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    University - Scholar Department: School of Medicine Position: Medical Fellow

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  • Mail Code: 5151

All Publications

  • Prehospital Prediction of Cardiogenic Shock Among Patients With ST-Segment-Elevation Myocardial Infarction: The EARLY SHOCK Score. Journal of the American Heart Association Yang, C., Lee, T., Kochan, A., Barker, M., Roston, T. M., Cairns, J. A., Singer, J., Grunau, B., Helmer, J., Berg, D. D., Wong, G. C., Fordyce, C. B. 2025: e040681

    Abstract

    BACKGROUND: Cardiogenic shock (CS) develops in up to 10% of patients with ST-segment-elevation myocardial infarction and is associated with high mortality and morbidity rates. The objective of the current study was to generate a clinical scoring system that can be easily applied in the prehospital setting to predict the development of in-hospital CS among patients undergoing primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.METHODS: The authors conducted a retrospective cohort study using prospective data from a dual hub-and-spoke health system. Logistic regression was used to assess the relationship between prespecified clinical predictors and the occurrence of in-hospital CS. Internal validation was conducted to assess the C statistic and calibration curve of the prediction model. The prediction model was converted to a risk score by scaling of the regression coefficients.RESULTS: From April 1, 2012, to December 31, 2020, there were 2736 consecutive patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Of these, 415 (15.2%) developed CS. Eight strong predictors were independently associated with CS by multivariable analysis and used to develop a prediction model. The model achieved a C statistic of 0.87. The EARLY SHOCK risk scoring algorithm incorporates Emergency Medical Services Heart Rate and Systolic Blood Pressure, Age, Renal Replacement, Location of Infarction, Sugar (diabetes), Heart Failure, and Cardiac Arrest.CONCLUSIONS: The authors identified 8 clinical variables that strongly predict CS among patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. This has been developed into the EARLY SHOCK score, which can be easily applied in the prehospital setting to rapidly identify CS and enable shock team activation. External validation for the scoring system is pending for broader application.

    View details for DOI 10.1161/JAHA.124.040681

    View details for PubMedID 40792594

  • Contemporary diagnosis and management of spontaneous coronary artery dissection HEART Yang, C., Chai, J., Saw, J. 2025

    Abstract

    Spontaneous coronary artery dissection (SCAD) has emerged over the last decade as an increasingly recognised cause of myocardial infarction, especially among younger women. The advances in our understanding of SCAD and the evolution of coronary angiography and intracoronary imaging have led to improved diagnoses and outcomes; however, there are still knowledge gaps and challenges in the management of this condition. In this review, we summarise the pathogenesis, genetics, diagnosis and acute and chronic management of patients with SCAD. We also provide focused updates on the following: genetics of SCAD, the role of cardiac CT angiography and cardiac MRI, the use of intracoronary imaging, revascularisation techniques and the overlap between SCAD and Takotsubo syndrome.

    View details for DOI 10.1136/heartjnl-2024-324732

    View details for Web of Science ID 001500049300001

    View details for PubMedID 40451276

  • Are familial risks of myocardial infarction with non-obstructive coronary arteries shared with obstructive coronary artery disease? European journal of preventive cardiology Yang, C., Saw, J. 2025

    View details for DOI 10.1093/eurjpc/zwaf133

    View details for PubMedID 40314964

  • Chapter 13.0. FFR, iFR, CFR, and IMR: Results from clinical trials. Cardiovascular revascularization medicine : including molecular interventions Yang, C., Wong, C., Teradaa, K., Tremmel, J. A. 2024

    Abstract

    In this review article, we provide an overview of the definition and application of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR) in the diagnosis, prognosis, and management of coronary microvascular dysfunction. We discuss their respective limitations as it relates to microvascular dysfunction. In each section, we review the most recent evidence supporting their use in microvascular and epicardial coronary artery disease. We also highlight specific clinical conditions with emerging indications for the use of these indices, including in the setting of microvascular dysfunction due to acute myocardial infarction, heart failure with preserved ejection fraction, and post-cardiac transplant.

    View details for DOI 10.1016/j.carrev.2024.12.011

    View details for PubMedID 39779401