CJC Open最新文献

{"title":"Clinical and Cost Outcomes Associated with Cardiologist Payment Models: A Qualitative Systematic Review","authors":"Sandeep Chand B. Pharm,&nbsp;Melissa Monaghan BSc,&nbsp;Riley Martens RN,&nbsp;Derek S. Chew MD, MSc,&nbsp;Satish R. Raj MD, MSCI,&nbsp;Cathy A. Eastwood RN, PhD,&nbsp;Glen Sumner MD, MSc","doi":"10.1016/j.cjco.2026.03.017","DOIUrl":"10.1016/j.cjco.2026.03.017","url":null,"abstract":"<div><h3>Background</h3><div>Payment models for cardiologists create financial incentives that can influence clinical decision-making and healthcare costs. In addition, some cardiologists may order diagnostic tests and procedures on equipment they own, which increases the likelihood of such tests being ordered. We aimed to assess the influence of cardiologist payment models on clinical and health system cost outcomes.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, National Health Service Economic Evaluation Database, EconLit, and Web of Science, for the period from database inception to August 2025. Studies were included if they examined cardiologist payment models and reported clinical and cost outcomes using randomized controlled trials, controlled clinical trials, controlled before–after studies, interrupted time series, or observational study designs.</div></div><div><h3>Results</h3><div>Of 4156 identified studies, 6 met the inclusion criteria. Within studies that evaluated patient volume in a fee-for-service (FFS) model, high-volume FFS cardiologists ordered more diagnostic tests than did low-billing FFS cardiologists, and high-billing cardiologists billed a lower volume of procedures. We observed a higher incidence of hospitalizations in patients with atrial fibrillation in the highest billing cohort, but a lower incidence in patients with heart failure. Among studies that directly compared payment models, diagnostic test utilization was consistently higher in FFS models than in non-FFS payment models.</div></div><div><h3>Conclusions</h3><div>FFS cardiologists order more diagnostic tests, which may lead to higher health system costs. Increased testing did not lead to improvement in key patient outcomes. Further research is needed to examine the relationship between cardiologist payment models, cost, and clinical outcomes of the care provided.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1119-1130"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beta-Blockers for Vasovagal Syncope in Aging Subjects: A Randomized Controlled Trial and Individual Patient Data Meta-Analysis of Clinical Trials","authors":"Nariman Sepehrvand MD, PhD,&nbsp;Sanaz Hatami MD, PhD,&nbsp;Satish R. Raj MD, MSCI,&nbsp;Lisa Semeniuk PhD,&nbsp;Rasha Hamzeh BsN, MsN,&nbsp;Felix Ayala-Paredes MD, PhD,&nbsp;Giuliano Becker MD,&nbsp;Teresa Kus MD, PhD,&nbsp;Panagiota Flevari MD,&nbsp;Angel Moya-Mitjans MD, PhD,&nbsp;Robert S. Sheldon MD, PhD","doi":"10.1016/j.cjco.2026.03.019","DOIUrl":"10.1016/j.cjco.2026.03.019","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies provided conflicting evidence of benefit of beta-blockers (BBs) in preventing vasovagal syncope (VVS), with possible benefit in older adults, leading to North American guidelines accepting BBs as a reasonable but weak option in patients aged ≥ 42 years with VVS (class IIb). In the <strong>P</strong>revention <strong>o</strong>f Vasovagal <strong>S</strong>yncope <strong>T</strong>rial 5 (POST 5), we conducted a randomized clinical trial of metoprolol in the prevention of VVS in patients aged ≥ 40 years.</div></div><div><h3>Methods</h3><div>Patients aged ≥ 40 years with ≥ 1 syncopal spell in the prior year and ≥ –2 points for the Calgary Syncope Symptom Score were randomized to receive either metoprolol or matching placebo for 12 months. Patient-level meta-analysis of patients with age ≥ 40 years was done for randomized controlled trials (RCTs) studying the effect of BBs in VVS.