CJC Open最新文献

{"title":"Adjustment of Antiplatelet Therapy in Patients With Myocardial Infarction Treated Without Revascularization: A Retrospective Cohort Study","authors":"Nicolas Dostie ,&nbsp;Arman Sarshoghi ,&nbsp;Alexis Doucet ,&nbsp;Robert Avram MD, MSc ,&nbsp;Jean-François Tanguay MD ,&nbsp;Guillaume Marquis-Gravel MD, MSc","doi":"10.1016/j.cjco.2025.04.012","DOIUrl":"10.1016/j.cjco.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Although a substantial proportion of patients with myocardial infarction (MI) are treated without revascularization, no randomized controlled trial has evaluated the optimal antiplatelet strategy in this vulnerable population and practice patterns may be heterogeneous. This study aims to describe postdischarge antiplatelet therapy (APT) practice patterns in medically managed patients with MI.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at the Montreal Heart Institute (July 31, 2020–July 31, 2023). Patients aged ≥18 years hospitalized for MI and discharged without revascularization were included, and discharge antiplatelet patterns were documented.</div></div><div><h3>Results</h3><div>A total of 365 patients were included, comprising 156 women (42.7%) (median age: 71.4 years [interquartile range: 61-83]). Reasons for being treated without revascularization include MI without obstructive coronary artery disease (n=139; 38%), no angiography performed (n=118; 32%), severe disease not amenable to revascularization (n=71; 20%), small branch disease (n=21; 6%), and spontaneous coronary dissection (n=16; 4%). At discharge, 41.9% (n=153) received dual APT (DAPT), 38.4% (n=140) received single APT, and 19.7% (n=72) received no antiplatelet agent. The most common DAPT regimen prescribed was clopidogrel–acetylsalicylic acid (aspirin) (34.0%; n=124), and the most frequently prescribed antiplatelet monotherapy was aspirin (25.8%; n=94). Among patients treated with DAPT, duration of prescription was 12 months in 91.5% of cases. Postdischarge antiplatelet strategy varied depending on the underlying MI etiology.</div></div><div><h3>Conclusion</h3><div>Postdischarge antiplatelet strategies prescribed in patients with an MI treated without revascularization are heterogeneous, whereas the preferred strategy is DAPT for 12 months. This variability reflects current clinical equipoise in this understudied population.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 913-920"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis for Minimally Invasive Mitral Valve Surgery: A Single-Centre Canadian Study","authors":"Toshiro W.S. Sembo MD, JD ,&nbsp;Ali Fatehi Hassanabad MD, MSc ,&nbsp;Kailey Stevens MSc ,&nbsp;Amy N. Brown MD, MSc, MPH ,&nbsp;Ken Parhar MD, MSc ,&nbsp;Corey Adams MD, MSc ,&nbsp;William D.T. Kent MD, MSc","doi":"10.1016/j.cjco.2025.04.072","DOIUrl":"10.1016/j.cjco.2025.04.072","url":null,"abstract":"<div><h3>Background</h3><div>Stakeholders within a publicly funded healthcare system have a duty to consider costs and economics, to utilize finite resources in the most effective manner. We aimed to quantify the postoperative costs associated with mitral valve repair (MVR) at the Foothills Medical Centre in Calgary, Canada.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent MVR from January 2020 to November 2023 was performed. For patients undergoing minimally invasive mitral valve surgery (MIMVS), a postoperative rapid recovery (RR) protocol was introduced. Postoperative costs were analyzed for 3 comparator groups: MIMVS with RR (MIMVS-RR), MIMVS without RR, , and median sternotomy.