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Acute Heart Failure Due to a Fistula Between the Anastomotic Pseudoaneurysm and the Right Atrium Following a Previous Aortic Dissection Repair 主动脉夹层修复术后,吻合假动脉瘤与右心房之间出现瘘管,导致急性心力衰竭
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.005
Nobunari Tomura MD , Takuo Nakagami MD, PhD , Masakazu Kikai MD, PhD , Tetsuro Hamaoka MD , Kuniyoshi Fukai MD, PhD , Shinichiro Yamaguchi MD , Keiji Matsubayashi MD, PhD , Satoaki Matoba MD, PhD
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引用次数: 0
Potent P2Y12 Inhibitor Selection and De-escalation Strategies in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: Systematic Review and Meta-analysis 接受 PCI 治疗的急性冠状动脉综合征患者的强效 P2Y12 抑制剂选择和去梗策略:系统回顾和 Meta 分析
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2023.11.024
Laurie-Anne Boivin-Proulx MD, MSc , Kevin R. Bainey MD, MSc , Guillaume Marquis-Gravel MD , Michelle M. Graham MD

Background

Balancing the effects of dual antiplatelet therapy (DAPT) in the era of potent purinergic receptor type Y, subtype 12 (P2Y12) inhibitors remains a challenge in the management of acute coronary syndrome (ACS).

Methods

We conducted a systematic review and meta-analysis following a 2-stage process consisting of searching for systematic reviews published between 2019 and November 2022. We included randomized controlled trials (RCTs) of ACS patients treated with percutaneous coronary intervention comparing (i) ticagrelor- vs prasugrel-based DAPT and (ii) P2Y12 inhibitor de-escalation strategies. Outcomes of interest were major adverse cardiovascular events (MACE), all-cause death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.

Results

Eight RCTs (n = 5571) compared ticagrelor to prasugrel. Ticagrelor was associated with an increased risk of MACE compared to prasugrel (RR 1.23, 95% CI 1.01-1.49, moderate certainty), without significant differences in death, stent thrombosis, or major bleeding. In 2 RCTs (n = 3343) comparing clopidogrel-based DAPT de-escalation after 1 month to potent P2Y12 inhibitor–based DAPT continuation, clopidogrel de-escalation did not significantly alter the incidence of MACE, death, or stent thrombosis, but reduced that of major bleeding (RR 0.51, 95% CI 0.28-0.92, high certainty). The effect of prasugrel dose de-escalation was inconclusive for all outcomes based on one trial.

Conclusions

Ticagrelor was associated with an increase in MACE compared with prasugrel, based on low-certainty evidence, whereas de-escalation to clopidogrel after 1 month of potent P2Y12 inhibitor was associated with a decrease in incidence of major bleeding without increasing thrombotic outcomes in ACS patients post-percutaneous coronary intervention.

背景在强效嘌呤能受体Y亚型12(P2Y12)抑制剂时代,平衡双重抗血小板疗法(DAPT)的效果仍是急性冠状动脉综合征(ACS)治疗中的一项挑战。方法我们进行了一项系统综述和荟萃分析,分为两个阶段,包括检索2019年至2022年11月期间发表的系统综述。我们纳入了对接受经皮冠状动脉介入治疗的 ACS 患者进行的随机对照试验(RCT),这些试验比较了(i)基于替卡格雷的 DAPT 与基于普拉格雷的 DAPT,以及(ii)P2Y12 抑制剂降级策略。我们关注的结果包括主要不良心血管事件 (MACE)、全因死亡、支架血栓和大出血。我们使用随机效应模型估算了风险比 (RR) 和 95% 置信区间 (CI)。与普拉格雷相比,替卡格雷增加了MACE风险(RR 1.23,95% CI 1.01-1.49,中度确定性),但在死亡、支架血栓或大出血方面无显著差异。在 2 项 RCT(n = 3343)中,比较了 1 个月后基于氯吡格雷的 DAPT 降级与基于强效 P2Y12 抑制剂的 DAPT 持续,氯吡格雷降级并未显著改变 MACE、死亡或支架血栓的发生率,但降低了大出血的发生率(RR 0.51,95% CI 0.28-0.92,高度确定性)。结论根据低确定性证据,与普拉格雷相比,替卡格雷与MACE的增加有关,而在经皮冠状动脉介入治疗后的ACS患者中,使用强效P2Y12抑制剂1个月后改为氯吡格雷与大出血发生率的降低有关,而不会增加血栓形成的结果。
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引用次数: 0
Sex Differences in Outcomes of Adults With Isolated Coarctation of the Aorta 孤立性主动脉粥样硬化症成人预后的性别差异
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.008
Alexander C. Egbe MD, MPH, MS , William R. Miranda MD , C. Charles Jain MD , Luke J. Burchill MBBS, PhD , Omar Abozied MBBS , Marwan H. Ahmed MBBS , Maan Jokhadar MD , Snigdha Karnakoti MBBS , Heidi M. Connolly MD

