Browsing by Author "Porapakkham P."

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    Cost-utility analysis of sutureless and rapid deployment versus conventional aortic valve replacement in patients with moderate to severe aortic stenosis in Thailand
    (2024-01-01) Permsuwan U.; Singhatanadgige S.; Boonpipattanapong K.; Slisatkorn W.; Chartrungsan A.; Nitayavardhana P.; Luangthong N.; Porapakkham P.; Yadee J.; Permsuwan U.; Mahidol University
    BACKGROUND: Sutureless and rapid deployment aortic valve replacement (SUAVR) has become an alternative to conventional aortic valve replacement (CAVR) for aortic stenosis (AS) treatment due to its advantages in reducing surgery time and improving outcomes. This study aimed to assess the cost-utility of SUAVR vs. CAVR treatment for patients with moderate to severe AS in Thailand. METHODS: A two-part constructed model was used to estimate the lifetime costs and quality-adjusted life years (QALYs) from both societal and healthcare perspectives. Data on short-term mortality, complications, cost, and utility data were obtained from the Thai population. Long-term clinical data were derived from clinical studies. Costs and QALYs were discounted annually at 3% and presented as 2022 values. The incremental cost-effectiveness ratio (ICER) was calculated to determine additional cost per QALY gained. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: SUAVR treatment incurred higher costs compared with CAVR treatment from both societal (THB 1,733,355 [USD 147,897] vs THB 1,220,643 [USD 104,150]) and healthcare provider perspectives (THB 1,594,174 [USD 136,022] vs THB 1,065,460 [USD 90,910]). In addition, SUAVR treatment resulted in lower health outcomes, with 6.20 life-years (LYs) and 4.95 QALYs, while CAVR treatment achieved 6.29 LYs and 5.08 QALYs. SUAVR treatment was considered as a dominated treatment strategy using both perspectives. Sensitivity analyses indicated the significant impact of changes in utilities and long-term mortality on the model. CONCLUSION: SUAVR treatment is not a cost-effective treatment strategy compared with CAVR treatment for patients with moderate-severe AS in Thailand, as it leads to higher costs and inferior health outcomes. Other important issues related to specific patients such as those with minimally invasive surgery, those undergoing AVR with concomitant procedures, and those with calcified and small aortic root should be taken into account.
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    Effect of renin angiotensin system inhibitors on long-term major cardiovascular outcomes in patients with high atherosclerotic cardiovascular risk
    (2023-12-01) Wongcharoen W.; Osataphan N.; Gunaparn S.; Srimahachota S.; Porapakkham P.; Dutsadeevettakul S.; Phrommintikul A.; Wongcharoen W.; Mahidol University
    The advantage of angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) in patients with preserved LV systolic function is uncertain. We aimed to investigate the effects of ACEI/ARB in high atherosclerotic risk patients without overt heart failure (HF) on long-term major cardiovascular outcomes (MACEs). The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. The patients with ejection fraction < 50% were excluded. Among 8513 recruited patients, there were 4246 patients included into final analysis after propensity score matching. At 5-years follow-up, Cox regression analysis showed that ACEI/ARB was significantly associated with reduced risk of all-cause mortality or non-fatal myocardial infarction, non-fatal stroke and HF hospitalization (HR 0.82, 95% CI 0.70–0.96, P = 0.011). The benefit was driven by the reduced all-cause mortality and HF. Subgroup analysis demonstrated that ACEI/ARB decreased risk of long-term MACEs in patients with diabetes (HR 0.77, 95% CI 0.63–0.94, P = 0.011) and patients not taking statin (HR 0.57, 95% CI 0.40–0.82, P = 0.002). We demonstrated that the use of ACEI/ARB was associated with reduced risk of long-term MACEs in a large cohort of high atherosclerotic risk patients. Reduction of all-cause mortality and HF were likely the main contributors to the benefit of ACEI/ARB.
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    The contemporary management and coronary angioplasty outcomes in young patients with ST-Elevation myocardial infarction (STEMI) age < 40 years old: the insight from nationwide Thai PCI registry
    (2024-10-10) Porapakkham P.; Porapakkham P.; Srimahachota S.; Limpijankit T.; Kiatchoosakun S.; Chandavimol M.; Kanoksilp A.; Chantadansuwan T.; Thakkinstian A.; Sansanayudh N.; Porapakkham P.; Mahidol University
    BACKGROUND: Cardiovascular disease (CVD) remains one of the major causes of death around the world in which ST elevation MI (STEMI) is in the lead. Although the mortality rate from STEMI seems to decline, this result might not be demonstrated in young adults who basically have different baseline characteristics and outcomes compared with older patients. METHODS: Data of the STEMI patients aged 18 years or older who underwent PCI during May 2018 to August 2019 from Thai PCI Registry, a prospective, multi-center, nationwide study, was included and aimed to investigate the predisposing factors and short-term outcomes of patients aged < 40 years compared with age 41-60, and > 61 years. RESULTS: Data of 5,479 STEMI patients were collected. The patients' mean age was 62.6 (SD = 12.6) years, and 73.6% were males. There were 204, 2,154, and 3,121 patients in the youngest, middle, and oldest groups. The young patients were mainly male gender (89.2% vs. 82.4% and 66.6%; p < 0.001), were current smokers (70.6%, 57.7%, 34.1%; p < 0.001), had BMI ≥ 25 kg/m2 more frequently (60.8%, 44.1%, 26.1%; p < 0.001), and had greater family history of premature CAD (6.9%, 7.2%, 2.9%; p < 0.001). The diseased vessel in the young STEMI patients was more often single vessel disease with the highest percentage of proximal LAD stenosis involvement. Interestingly, there were trends of higher events of procedural failure (2.9%, 2.1%, 3.3%; p = 0.028) and procedural complications (8.8%, 5.8%, 9.4%; p < 0.001) in both youngest and oldest groups compared to the middle-aged group. In-hospital death was found in 3.4% in the youngest group compared to 3.3% in the middle-aged patients and 9.2% in the older patients (p < 0.001). CONCLUSIONS: Despite experiencing higher rates of procedural failure and complications during treatment compared to middle-aged and older patients, young STEMI individuals demonstrate a significantly lower risk of death during hospitalization and within one year of the event. Younger patients might have a more robust physiological reserve or benefit from more aggressive post-procedure management. However, the higher prevalence of modifiable risk factors like smoking and obesity in younger individuals underscores the need for preventative measures. Encouraging smoking cessation and weight control in this demographic is crucial not only to prevent STEMI but also to potentially improve their long-term survival prospects.