</div></div><div><h3>Results</h3><div>Care in the cardiovascular intensive care unit (CVICU) is 2.83 times more expensive than care on the cardiac surgery ward. Length of stay (LOS) in the CVICU was identified to be the primary driver of postoperative costs. The CVICU LOS and total LOS for sternotomy patients was longer than those of MIMVS patients. This difference translated to increased postoperative costs for sternotomy compared to MIMVS on a per-patient basis. The postoperative costs associated with sternotomy are 1.42 times higher than those for MIMVS-RR. When modelled with 200 patients, MIMVS-RR represents a postoperative cost-savings of $3.657 million CAD, compared to sternotomy.</div></div><div><h3>Conclusions</h3><div>Following MVR, a minimally invasive approach demonstrates cost-savings, compared to a sternotomy. Reduced CVICU LOS was the primary driver of cost-savings for MIMVS. Further analysis and investigations are required to fully quantify the true economic benefits of MIMVS-RR at our centre.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 871-878"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Re-Evaluate Blood Pressure Recommendations for Exercise Testing in Spontaneous Coronary Artery Dissection? A Case Series","authors":"Carolina G. Carvalho MD, MScCH (HPTE), PhD ,&nbsp;Lisa Cotie RKin, PhD ,&nbsp;Mina Madan MD, MHS ,&nbsp;Rajni Nijhawan MD ,&nbsp;Paul Oh MD, MSc ,&nbsp;Tracey J.F. Colella RN, PhD, APN, FCAN","doi":"10.1016/j.cjco.2025.04.074","DOIUrl":"10.1016/j.cjco.2025.04.074","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 960-963"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stellate Ganglion Phototherapy Using a Portable Radiation Device, for Destination Therapy of Drug-Refractory Ventricular Tachycardia","authors":"Yutaro Okidono MD,&nbsp;Hiro Yamasaki MD, PhD,&nbsp;Yuka Oda MD,&nbsp;Yuki Komatsu MD, PhD,&nbsp;Miyako Igarashi MD, PhD,&nbsp;Tomoko Ishizu MD, PhD","doi":"10.1016/j.cjco.2025.04.073","DOIUrl":"10.1016/j.cjco.2025.04.073","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 948-951"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transapical Closure of Re-entry Tear in Aortic Dissection With the Off-Label Use of a Gore Cardioform Septal Occluder Using 3D-Printed Simulation","authors":"Christoph Huber MD ,&nbsp;Louis Vaisière ,&nbsp;Hajo Müller MD ,&nbsp;Christoph Ellenberger MD ,&nbsp;Mustafa Cikirikcioglu MD, PhD ,&nbsp;Jean Paul Vallée MD, PhD ,&nbsp;Stephane Noble MD","doi":"10.1016/j.cjco.2025.04.010","DOIUrl":"10.1016/j.cjco.2025.04.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 928-931"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Coronary Intervention on In-Hospital Mortality in Octogenarians and Nonagenarians, Compared to Elderly Patients Aged < 80 Years with Acute Coronary Syndromes","authors":"Jayant Ravindran BSc Med, MBBS, MMed ,&nbsp;David Brieger MBBS, PhD ,&nbsp;Karice Hyun PhD ,&nbsp;Vincent Chow MBBS, PhD ,&nbsp;Andy Yong MBBS, PhD ,&nbsp;Leonard Kritharides MBBS, PhD ,&nbsp;Austin Chin Chwan Ng MBBS, BSc Med, MMed","doi":"10.1016/j.cjco.2025.04.006","DOIUrl":"10.1016/j.cjco.2025.04.006","url":null,"abstract":"<div><h3>Background</h3><div>Given that the Australian population is aging, with older patients presenting with acute coronary syndrome (ACS), its management over the past 20 years is likely to have changed.</div></div><div><h3>Methods</h3><div>Retrospective observational study from the New South Wales statewide Admission Patient Data Collection database of those aged ≥ 65 years hospitalized for ACS between January 2002 and December 2021. Patients were stratified into 3 age groups: 65-79 years, 80-89 years, ≥ 90 years). Temporal trends of ACS, coronary angiogram (CA), and percutaneous coronary intervention (PCI) and in-hospital mortality were evaluated. Multivariable analysis was used to adjust for baseline profiles and year of admission in mortality analysis.