residents in Singapore?
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Cheng Sim Lee, Jill, Xiang Lee Jamie Kee, Wiener-Ogilvie, Sharon, Su Min Chern, Bernard, and Chee Yang Chin
- Subjects
ATTRITION in research studies ,GYNECOLOGY ,OBSTETRICS ,JOB satisfaction - Abstract
Background: Resident attrition is costly but literature studying the motivations behind it in obstetrics and gynaecology (OBGYN) is lacking. Objectives: We aimed to study the relationship between prior specialty-appropriate work experience and risk of attrition amongst OBGYN residents in Singapore, and identify factors placing residents at greater risk of attrition. Methods: This nationwide mixed methods case control study studied all OBGYN residents in Singapore for the 2011 and 2012 intakes. A pre-piloted questionnaire was used to identify work experience and risk factors related to resident attrition. Structured interviews were conducted with a subgroup of participants chosen for diversity of educational background, work experience, and position towards residency. Results: 28 of 33 (84.8%) eligible residents participated in this study. Female (40.9% vs. 0%), married (50.0% vs. 22.2%) and Singaporean (38.1% vs.14.3%) residents more often considered attrition from training. Those accepted into residency after graduation were 33% less likely to have considered leaving. No statistical difference was observed between residents with prior work experience and those without (38.9% vs. 20.0%, p=0.417). All interviewees believed that prior experience informs expectations and eases initial learning. Low job satisfaction related to mismatched expectations was the most quoted reason for considering attrition. 85.7% of interviewed residents were concerned about competing work and family demands. Conclusions: Lack of specialty-appropriate work experience contributes to misinformed training expectations and increased attrition risk. Residents who have considered attrition may still desire career longevity in their specialty. Reduction in mismatched expectations promises to improve job satisfaction and translate to career longevity. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
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31. TCTAP C-124 Recurrent Occlusion of Left Anterior Descending Artery During Intervention of Left Main Bifurcation
- Author
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Chee Yang Chin, Wenbin Zhang, Binquan Zhou, and Guosheng Fu
- Subjects
medicine.medical_specialty ,Unstable angina ,business.industry ,Canadian Cardiovascular Society ,medicine.disease ,Angina ,medicine.anatomical_structure ,Clinical history ,Internal medicine ,Occlusion ,medicine ,Cardiology ,Physical exam ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
Patient initials or identifier number STK ### Relevant clinical history and physical exam A 67-year-old man has experienced recurrent unstable angina pectoris (Canadian Cardiovascular Society angina class IV) in the last six months. He had a 30-year history of smoking twenty cigarettes per
- Published
- 2016
- Full Text
- View/download PDF
32. 'BALANCED ISCHEMIA' ON ECG IN DUAL TERRITORY STEMI
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Chee Yang Chin, Louis L. Y. Teo, Khung Keong Yeo, Iswaree Balakrishnan, and Boon Yew Tan
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Ischemia ,medicine ,Cardiology ,DUAL (cognitive architecture) ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2017
- Full Text
- View/download PDF
33. OPTICAL COHERENCE TOMOGRAPHY ASSESSMENT OF MORPHOLOGICAL CHARACTERISTICS IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE, BUT WITH ANGIOGRAPHICALLY NON-OBSTRUCTIVE LESIONS
- Author
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Mitsuaki Matsumura, Chee Yang Chin, Gary S. Mintz, Monica Losquardo, Richard Shlofmitz, Myong Hwa Yamamoto, Lei Song, Akiko Maehara, and Fernando Sosa
- Subjects
Coronary artery disease ,medicine.medical_specialty ,Optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Internal medicine ,medicine ,Cardiology ,In patient ,Radiology ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business - Published
- 2016
- Full Text
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34. MECHANISMS AND PATTERNS OF IN-STENT RESTENOSIS AMONG BARE-METAL AND 1ST AND 2ND GENERATION DRUG-ELUTING STENTS: AN OPTICAL COHERENCE TOMOGRAPHY STUDY
- Author
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Mitsuaki Matsumura, Lei Song, Ajay J. Kirtane, Akiko Maehara, Gary S. Mintz, Jeffrey W. Moses, Manish Parikh, Myong Hwa Yamamoto, Ziad A. Ali, Richard Shlofmitz, and Chee Yang Chin
- Subjects
medicine.medical_specialty ,genetic structures ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Stent ,Lumen (anatomy) ,equipment and supplies ,medicine.disease ,eye diseases ,Optical coherence tomography ,Restenosis ,Medicine ,Bare metal ,cardiovascular diseases ,sense organs ,Radiology ,In stent restenosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Mechanisms and patterns of in-stent restenosis (ISR) comparing bare metal stents (BMS) and 1st and 2nd generation drug-eluting stent (DES) as evaluated by optical coherence tomography (OCT) have not been well delineated. OCT evaluation of ISR (minimum lumen area
- Published
- 2016
- Full Text
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35. Utility of near-infrared spectroscopy for detection of thin-cap neoatherosclerosis.
- Author
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Roleder, Tomasz, Galougahi, Keyvan Karimi, Chee Yang Chin, Bhatti, Navdeep K., Brilakis, Emmanouil, Nazif, Tamim M., Kirtane, Ajay J., Karmpaliotis, Dimitri, Wojakowski, Wojciech, Leon, Martin B., Mintz, Gary S., Maehara, Akiko, Stone, Gregg W., and Ali, Ziad A.
- Abstract
Aims: Near-infrared spectroscopy (NIRS) has been employed to assess the composition of the atherosclerotic plaques in native coronary arteries. However, little is known about the detection of neoatherosclerosis by NIRS in in-stent restenosis (ISR). The aim of the study was to assess the relationship between the distribution of lipid determined by NIRS and morphology of ISR on optical coherence tomography (OCT). Methods and results: We performed both NIRS and OCT in 39 drug-eluting stents with ISR. Values of lipid-core burden index (LCBI) derived by NIRS were compared with the OCT-derived thickness of the fibrous cap covering neoatherosclerotic lesions. A total of 22 (49%) in-stent neointimas were identified as lipid rich by both NIRS and OCT. There was good agreement between OCT and NIRS in identifying lipid within in-stent neointima (kappa = 0.60, 95% CI: 0.34-0.86). OCT identified thin-cap neoatheromas (TCNA) (<65 µm) in 12 stents (23%). The minimal cap thickness of in-stent neoatherosclerotic plaque measured by OCT correlated with the maxLCBI
4mm (maximal LCBI per 4 mm) within the stent (r = -0.77, P< 0.01). Moreover, maxLCBI4mm was able to accurately predict TCNA with a cut-off value of >144. Conclusion: NIRS correlates with OCT identification of lipids in stented vessels and is able to predict the presence of thin fibrous cap neoatheroma. [ABSTRACT FROM AUTHOR]- Published
- 2017
- Full Text
- View/download PDF
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