</div></div><div><h3>Results</h3><div>A total of 51 patients (age 64 ± 11 years, 59% female) were included in POST 5 (26 metoprolol, 25 placebo). Treatment arms were balanced in demographic and clinical characteristics. Eight patients (31%) in the metoprolol arm and 10 (40%) in the placebo arm experienced syncope during a median follow-up period of 12 months (<em>P</em> = 0.69). In the pooled analysis of 173 patients from 4 RCTs, 29 of 85 patients on BB (34%) and 30 of 88 patients (34%) on placebo had at least one syncope recurrence (odds ratio 0.99, 95% confidence interval 0.43, 2.29).</div></div><div><h3>Conclusion</h3><div>BBs showed no effect on reducing syncope recurrence in older patients with VVS. These results may inform practice guidelines by removing their recommendations for using BBs in this specific context.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT02123056.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 939-947"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Tachycardia Recurrence After Catheter Ablation in Nonischemic Cardiomyopathy with Mildly to Moderately Reduced Ejection Fraction","authors":"Boldizsar Kovacs MD, MSc,&nbsp;Leon Dinshaw MD,&nbsp;Alvaro Marco del Castillo MD, PhD,&nbsp;Christiane Jungen MD,&nbsp;Stefan Kurath-Koller MD, PhD,&nbsp;Stefan Stojković MD, PhD,&nbsp;Francesco Santoro MD, PhD,&nbsp;Giacomo Mugnai MD, PhD,&nbsp;Laura Perrotta MD, PhD,&nbsp;Rachel M.A. ter Bekke MD, PhD,&nbsp;Kevin Vernooy MD, PhD,&nbsp;Paul G.A. Volders MD, PhD,&nbsp;Bert Vandenberk MD, PhD","doi":"10.1016/j.cjco.2026.04.009","DOIUrl":"10.1016/j.cjco.2026.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Patients with nonischemic cardiomyopathy (NICM) are at risk for sustained ventricular tachycardia (VT). Implantable cardioverter-defibrillators (ICDs) are guideline-recommended for secondary prevention, but the necessity of routine ICD implantation after successful catheter ablation (CA) in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF &gt; 35%) remains uncertain. This review summarizes the current evidence.</div></div><div><h3>Methods</h3><div>A PROSPERO-registered systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane were searched through June 2025. Studies including adults with NICM and LVEF &gt; 35% undergoing CA for sustained monomorphic VT were eligible. Data on patient characteristics, ablation outcomes, VT recurrence, mortality, and ICD therapies were extracted. Results were descriptively synthesized, and weighted means were calculated when feasible.</div></div><div><h3>Results</h3><div>Eleven studies (1995-2024), including 1430 patients, were identified; 936 (66%) were analyzable. The weighted mean LVEF was 38% ± 14%; mean age was 59 ± 14 years. Sustained VT recurrence ranged from 14%-67% during a weighted mean follow-up period of 608 ± 745 days. Procedural noninducibility consistently predicted lower recurrence rates (18%-32%), than those in inducible patients (up to 75%). Two studies using cardiac magnetic resonance imaging found non-circumferential mid-myocardial late gadolinium enhancement with septal involvement associated with higher recurrence risk. Risk of bias was moderate to serious.</div></div><div><h3>Conclusions</h3><div>In NICM patients with LVEF &gt; 35%, noninducibility after CA predicts favourable arrhythmic outcomes. Non-circumferential mid-myocardial late gadolinium enhancement with septal involvement, and inducibility after VT ablation, identify higher-risk patients.</div></div><div><h3>Registration</h3><div>PROSPERO CRD420251075109.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 958-967"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Community Size and Commute Time on Severity of Pulmonary Arterial Hypertension at Diagnosis and Follow-up in Patients Across 3 Sites","authors":"Renee Reimer MD,&nbsp;John R. Swiston MD,&nbsp;Carter McInnis MD,&nbsp;Freda Tom,&nbsp;Mitesh V. Thakrar MD,&nbsp;Naushad Hirani MD,&nbsp;Doug Helmersen MD,&nbsp;Nathan Hambly MD,&nbsp;Jason Weatherald MD,&nbsp;Monica Norena MSc,&nbsp;Nathan W. Brunner MD","doi":"10.1016/j.cjco.2026.04.014","DOIUrl":"10.1016/j.cjco.2026.04.014","url":null,"abstract":"<div><h3>Background</h3><div>Rare diseases such as pulmonary arterial hypertension (PAH) require centralized referral centres for diagnosis and management. It is unclear whether a patient’s geographic proximity to a referral centre influences the severity of illness on diagnosis and follow-up.