</div></div><div><h3>Results</h3><div>The study cohort comprised 118,608 patients (56.7% aged 65-79 years [n = 67,211]; 34.1% aged 80-89 years [n = 40,452]; 9.2% aged ≥ 90 years [n = 10,945]). Those aged 65-79 years, compared to older groups, had proportionally more male patients, with higher rates of ischemic heart disease, diabetes, smoking history, prior PCI and/or surgical bypass revascularization, and obesity. Heart failure, chronic pulmonary and renal disease, and dementia were more common in the older age groups. Proportionally, ST-elevation myocardial infarction decreased over time, whereas non-ST-elevation myocardial infarction rates increased. Although fewer CAs were performed in the older age groups, PCI rates in those who had CA were higher in those aged ≥ 80 years. Multivariable analysis showed that in-hospital mortality fell 49% in the group admitted in 2017 or later, vs in 2006 or earlier; for the younger, vs the older age groups, mortality fell by 55.4%, 52.5%, and 44.6%, respectively. The group aged ≥ 90 years had 3.1-fold higher adjusted odds of in-hospital death, compared to the group aged 65-79 years.</div></div><div><h3>Conclusions</h3><div>Over the past 2 decades, with increasing rates of coronary intervention, rates of in-hospital mortality in the elderly decreased, but older patients continue to have poorer outcomes following ACS.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 897-906"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Frailty With Readmissions and Outcomes After Impella Mechanical Circulatory Support","authors":"Max W. Maffey MBBS ,&nbsp;Adrian A. Kuchtaruk BSc ,&nbsp;Abdulla A. Damluji MD, PhD ,&nbsp;Santiago García MD ,&nbsp;Islam Y. Elgendy MD ,&nbsp;Pedro Villablanca MD, MSc ,&nbsp;Francesco Moroni MD ,&nbsp;Martin Denicolai MD ,&nbsp;Mamas A. Mamas BMBCh, DPhil ,&nbsp;Rodrigo Bagur MD, PhD, FRCPC, DRCPSC, FAHA, FSCAI","doi":"10.1016/j.cjco.2025.04.011","DOIUrl":"10.1016/j.cjco.2025.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is associated with a greater risk of readmission after cardiovascular procedures. However, the impact of frailty on readmission rates and outcomes after Impella mechanical circulatory support (MCS) remains unknown. We aimed to explore the impact of frailty on readmission outcomes in patients who received Impella MCS.</div></div><div><h3>Methods</h3><div>Using the National Readmissions Database, patients aged 65 years and older who received Impella MCS between January 2016 and December 2020 were identified. Frailty was determined by the Hospital Frailty Risk Score (HFRS), which stratifies patients into 3 frailty risk categories as low (&lt;5), intermediate (5-15), and high (&gt;15), with intermediate- and high-risk groups defined as frail. The impact of frailty on short-term (within 30 days) and midterm (31-180 days) readmission rates and in-hospital outcomes was assessed.</div></div><div><h3>Results</h3><div>Of the 16,289 patients identified in the 30-day cohort, 8647 (53.1%) were identified as frail (HFRS ≥5) and 2185 (13.4%) had an unplanned readmission at 30 days. After adjusting for age, sex and comorbidities, frailty status (HFRS ≥5) was associated with a greater risk of 30-day readmission (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.17-1.37), death (OR 2.0, 95% CI 1.22-3.30), major adverse events (OR 1.73, 95% CI 1.29-2.33), length of stay &gt;4 days (OR 1.80, 95% CI 1.44-2.26) and greater hospitalization expenditures (OR 1.44, 95% CI 1.17-1.80) during readmission. Of the 6497 patients identified in the 31-180-day cohort, 3521 (54.2%) were considered frail and 1809 (27.8%) experienced unplanned readmissions. An HFRS ≥5 was associated with a greater risk of readmission (OR 2.10, 95% CI 1.88-2.34), in-hospital death (OR 3.02, 95% CI 1.33-6.86), length of stay &gt;4 days (OR 1.66, 95% CI 1.29-2.14), and greater hospital expenditures (OR 1.36, 95% CI 1.05-1.75) during 31-180-day readmission.