Background

Data are limited about the effect (or lack thereof) of sex on clinical outcomes in adults with coarctation of the aorta (COA). The purpose of this study was to compare atherosclerotic cardiovascular disease (ASCVD) risk profile, blood pressure (BP) data, echocardiographic indices, and mortality between men and women with COA.

Methods

Retrospective study of adults with COA, and no associated left-sided obstructive lesions, who received care at Mayo Clinic (2003-2022). ASCVD risk profile was assessed as the prevalence of hypertension, hyperlipidemia, type 2 diabetes, obesity, smoking history, and coronary artery disease. A 24-hour BP monitor was used to assess daytime and nighttime BP and calculate nocturnal dipping.

Results

Of 621 patients with isolated COA, 375 (60%) were men, and 246 (40%) were women. Women had similar ASCVD risk profile and daytime BP as men. However, women had less nocturnal dipping (7 ± 5 mm Hg vs 16 ± 7 mm Hg, P < 0.001), higher pulmonary artery mean pressure (23 mm Hg [interquartile range: 16-31] vs 20 mm Hg [interquartile range: 15-28], P = 0.04), and higher pulmonary vascular resistance index (3.41 ± 1.14 WU · m2 vs 3.02 ± 0.76 WU · m2, P = 0.006). Female sex was associated with all-cause mortality (adjusted hazard ratio 1.26, 95% confidence interval 1.04-1.94) and cardiovascular mortality (adjusted hazard ratio 1.38, 95% confidence interval 1.09-2.18).

Conclusions

Women had a higher risk of both cardiovascular mortality and all-cause mortality compared to the risks in men. This difference may be related to the higher-than-expected ASCVD risk factors, abnormal nocturnal blood pressure, and pulmonary hypertension observed in women in this cohort. Further studies are required to identify optimal measures to address these risk factors.