</div></div><div><h3>Methods</h3><div>We identified all patients with a diagnosis of PAH across 3 tertiary referral centres. Postal code data were used to stratify patients based on community size. Commute time to a tertiary centre was determined using mapping software. Community size and commute time were compared with baseline catheterization data in addition to follow-up data including biomarkers, functional class, 6-minute walk distance, echocardiography, and repeat catheterization, if available. Follow-up data were used to create a risk factor stratification score as per the most recent guidelines of the European Society of Cardiology/European Respiratory Society.</div></div><div><h3>Results</h3><div>Of the 504 patients in our analysis, 51 (10.1%) lived in a rural area, 69 (13.7%) in a small population centre, 60 (11.9%) in a medium population centre, and 324 (64.3%) in a large urban centre. For commute time, 308 (61.1%) patients had a commute time &lt; 1 hour, 93 (18.5%) patients commuted 1-3 hours, and 103 (20.4%) of patients commuted &gt; 3 hours. There were no robust or consistent associations found between community size or commute time and baseline right heart catheterization data or follow-up indices.</div></div><div><h3>Conclusions</h3><div>In this multicentre analysis we found no clear associations between community size or commute time with severity of illness at diagnosis or follow-up. This supports previous conclusions that patients living in rural communities do not experience disparities in their PAH outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1052-1059"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Presentation and Management of Patients Referred for Transthoracic Echocardiography in Canada’s Arctic Region","authors":"Gaspard Suc MD, PhD,&nbsp;Ian G. Burwash MD,&nbsp;Luc Beauchesne MD,&nbsp;Francois de Wet MD,&nbsp;Lawrence Lau MD,&nbsp;Hassan Alfraidi MD,&nbsp;Anahita Tavoosi MD,&nbsp;Andrew Mulloy MD,&nbsp;David Ian Paterson MD,&nbsp;Markus Schwerzmann MD,&nbsp;Hassan Mir MD,&nbsp;Ellamae Stadnick MD,&nbsp;Kwan L. Chan MD,&nbsp;Hanh Nguyen MD,&nbsp;Christele Ferry MD,&nbsp;Roja Gauda MSc,&nbsp;Rob S. Beanlands MD,&nbsp;David H. Birnie MD,&nbsp;Mehrdad Golian MD,&nbsp;Richard F. Davies MD,&nbsp;David Messika-Zeitoun MD, PhD","doi":"10.1016/j.cjco.2026.03.007","DOIUrl":"10.1016/j.cjco.2026.03.007","url":null,"abstract":"<div><h3>Background</h3><div>Indigenous populations in Canada experience disproportionately high cardiovascular risk, yet contemporary data on echocardiographic findings in the Arctic remain limited. This study evaluated indications, echocardiographic findings, and subsequent management of patients undergoing transthoracic echocardiography in Eastern Nunavut.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of all consecutive transthoracic echocardiograms performed between January 2020 and December 2023 in Iqaluit and surrounding remote communities. Demographic data, echocardiographic results, and management decisions were collected and compared between Indigenous and non-Indigenous patients. Significant abnormalities were defined as moderate or severe valvular heart disease (VHD), prosthetic valve dysfunction, left ventricular ejection fraction (LVEF) &lt; 50%, regional wall-motion abnormalities (RWMA), systolic pulmonary artery pressure ≥ 40 mm Hg, or congenital heart disease.</div></div><div><h3>Results</h3><div>Among 662 patients (mean age 55 ± 16 years; 47% women), 530 (80%) were Indigenous. Significant abnormalities were identified in 197 patients (30%). Moderate or severe VHD was present in 67 patients (10%), most commonly degenerative (31%), followed by functional (25%) and rheumatic (16%) etiologies. Reduced LVEF was seen in 16%, and RWMA was seen in 7%. Management included local follow-up (44%), transfer or hospital admission (16%), and tertiary-care referral (9%). Compared to non-Indigenous patients, Indigenous patients had higher unadjusted rates of significant abnormalities (33% vs 18%, <em>P</em> &lt; 0.01), moderate or severe VHD (12% vs 5%, <em>P</em> = 0.04), and reduced LVEF or RWMA (21% vs 13%, <em>P</em> = 0.07).