</div></div><div><h3>Conclusions</h3><div>Frailty is common among patients undergoing Impella MCS and is associated with higher rates of readmission and adverse outcomes during readmission.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 972-985"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Release of Cardiac Myosin-binding Protein C Compared With Cardiac Troponin After Brief Ischemia in Humans","authors":"Bashir Alaour PhD,&nbsp;Rasmus Bo Hasselbalch PhD,&nbsp;Asthildur Arnadottir PhD,&nbsp;Thomas E. Kaier PhD,&nbsp;Samuel McGrath MBBS,&nbsp;Sune Ammentorp Haahr-Pedersen PhD,&nbsp;Henning Bundgaard PhD,&nbsp;Michael Marber PhD,&nbsp;Kasper Karmark Iversen PhD","doi":"10.1016/j.cjco.2025.04.014","DOIUrl":"10.1016/j.cjco.2025.04.014","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 969-971"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Mitral Valve Surgery: Long-Term (20-Year) Follow-Up After Right Anterolateral Minithoracotomy","authors":"Razan Salem MD ,&nbsp;Katharina Fay MD ,&nbsp;Philipp Kaiser MD ,&nbsp;Afsaneh Karimian-Tabrizi ,&nbsp;Eva Herrmann PhD ,&nbsp;Andreas Winter MD ,&nbsp;Jan Hlavicka MD, PhD ,&nbsp;Florian Hecker MD ,&nbsp;Anton Moritz MD ,&nbsp;Thomas Walther MD ,&nbsp;Tomas Holubec MD, PhD","doi":"10.1016/j.cjco.2025.02.001","DOIUrl":"10.1016/j.cjco.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive mitral valve (MV) surgery (MIMVS) through right lateral minithoracotomy has evolved as the standard approach for most patients. Data on long-term functional outcomes, however, are rare. We evaluated long-term outcomes after MIMVS through right minithoracotomy for up to 21.6 years.</div></div><div><h3>Methods</h3><div>From 1997 to 2017, 301 patients with a median age of 57 years (range, 20-81; 54.5% female) underwent MIMVS through right anterolateral minithoracotomy. Follow-up data were evaluated using Kaplan–Meier analyses and competing risk analysis.</div></div><div><h3>Results</h3><div>A total of 249 patients (82.7%) underwent MV repair, and 52 (17.2%) received valve replacement. Conversion to sternotomy was required in 2 patients (0.8%), and 2 patients (0.8%) suffered perioperative stroke. The 30-day mortality rate was 3.3%. During follow-up, 21 patients required MV reoperation after a mean period of 21.6 ± 0.2 years. The cumulative incidence of reoperation at 5, 10, 15, and 20 years, respectively, was 2.0% ± 0.8%, 4.5% ± 1.2%, 6.0% ± 1.4%, and 7.0% ± 1.6%. The cumulative incidence of recurrent mitral regurgitation ≥ moderate at 5, 10, 15, and 20 years, respectively, was 4.5% ± 1.2%, 11.1% ± 1.9%, 16.4% ± 2.2%, and 20.2% ± 2.7%. The 10- and 20-year survival of all patients was 83.6% ± 2% and 55.0% ± 4%, respectively.</div></div><div><h3>Conclusions</h3><div>MIMVS can be performed safely with very good perioperative outcomes, a low incidence of mortality, and excellent long-term valve performance.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 879-886"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Closure of a Complex Aorta–Right Atrial Fistula Following Surgical Repair of an Aortic Dissection with 3-Dimensional Printing Guidance","authors":"Yiwei Wang MD, PhD ,&nbsp;Mengen Zhai MD, PhD ,&nbsp;Ping Jin MD, PhD ,&nbsp;Zhenchao Wang MD, PhD ,&nbsp;Rongji Zhang MD, PhD ,&nbsp;Yang Liu MD, PhD ,&nbsp;Jian Yang MD, PhD","doi":"10.1016/j.cjco.2025.05.004","DOIUrl":"10.1016/j.cjco.2025.05.004","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 7","pages":"Pages 932-935"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}