背景关于性别对患有主动脉共动脉症(COA)的成人临床预后的影响(或不影响)的数据很有限。本研究的目的是比较COA患者中男性和女性的动脉粥样硬化性心血管疾病(ASCVD)风险概况、血压(BP)数据、超声心动图指数和死亡率。方法对在梅奥诊所接受治疗(2003-2022年)的患有COA且无相关左侧阻塞性病变的成人进行回顾性研究。ASCVD风险状况是指高血压、高脂血症、2型糖尿病、肥胖、吸烟史和冠状动脉疾病的患病率。结果 在621名孤立性COA患者中,男性375人(60%),女性246人(40%)。女性的 ASCVD 风险状况和日间血压与男性相似。然而,女性夜间血压下降较少(7 ± 5 mm Hg vs 16 ± 7 mm Hg,P < 0.001),肺动脉平均压力较高(23 mm Hg [四分位间范围:16-31] vs 20 mm Hg [四分位间范围:15-28],P = 0.04),肺血管阻力指数较高(3.41 ± 1.14 WU - m2 vs 3.02 ± 0.76 WU - m2,P = 0.006)。女性性别与全因死亡率(调整后危险比为 1.26,95% 置信区间为 1.04-1.94)和心血管死亡率(调整后危险比为 1.38,95% 置信区间为 1.09-2.18)相关。这一差异可能与该队列中观察到的女性ASCVD风险因素、夜间血压异常和肺动脉高压高于预期有关。要确定应对这些风险因素的最佳措施,还需要进一步的研究。
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引用次数: 0
The VENERE Study: EffectiVenEss of a Rehabilitation Treatment With Nordic Walking in ObEse or OveRweight Diabetic PatiEnts With Cardiovascular Disease VENERE 研究:北欧式健走对肥胖或超重糖尿病心血管疾病患者的康复治疗效果
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.002
Anna Torri MD , Eleonora Volpato PsyD, PhD , Giampiero Merati MD , Martina Milani MD , Anastasia Toccafondi , Damiano Formenti PhD , Francesca La Rosa PhD , Simone Agostini PhD , Cristina Agliardi PhD , Letizia Oreni MSc , Alice Sacco MD , Marta Rescaldani MD , Stefano Lucreziotti MD , Ada Giglio MD , Giulia Ferrante MD , Maristella Barbaro MD , Claudio Montalto MD , Stefano Buratti MD , Nuccia Morici MD, PhD

Background

Nordic walking (NW) has several potential benefits for individuals with cardiovascular (CV) disease, type 2 diabetes, and obesity and/or overweight. NW improves cardiovascular health, including exercise capacity and blood pressure control. NW enhances glycemic control and insulin sensitivity in diabetes, and aids in weight management and body composition improvement. NW offers additional advantages, such as improvement in muscular strength, joint mobility, physical activity levels, and psychological well-being.

Methods

This open-label study with 3 arms will aim to evaluate the efficacy, safety, and adherence to exercise prescription in obese and/or overweight diabetic patients with CV complications. The primary objective will be to assess the CV performance of participants after a 6-month and a 12-month follow-up period, following a 3-month NW intervention, compared with standard rehabilitation, and with cardiological counseling (control group) training lasting 3 months.

Results

The results of the study will provide valuable insights into the comparative effectiveness of a NW intervention vs standard rehabilitation and control group training in improving CV performance in obese and/or overweight diabetic patients with CV complications. Additionally, safety and adherence data will help inform the feasibility and sustainability of the exercise prescription over an extended period.

Conclusions

These findings may have implications for the development of tailored exercise programs for this specific patient population, with the aim of optimizing CV health outcomes.

Clinical Trials Registration

NCT05987410

背景北欧式健走(NW)对心血管疾病、2 型糖尿病、肥胖和/或超重患者有多种潜在益处。北欧健走能改善心血管健康,包括运动能力和血压控制。负重行走可增强糖尿病患者的血糖控制和胰岛素敏感性,并有助于控制体重和改善身体结构。方法这项开放标签研究分为 3 个阶段,旨在评估肥胖和/或超重糖尿病并发症患者运动处方的有效性、安全性和依从性。主要目的是评估参与者在接受为期 3 个月的 NW 干预后,与标准康复训练和为期 3 个月的心脏病咨询(对照组)训练相比,在 6 个月和 12 个月的随访期后的 CV 表现。此外,安全性和依从性数据将有助于了解长期运动处方的可行性和可持续性。结论这些研究结果可能会对为这一特殊患者群体制定量身定制的运动计划产生影响,从而达到优化心血管健康结果的目的。
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引用次数: 0
Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease With Recent or Remote Events: Systematic Review and Meta-analysis 心房颤动和冠心病患者近期或远期事件的抗血栓治疗:系统回顾和荟萃分析
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.001
Ahmad Hayek MD , Blair J. MacDonald BA PharmD , Guillaume Marquis-Gravel MD, MSc , Kevin R. Bainey MD, MSc , Samer Mansour MD , Margaret L. Ackman PharmD , Warren J. Cantor MD , Ricky D. Turgeon BSc(Pharm), PharmD

Background

Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.