</div></div><div><h3>Conclusions</h3><div>Patients in Canada’s Arctic, particularly Indigenous communities, carry a substantial burden of cardiac disease, including elevated rates of VHD and ventricular dysfunction. Improved prevention and access to cardiovascular care are essential to reduce these disparities.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 989-998"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) Levels and Major Adverse Cardiovascular Events in Alberta, Canada: A Retrospective Cohort Study","authors":"Glen J. Pearson PharmD,&nbsp;Phongsack Manivong PhD,&nbsp;Tram Pham MPH,&nbsp;Eileen Shaw MSc,&nbsp;Patrick Leclerc PhD,&nbsp;Jonathan Fortier MSc,&nbsp;Nada Farhat PhD,&nbsp;Melanie Kok PhD,&nbsp;Todd J. Anderson MD","doi":"10.1016/j.cjco.2026.03.015","DOIUrl":"10.1016/j.cjco.2026.03.015","url":null,"abstract":"<div><h3>Background</h3><div>Elevated lipoprotein(a) (Lp(a)) is a key contributor to residual cardiovascular risk in secondary prevention populations. However, Lp(a) testing rates remain low despite guideline recommendations, highlighting a gap in atherosclerotic cardiovascular disease (ASCVD) management. The purpose of this study was to characterize patients with Lp(a) testing and established ASCVD and quantify the risk of subsequent major adverse cardiovascular events (MACE).</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using administrative health data from Alberta, Canada. Patients were indexed on their first ASCVD event between January 1, 2015 and September 30, 2022. Time-to-first MACE was assessed using Kaplan–Meier and Cox regression models, grouped by different Lp(a) thresholds. Multivariable models were adjusted for significant characteristics identified through univariable analysis.</div></div><div><h3>Results</h3><div>The study cohort included 6891 patients with a mean age of 60.0 years (standard deviation: 12.2), 35.9% female; 5163 had an Lp(a) level ≤ 50 mg/dL (∼120 nmol/L), and 1728 had an Lp(a) level &gt; 50 mg/dL. At 8 years post-index, the MACE-free probability (95% confidence interval [CI]) was 76.3% (73.7%-79.0%) for ≤ 50 mg/dL, 64.7% (58.9%-70.4%) for &gt; 50 mg/dL, 60.7% (53.4%-68.0%) for &gt; 70 mg/dL (∼168 nmol/L), and 57.1% (46.8%-67.3%) for &gt; 90 mg/dL (∼216 nmol/L). The adjusted hazard ratio (95% CI) for Lp(a) &gt; 50, &gt; 70, and &gt; 90 mg/dL (vs the corresponding reference category) was 1.49 (1.29-1.73), 1.56 (1.33-1.83), and 1.60 (1.33-1.93), respectively.</div></div><div><h3>Conclusions</h3><div>Patients with elevated Lp(a) level and ASCVD had increased risk of MACE. These findings support broader, routine Lp(a) testing to enable earlier intervention and inform use of targeted Lp(a)-lowering therapies in Canada.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 981-988"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrioventricular Nodal Reentrant Tachycardia–Induced Ventricular Tachycardia in a Patient with Mitral Valve Prolapse","authors":"Jakub Honěk MD, PhD,&nbsp;Tomáš Hnát MD,&nbsp;Hana Línková MD, PhD,&nbsp;Václav Durdil MD,&nbsp;Martin Horváth MD, PhD,&nbsp;Petr Ošťádal MD, PhD","doi":"10.1016/j.cjco.2026.04.006","DOIUrl":"10.1016/j.cjco.2026.04.006","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 968-970"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Oral Anticoagulants Compared to Warfarin Early After Cardiac Surgery: A Pilot Randomized Controlled Trial","authors":"Erica H.Z. Wang BScPharm, PharmD,&nbsp;Ricky Turgeon BScPharm, PharmD,&nbsp;Eric Chu BScPharm, PharmD,&nbsp;Terri Sun MD,&nbsp;Jamil Bashir MD,&nbsp;Defen Peng PhD,&nbsp;Richard Cook MD,&nbsp;Juliet Atherstone MD,&nbsp;Tracy Gwozd MN,&nbsp;Jian Ye MD","doi":"10.1016/j.cjco.2026.03.011","DOIUrl":"10.1016/j.cjco.2026.03.011","url":null,"abstract":"<div><h3>Background</h3><div>The goal was to conduct a pilot randomized controlled trial (RCT) of direct oral anticoagulants (DOACs) early after cardiac surgery to determine the feasibility of a larger RCT.