Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European heart journal
Surgical left atrial appendage occlusion in valvular heart disease without atrial fibrillation: the OPINION trial
BACKGROUND AND AIMS: While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHA₂DS₂-VASc ≥2 remains uncertain despite their high post-operative AF risk (15-54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients. METHODS: The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHA₂DS₂-VASc ≥2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population. RESULTS: Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA2DS2-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61-1.14; P = .25). CONCLUSIONS: For valvular surgery patients with CHA₂DS₂-VASc scores ≥2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up. TRIAL REGISTRATION: ChiCTR.org registry ChiCTR2100042238.
22 May 2026
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Development of a prediction model for the risk of prolonged ICU length of stay in patients undergoing coronary artery bypass surgery: A retrospective analysis based on the MIMIC-IV database
The duration of hospitalization, particularly in the intensive care unit (ICU), for patients undergoing coronary artery bypass grafting (CABG), is influenced by both patient prognosis and treatment-related costs. Reducing the ICU length of stay (LOS) in CABG patients is critical for improving healthcare resource utilization. This study aimed to develop a model for identifying risk factors associated with prolonged ICU LOS in CABG patients, thus providing a foundation for clinical treatment, healthcare safety, and quality management research. In this single-center, retrospective cohort study, data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were analyzed. Clinical data from 6152 CABG patients who required treatment in ICU were included. The dataset was split into a training set and an internal validation set. Predictor variables were identified using least absolute shrinkage and selection operator regression. A nomogram prediction model was developed based on the identified predictors. The predictors incorporated into the model included the Charlson comorbidity index, acute physiology score III, atrial fibrillation, heart failure (HF), body mass index, acute kidney injury stage, type 1 diabetes mellitus and glucose levels. The prediction model demonstrated robust performance, achieving an area under the curve of 0.789 in the training cohort and 0.790 in the validation cohort. The Hosmer-Lemeshow (H-L) test and calibration plots validated the model's accuracy in both cohorts. The nomogram prediction model proposed in this study provides significant clinical utility for predicting prolonged ICU LOS in patients undergoing CABG. This model can assist clinicians in identifying CABG patients at risk for prolonged ICU LOS, thus enabling timely interventions and improving prognostic outcomes.
5 Apr 2026
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