Methods

We performed a systematic review and meta-analysis to synthesize randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant [OAC] plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.

Results

Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.

Conclusions

In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.

背景关于心房颤动(AF)和冠状动脉疾病患者的最佳抗血栓治疗仍存在争论。方法我们进行了一项系统综述和荟萃分析,综合比较了以下随机对照试验(RCT):(i) 经皮冠状动脉介入治疗(PCI)或急性冠状动脉综合征(ACS)后的双途径疗法(DPT;口服抗凝剂 [OAC] 加抗血小板)与三联疗法(OAC 和双抗血小板疗法);(iii) PCI 或 ACS 至少 1 年后的 OAC 单药疗法与 DPT。经过两个阶段,我们确定了 2019 年至 2022 年期间发表的有关这两个临床问题的系统综述,并对截至 2022 年 10 月发表的其他 RCT 进行了最全面的检索更新。我们关注的结果是主要不良心血管事件(MACE)、死亡、支架血栓和大出血。结果基于6项RCT(n = 10,435),与PCI或药物治疗ACS后的三联疗法相比,DPT减少了大出血(RR 0.62,95% CI 0.52-0.73),增加了支架血栓形成(RR 1.55,95% CI 1.02-2.36),但在MACE和死亡方面无显著差异。在 2 项 RCT(n = 2905)中,对于远期 PCI 或 ACS 的房颤患者,OAC 单药与 DPT 相比可减少大出血(RR 0.66,95% CI 0.49-0.91),但在 MACE 或死亡方面无明显差异。这些结果支持对这些患者采取最小化但个性化的抗血栓策略。
{"title":"Antithrombotic Therapy in Patients With Atrial Fibrillation and Coronary Artery Disease With Recent or Remote Events: Systematic Review and Meta-analysis","authors":"Ahmad Hayek MD ,&nbsp;Blair J. MacDonald BA PharmD ,&nbsp;Guillaume Marquis-Gravel MD, MSc ,&nbsp;Kevin R. Bainey MD, MSc ,&nbsp;Samer Mansour MD ,&nbsp;Margaret L. Ackman PharmD ,&nbsp;Warren J. Cantor MD ,&nbsp;Ricky D. Turgeon BSc(Pharm), PharmD","doi":"10.1016/j.cjco.2024.01.001","DOIUrl":"10.1016/j.cjco.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.</p></div><div><h3>Methods</h3><p>We performed a systematic review and meta-analysis to synthesize randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant [OAC] plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.</p></div><div><h3>Results</h3><p>Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.</p></div><div><h3>Conclusions</h3><p>In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24000210/pdfft?md5=650af0e97f6f4e4a0c1f0377d24db216&pid=1-s2.0-S2589790X24000210-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539717","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}
引用次数: 0
Community Pharmacy-Based Blood Pressure Screening in Newfoundland and Labrador, Canada for World Hypertension Day 2022: A Cross-Sectional Study 加拿大纽芬兰省和拉布拉多半岛为 2022 年世界高血压日开展的社区药房血压筛查:横断面研究
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2023.12.012
Tiffany A. Lee BSc(Pharm), PharmD, PhD(c) , Melanie King PharmD(c) , Stephanie W. Young BSc(Pharm), PharmD, MSc , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc

Background

High blood pressure (BP) is a leading cause of cardiovascular and stroke-related events. Office-based BP measurement has declined in recent years due to the COVID-19 pandemic, which may have resulted in higher rates of undetected and uncontrolled hypertension. To gain a better idea of adult BP levels in Newfoundland and Labrador, we engaged community pharmacists in BP screening on World Hypertension Day.

