The Canadian journal of cardiology
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Comparative Study
Impact of female sex on long-term outcomes in patients with ST-elevation myocardial infarction treated by primary percutaneous coronary intervention.
Conflicting information exists about whether sex differences affect long-term outcomes in patients undergoing primary percutaneous coronary intervention (PCI). ⋯ Women undergoing primary PCI experience worse long-term outcomes than men, but this difference is largely explained by their more adverse baseline cardiovascular profile.
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Comparative Study
Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: the Toronto experience.
Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH). However, this surgery remains performed in few experienced centres only. The goal of the study is to review our overall experience since the implementation of our program in August 2005. ⋯ Elective PEA can be performed with limited risk, and results in excellent early and long-term outcome. All patients diagnosed with chronic thromboembolic PH should be referred for consideration of PEA in a specialized centre.
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Complex cardiac surgery in Jehovah's Witness patients can be challenging, especially if it is a reoperation and the patient has a preexisting bleeding disorder. We operated on a patient who was declined for percutaneous aortic valve replacement and who required repeat surgery for aortic valve repeat replacement and root repair. In addition to being of Jehovah's Witness faith, the patient had chronic thrombocytopenia. We describe our strategy in managing this situation.
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Clopidogrel has mostly replaced the use of ticlopidine due to its more favourable hematologic adverse event profile. Prasugrel is the newest thienopyridine approved for use in Canada. This case describes a patient who was diagnosed with an acute coronary syndrome and treated with bare metal stenting of his coronary artery. ⋯ Clopidogrel was discontinued and prasugrel was initiated. Neutrophil count gradually increased and returned to normal. In patients with neutropenia associated with clopidogrel therapy, prasugrel may be considered as an alternative.
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Interventional cardiology is a subspecialty of adult cardiology dedicated to the use and application of imaging-based diagnostic techniques and minimally invasive modalities for the treatment of cardiovascular disease. Currently, interventional cardiologists must demonstrate expert knowledge of cardiac imaging, along with cardiovascular anatomy and the pathophysiology of cardiovascular disease. ⋯ The 2010 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiologists Guidelines for Training and Maintenance of Competency in Adult Interventional Cardiology are the first such guidelines to be published in Canada. These guidelines should allow for more-fluid provision of high-quality interventional cardiology education, along with less geographic variation, resulting in more-widespread high-level services to the population.