</div></div><div><h3>Methods</h3><div>We conducted an open-label, 2-site, pilot RCT of adults undergoing cardiac surgery with an indication for anticoagulation, excluding mechanical valves and bioprosthetic mitral valve replacements. We randomized patients 1:1 to receive a DOAC or warfarin started during the index hospitalization with a standardized time of postoperative initiation and bridging for high thrombosis risk. The coprimary feasibility outcome goals were recruitment of ≥ 70% eligible patients and adherence to the anticoagulation protocol in ≥ 80% patients. The primary clinical composite outcome included all-cause mortality, major bleeding, stroke, systemic embolism, or pericardial effusion requiring intervention within 3 months.</div></div><div><h3>Results</h3><div>Between October 2022 and February 2024, a total of 547 patients were screened, 163 met inclusion criteria, 104 were randomized, and 100 were analyzed (50 in each group). The median age was 72 years; 22% were female; 54% had preexisting atrial fibrillation; 37% had postoperative atrial fibrillation, with a median <strong>C</strong>ongestive Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge ≥ 75 Years, <strong>D</strong>iabetes Mellitus, <strong>S</strong>troke, <strong>V</strong>ascular Disease, <strong>A</strong>ge 65 to 74 Years, <strong>S</strong>ex <strong>C</strong>ategory (CHA₂DS₂-VASc) score of 3 and a <strong>H</strong>ypertension, <strong>A</strong>bnormal Renal/Liver Function, <strong>S</strong>troke, <strong>B</strong>leeding History or Predisposition, <strong>L</strong>abile INR, <strong>E</strong>lderly (&gt; 65 Years), <strong>D</strong>rugs/Alcohol Concomitantly (HAS-BLED) score of 2. We recruited 64% of eligible patients, and anticoagulation protocol adherence was 91%. The clinical composite outcome occurred in 8% with DOAC (2 major bleeding, 1 pericardial effusion, 1 death) vs 4% with warfarin (2 strokes); log-rank <em>P</em> = 0.42.</div></div><div><h3>Conclusions</h3><div>Although the a priori recruitment goal was not met, this trial supports the need for and provides valuable insights into key challenges to mitigate, thereby guiding the design of a large, definitive multicentre RCT comparing DOACs vs warfarin in cardiac surgery patients.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>NCT05006287</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1109-1118"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Predictors of Lipoprotein(a) Measurement in Younger Patients Following ST-Elevation Myocardial Infarction","authors":"Negar Atefi MD,&nbsp;Joshua Yoon MD,&nbsp;Farshad Hosseini MD,&nbsp;Terry Lee PhD,&nbsp;Liam R. Brunham MD, PhD, FRCPC,&nbsp;John A. Cairns MD, FRCPC, FACC, FCAHS,&nbsp;G.B. John Mancini MD, FRCPC, FACC,&nbsp;Thomas M. Roston MD, PhD, FRCPC,&nbsp;Joel Singer PhD,&nbsp;Graham C. Wong MD, MPH, FRCPC,&nbsp;Christopher B. Fordyce MD, MSc, FRCPC","doi":"10.1016/j.cjco.2026.04.003","DOIUrl":"10.1016/j.cjco.2026.04.003","url":null,"abstract":"<div><h3>Background</h3><div>Lipoprotein(a) [Lp(a)] level is a well established, independent risk factor for premature atherosclerotic cardiovascular disease. The 2021 Canadian Cardiovascular Society dyslipidemia recommendations advise that Lp(a) measurement be performed as part of cardiovascular risk stratification. However, little is known about the clinical adoption of this recommendation, particularly as undertaken for young patients presenting with acute coronary syndromes.