Methods

Data collection and BP screening occurred on May 17, 2022. Pharmacists and pharmacy students collected 3 seated BP readings from participants, using an automated device. The average of readings 2 and 3 was used to estimate BP, with elevated BP defined as ≥ 140/90 mm Hg, or ≥ 130/80 mm Hg for individuals with diabetes. Data on participant demographics, access to primary care, medical history, and antihypertensive use were also collected. Data analysis included descriptive statistics and logistic regression techniques.

Results

A total of 460 participants were included in the analysis. The mean age was 56.3 years (standard deviation: 16.95); 63.3% (n = 291) were female; and 43.7% (n = 201) reported having hypertension. Elevated BP was identified in 27% (n = 123). Of those with elevated BP, 41.5% (n = 51) had no history of diagnosed hypertension. Age, sex, and diabetes were statistically significant predictors of elevated BP in the multivariable model.

Conclusions

A large proportion of participants in our study had elevated BP. Targeted measures are needed to improve the detection, treatment, and control of high BP in Newfoundland and Labrador. Community pharmacists can support BP care.

背景高血压(BP)是心血管和中风相关事件的主要原因。近年来,由于 COVID-19 的流行,以办公室为基础的血压测量有所减少,这可能导致未被发现和未得到控制的高血压发病率升高。为了更好地了解纽芬兰省和拉布拉多半岛的成人血压水平,我们在世界高血压日让社区药剂师参与了血压筛查。药剂师和药剂学专业学生使用自动设备采集了 3 个参与者的坐位血压读数。血压升高的定义是血压≥ 140/90 mm Hg,或糖尿病患者血压≥ 130/80 mm Hg。此外,还收集了有关参与者人口统计学、初级保健、病史和降压药使用情况的数据。数据分析包括描述性统计和逻辑回归技术。平均年龄为 56.3 岁(标准差:16.95);63.3%(n = 291)为女性;43.7%(n = 201)报告患有高血压。27%(n = 123)的人发现血压升高。在血压升高的患者中,41.5%(n = 51)没有确诊的高血压病史。在多变量模型中,年龄、性别和糖尿病对血压升高的预测具有统计学意义。在纽芬兰省和拉布拉多半岛,需要采取有针对性的措施来改善高血压的检测、治疗和控制。社区药剂师可以为血压护理提供支持。
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引用次数: 0
ICD Implantation Rates in Cardiac Arrest Survivors in Canada 加拿大心脏骤停幸存者的 ICD 植入率
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2023.12.011
Farzad Darabi MD , Nigel S. Tan MD , Katherine S. Allan PhD , Steve Lin MD, MSc , Paul Angaran MD, MSc , Paul Dorian MD, MSc

Background

Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care.

Methods

The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were potentially eligible to have an ICD.

Results

Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were potentially eligible to receive an ICD. Among these potentially eligible patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (P-value for time trend < 0.05). The rate of ICD implantations in potentially eligible patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%).

Conclusions

Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.

背景院外心脏骤停(OHCA)后复苏的患者复发的风险很高,给医疗系统带来了沉重的负担。尽管植入式心律转复除颤器(ICD)治疗对许多此类患者有明显的益处,而且指南也提出了建议,但很少有研究说明院外心脏骤停患者接受与指南一致的治疗的比例。结果2013年至2017年期间,数据库共记录了10435名入院的OHCA患者;4486人(43%)存活至出院,2580名存活者(57.5%)可能符合接受ICD治疗的条件。在这些可能符合条件的患者中,有 757 人(29.3%)在指标入院期间或出院后 30 天内接受了 ICD 治疗。索引入院期间的ICD植入率从2013年的13.8%增至2017年的19.6%(时间趋势的P值为< 0.05)。可能符合条件的患者的 ICD 植入率在城市高于农村(19.5% vs 11.1%),在教学医院高于社区医院(34.7% vs 9.8%)。结论虽然在可能符合二级预防条件的 OHCA 患者中,ICD 植入率呈上升趋势,但这些患者的 ICD 使用率仍然严重不足。
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引用次数: 0
Ventricular Tachycardia as a Late Complication of COVID-19 in a Young Patient With No History of Cardiovascular Disease 室性心动过速是一名无心血管疾病史的年轻患者服用 COVID-19 后的并发症
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.010
Abdel Hadi El Hajjar MD , Michel Chedid El Helou MD , Aqieda Bayat MD , Daniel Cantillon MD , Tamanna Singh MD , Tyler Taigen MD , Rohit Moudgil MD, PhD
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引用次数: 0
Early Effects of the COVID-19 Pandemic on Patients in a Virtual Multicenter Spontaneous Coronary Artery Dissection (SCAD) Registry COVID-19 大流行对虚拟多中心自发性冠状动脉夹层 (SCAD) 登记患者的早期影响
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.006
Yeonsoo Sara Lee BS , Sharonne N. Hayes MD , Patricia J.M. Best MD , Rajiv Gulati MD, PhD , Benjamin R. Gochanour MS , Marysia S. Tweet MD, MS