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    Trends in Economic Burden and Mortality of Hospitalized Patients With Aortic Stenosis in Thailand
    (2023-10-15) Yadee J.; Slisatkorn W.; Singhatanadgige S.; Porapakkham P.; Permsuwan U.; Mahidol University
    This study aimed to assess the temporal trends in aortic stenosis (AS)–related hospitalizations, in-hospital mortality, and economic burden in Thailand. The study cohort was derived from the electronic claim system of the National Health Security Office, which serves as a reimbursement database for all Thai beneficiaries under the Universal Health Coverage Scheme, covering ∼70% of the entire population. Hospitalization, mortality, and costs were estimated by year, with the primary diagnosis for AS-related hospitalizations identified using code I350. The Cochrane Armitage test was used to examine trends in AS-related hospitalization and in-hospital mortality, whereas a nonparametric trend test was used to analyze the trend of hospitalization costs. Of the 8-year period, 10,406 adults were admitted with a primary diagnosis of AS. AS-related hospitalizations increased from 1,274 in 2015 to 1,945 in 2022 (p = 0.251), with the most significant observed in the age group 60 to 79 years (p <0.001). In-hospital mortality increased from 4.8% to 6.1%. Hospitalization cost significantly increased from $2,879 to $3,443 (p <0.001), with an average length of stay of 6.6 ± 9.2 days. The trend of patients admitted with primary diagnosis of AS in Thailand has significantly increased in the age group 60 to 79 years. In-hospital admission is found at older age and is likely to have high mortality rate. The increased hospitalization cost may impose a substantial economic burden on the Thai health care system.
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    Trimethylamine-N-oxide and 5-year mortality: the role of gut microbiota-generated metabolite from the CORE-Thailand cohort
    (2024-12-01) Senthong V.; Kiatchoosakun S.; Wongvipaporn C.; Phetcharaburanin J.; Sritara P.; Phrommintikul A.; Worasuwannarak S.; Dutsadeevettakul S.; Suksuphew S.; Cheewatanakornkul S.; Suwanugsorn S.; Taweesangsuksakul P.; Senthong V.; Tatsanaviva P.; Kiatchoosakun S.; Wongvipaporn C.; Simtharakaew T.; Sukanandachai B.; Dinchuthai P.; Kositchaiwat J.; Siriaree K.; Siriwattana K.; Chotechuang Y.; Phengtham U.; Watcharasaksilp K.; Buranapin S.; Prasertwitayakij N.; Wongcharoen W.; Phrommintikul A.; Paspitsanu P.; Laksomya T.; Maraprasertsak M.; Jai-aue S.; Wongtheptien W.; Deerochanawong C.; Hutayanon P.; Changsirikulchai S.; Porapakkham P.; Kanaderm C.; Suraamornkul S.; Satirapoj B.; Tiyanon W.; Rattanasumawong K.; Wongpraparut N.; Boonyasirinant T.; Krittayaphong R.; Udol K.; Lertsuwunseri V.; Satitthummanid S.; Boonyaratavej S.; Srimahachota S.; Yamwong S.; Sritara P.; Senthong V.; Mahidol University
    The gut microbiota metabolite trimethylamine-N-oxide (TMAO)—derived from dietary phosphatidylcholine—is mechanistically linked to cardiovascular disease (CVD) and increased cardiovascular risk. This study examined the relationship between fasting plasma TMAO levels and 5-year all-cause mortality in a cohort of patients at high risk of cardiovascular events (CORE-Thailand Registry). Of the 134 patients, 123 (92%) had established cardiovascular disease, and 11 (8%) had multiple risk factors. Fasting plasma TMAO levels were measured using nuclear magnetic resonance spectroscopy. Within this prospective cohort study, the median TMAO was 3.81 μM [interquartile range (IQR) 2.89–5.50 μM], with a mean age of 65 ± 11 years; 61% were men, and 39.6% had type II diabetes. Among 134 patients, 65 (49%) were identified as the high-TMAO group (≥ 3.8 μM), and 69 (51%) were identified as the low-TMAO group (< 3.8 μM). After a median follow-up of 58.8 months, the high-TMAO group was associated with a 2.88-fold increased mortality risk. Following adjustment for traditional risk factors, high-sensitivity cardiac troponin-T, estimated glomerular filtration rate, angiotensin-converting enzyme (ACEI), or angiotensin-receptor blocker (ARB) use, the high-TMAO group remained predictive of 5-year all-cause mortality risk (the high-TMAO vs. the low-TMAO group, adjusted hazard ratio 2.73, 95% CI 1.13–6.54; P = 0.025). Among Thai patients at high risk of cardiovascular events, increased plasma TMAO levels portended greater long-term mortality risk.