</div></div><div><h3>Methods</h3><div>This study assessed the prevalence and predictors of Lp(a) measurement in a contemporary cohort of patients aged <span><math><mrow><mo>≤</mo></mrow></math></span> 65 years presenting with ST-elevation myocardial infarction (STEMI) in Vancouver, Canada between January 2016 and January 2023. The primary outcome was the proportion of such patients who had a measurement of Lp(a) prior to or within 1 year of index STEMI hospitalization. Secondary analyses explored predictors of Lp(a) measurement at any point in the lifetime, as well as measurement trends through years.</div></div><div><h3>Results</h3><div>A total of 1106 patients were studied (mean age 55.9 years; 88.1% male). Only 240 patients (21.7%) had Lp(a) level assessed within 1 year of STEMI. The rate of Lp(a) measurement increased from 15% to 39% during the interval from 2016-2023 (<em>P</em> &lt; 0.01 for trend). Older age (OR 0.67; 95% confidence interval [CI] [0.60, 0.75], <em>P</em> &lt; 0.01), prior history of smoking (OR 0.65; 95% CI [0.46, 0.91], <em>P</em> = 0.01), and earlier year of STEMI in the study period (OR 0.83; 95% CI [0.77, 0.90], <em>P</em> &lt; 0.01) were independently associated with a lower likelihood of Lp(a) measurement.</div></div><div><h3>Conclusions</h3><div>Although rates of measurement have increased from 2016 to 2023, Lp(a) testing remains underutilized among younger STEMI patients. Strategies are needed to increase the testing of Lp(a) level among younger patients with STEMI, especially with the development of novel targeted therapeutics.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 972-980"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preprocedural CALLY Index As a Novel Predictor of Pacemaker Requirement After Transcatheter Aortic Valve Replacement","authors":"Haitham Abu Khadija MD,&nbsp;Nizar Abu Hamdeh MD,&nbsp;Mohammad Masu'd MD,&nbsp;Duha Najajra MD,&nbsp;Ali Abdullah MD,&nbsp;Jebrin Alkrinawi MD,&nbsp;Alena Kirzhner MD,&nbsp;Zeina Sinnokrot MD,&nbsp;Lilian Jofa MD,&nbsp;Firas Besharieh MD,&nbsp;Rashed Saed MD,&nbsp;Alaa Zayed MD,&nbsp;Sarah Awad MD,&nbsp;Tal Schiller MD,&nbsp;Mohammad Alnees MD","doi":"10.1016/j.cjco.2026.03.008","DOIUrl":"10.1016/j.cjco.2026.03.008","url":null,"abstract":"<div><h3>Background</h3><div>Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Although procedural and electro-anatomic factors are well established, patient-related susceptibility markers remain unclear. We aimed to evaluate whether the preprocedural C-reactive protein–albumin–lymphocyte (CALLY) index independently predicts and aids in risk stratification for 30-day PPI after TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 812 consecutive TAVR patients with complete baseline labs (2010-2025). The CALLY index was calculated as (albumin × lymphocytes ÷ C-reactive protein) ×10, and patients were stratified into quartiles (Q1-Q4). The primary endpoint was new PPI within 30 days. Kaplan–Meier curves and Cox regression assessed the association between CALLY index quartiles and PPI risk. Multivariable models adjusted for prespecified clinical, anatomic, and procedural factors. Subgroup analyses evaluated consistency across age, sex, hypertension, and valve type.</div></div><div><h3>Results</h3><div>Median time to PPI was 4 days (interquartile range 2-9), and 145 patients (17.9%) required implantation. Higher CALLY index quartiles were associated with a progressively lower PPI risk compared with Q1: Q2 hazard ratio (HR) 0.64 (95% confidence interval [CI] 0.42-0.99), Q3 HR 0.63 (95% CI 0.41-0.98), and Q4 HR 0.50 (95% CI 0.31-0.79). After multivariable adjustment, Q4 remained independently protective (HR 0.57, 95% CI 0.35-0.94). The protective effect of Q4 was consistent across subgroups, including age ≥ 80 years, male patients, female patients, hypertensive patients, and recipients of self-expanding valves. No significant effect modification was observed.</div></div><div><h3>Conclusions</h3><div>A higher preprocedural CALLY index was independently linked to a lower 30-day pacemaker requirement after TAVR. As a simple, inexpensive marker, the CALLY index may improve pre-TAVR risk stratification and guide periprocedural planning.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 925-938"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}