Background

The COVID-19 pandemic effects among patients with a history of spontaneous coronary artery dissection (SCAD), a cause of acute coronary syndrome associated with emotional and physical stress, are unknown.

Methods

For this cross-sectional cohort study, participants of the Mayo Clinic “Virtual” Multicenter SCAD Registry were surveyed about the COVID-19 pandemic.

Results

Among 1352 participants, 727 (53.8%) completed surveys between June 2, 2021 and September 29, 2021. The majority of respondents (96.7%) were female, with a mean age of 54.9 ± 9.4 years. At the time of completing the survey, which was early in the pandemic, 91 respondents (12.6%) reported having prior COVID-19 symptoms, with < 1% experiencing hospitalization (n = 4) or cardiac complications (n = 6). A total of 14% had ≥ moderate anxiety symptoms, per the General Anxiety Disorder-7 item survey, and 11.8% had ≥ moderate depressive symptoms, per the Patient Health Questionnaire-9 item. Higher stress scores on the Likert scale were correlated with pandemic-related reduction in work hours and/or pay and/or unemployment (P = 0.013), remote work and/or change of job (P < 0.001), and loss of insurance and/or medical coverage (P = 0.025). A higher anxiety level, as measured on the Likert scale, was correlated with pandemic-related remote work and/or change of job (P = 0.007) and loss of insurance and/or medical coverage (P = 0.008). Since the start of the pandemic, 54% of respondents reported having at least monthly chest pain. Chest pain and COVID symptoms were each associated with higher scores on the General Anxiety Disorder-7 item survey and the Patient Health Questionnaire-9 item.

Conclusions

Early in the pandemic, COVID-19 symptoms, hospitalization, and cardiac complications were uncommon among SCAD patients. The burden of anxiety and depressive symptoms was minimal to mild, similar to that in prior reports. Likert-scale measures of stress and anxiety were higher among persons with work and/or pay reduction and/or unemployment, remote work and/or change of job, and loss of insurance and/or medical coverage. Over half of respondents reported experiencing chest pain, which was correlated with depressive and anxiety symptoms, highlighting an overarching clinical need.

背景COVID-19大流行对有自发性冠状动脉夹层(SCAD)病史患者的影响尚不清楚,自发性冠状动脉夹层是与情绪和身体压力相关的急性冠状动脉综合征的病因。结果在1352名参与者中,有727人(53.8%)在2021年6月2日至2021年9月29日期间完成了调查。大多数受访者(96.7%)为女性,平均年龄为 54.9 ± 9.4 岁。在完成调查时,也就是大流行初期,91 名受访者(12.6%)称曾出现过 COVID-19 症状,< 1%的受访者曾住院治疗(4 人)或出现心脏并发症(6 人)。根据一般焦虑症-7 项调查,共有 14% 的受访者有≥中度焦虑症状,根据患者健康问卷-9 项调查,11.8% 的受访者有≥中度抑郁症状。李克特量表上较高的压力评分与大流行导致的工时和/或工资减少和/或失业(P = 0.013)、远程工作和/或更换工作(P < 0.001)以及失去保险和/或医疗保险(P = 0.025)相关。李克特量表显示,焦虑程度越高,与大流行病相关的远程工作和/或更换工作(P = 0.007)以及失去保险和/或医疗保险(P = 0.008)越相关。自大流行开始以来,54% 的受访者表示每月至少有一次胸痛。胸痛和 COVID 症状分别与一般焦虑症-7 项调查和患者健康问卷-9 项的较高得分相关。焦虑和抑郁症状轻微,与之前的报告相似。在工作和/或减薪和/或失业、远程工作和/或更换工作以及失去保险和/或医疗保险的人群中,压力和焦虑的李克特量表测量值较高。超过半数的受访者表示曾有过胸痛的经历,这与抑郁症状和焦虑症状相关,凸显了一个重要的临床需求。
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引用次数: 0
Better Respiratory Function in Heart Failure Patients With Use of Central-Acting Therapeutics 利用中枢作用疗法改善心力衰竭患者的呼吸功能。
Q3 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.cjco.2024.01.003
Julie K.K. Vishram-Nielsen MD, PhD , Fernando Luis Scolari MD, PhD , Chun-Po Steve Fan PhD , Yas Moayedi MD , Heather J. Ross MD, MHSc , Cedric Manlhiot PhD , Melissa A. Allwood MD, PhD , Ana Carolina Alba MD, PhD , Keith R. Brunt PhD , Jeremy A. Simpson PhD , Filio Billia MD, PhD

Background

Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients.

Methods

A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs.

Results

Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO2], P = 0.020; forced expiratory volume in 1 second [FEV1], P = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO2], P < 0.001; end-tidal carbon dioxide tension [PETCO2], P = 0.015; and trend for forced vital capacity [FVC], P = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events (P = 0.023), and HF hospitalizations (P = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively.

Conclusions

Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

背景膈肌萎缩可能导致心力衰竭(HF)患者呼吸困难,这与中枢神经激素过度激活有关。可穿过血脑屏障的高血压药物可发挥中枢作用并改善呼吸功能,从而缓解膈肌萎缩。因此,我们比较了通过单一心肺运动测试(CPET)评估的中枢与外周作用的高血压药物对呼吸功能的益处以及高血压患者的预后。方法我们对 624 名左室射血分数降低≤40% 且有完整 CPET 的卧床成年高血压患者(80% 为男性)进行了回顾性研究,这些患者在 2001 年至 2017 年期间在一家机构接受了随访。比较了接受中枢作用药物(n = 550)与外周作用药物(n = 74)的患者的 CPET 参数、全因死亡、复合终点(全因死亡、需要左室辅助装置、心脏移植)以及全因和/或高血压住院治疗的结果。结果与接受外周作用药物的患者相比,接受中枢作用药物的患者呼吸功能更好(逐次呼吸摄氧量峰值[VO2],P = 0.020;1秒内用力呼气容积[FEV1],P = 0.007)和通气效率(分钟通气量/二氧化碳产生量[VE/VCO2],P <0.001;潮气末二氧化碳张力[PETCO2],P = 0.015;以及用力肺活量[FVC]的趋势,P = 0.056)。经多变量调整后,CPET 参数与药物类型之间的许多关联仍然显著。此外,接受中枢作用药物治疗的患者发生的综合事件(P = 0.023)和心房颤动住院(P = 0.044)较少,尽管危险比分别为 0.664 和 0.757,但经多变量校正后仍未达到显著性。结论中枢作用药物与高血压患者通过 CPET 参数测量的呼吸功能改善有关,这可能会延伸到有临床意义的综合结果和住院治疗,但需要更多的力量才能明确地将药物效应联系起来。中枢作用型高血压药物在缓解膈肌无力方面发挥了作用。
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