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primary outcome and was assessed using a five-item ordinal scale (1, strongly regret; 5, absolutely no regret) survey item administered by telephone or mail 30 to 90 days after surgery. Regret was categorized as any regret (score, 1-4) vs no regret (score, 5). Logistic regression models were used to examine the associations between decisional regret, procedure type, and 30-day postoperative complications.Results: A total of 572 patients were included in the analysis (mean age, 68.5 6 11.0 years; 190 women [33%]; 433 [76%] non-Hispanic white). The procedures included 110 LE amputations (19.2%), 172 LE revascularizations (30.1%), 77 AAA repairs (13.5%), and 213 CEAs (37.3%). The overall prevalence of regret was 14.2%. Patients undergoing LE amputation or revascularization reported significantly more regret than patients undergoing AAA repair or CEA (23.6% and 20.3% vs 6.5% and 7.0%, respectively; P < .001; Fig) . No associations between decisional regret and age, sex, surgical acuity (elective vs urgent/emergent), comorbidities, or 30-day postoperative complications were identified.Conclusions: Decision regret varied significantly across vascular surgery procedure type, was significantly more common among patients undergoing LE procedures, and was not associated with perioperative outcomes. Patients undergoing LE vascular procedures might benefit from targeted education and preference elicitation to support mutual understanding and shared goals. Further research is needed to understand whether patient factors, procedural factors, and/or disease-specific factors related to the nature of peripheral artery disease are the underlying cause of decision regret.

Introduction: Alcohol septal ablation (ASA) is an elective nonsurgical procedure proven to be effective for patients with hypertrophic obstructive cardiomyopathy (HOCM). The intraprocedural change in left ventricular end-diastolic pressure (LVEDP) is unknown. In this study we assessed the hypothesis that LVEDP decreases immediately post ablation during ASA in patients with HOCM independently of the effects of sedation and heart rate. Methods: We retrospectively identified 133 elective ASA procedures for patients with HOCM between 2015 and 2021 at our institution using an internally maintained database. Pre- and post-ablation LVEDP measurements were taken using the pressure tracing corresponding with end-expiratory R wave of the ECG tracing. LVEDP was recorded for post-“a” wave points on the pressure tracing at three distinct points during the procedure: the immediate start of the procedure (Group A), prior to alcohol injection after sedation had taken effect (Group B), and post ablation (Group C). Heart rate (HR) and left ventricular outflow tract gradient (LVOTG) were obtained from the catheterization report. Paired t-tests, ANOVA, and regression analyses were performed using SPSS Statistics. Results: The average patient age was 64 years old; mean NYHA Class 2.7; and 67% were women. There was no difference between LVEDP of Groups A and B (32mmHg, 32mmHg, p=0.92). LVEDP between Groups A and C (32mmHg, 26mmHg, respectively; p<0.001) and Groups B and C (32mmHg, 26mmHg, respectively; p<0.001) were significantly different. There was no correlation between HR and LVEDP for the groups (R2A=0.002, R2B=0.000, R2C=0.054), and similarly, no correlation between the average change in LVEDP and the change in resting or provoked LVOTG (R2=0.033, R2=0.003, respectively). Conclusions: These results support that alcohol septal ablation causes an immediate reduction in LVEDP post-ablation independent of heart rate, reduction in LVOTG, and effects of sedation. In conclusion, this instantaneous change in LVEDP may account for the immediate resolution in symptoms reported by patients with HOCM undergoing ASA.

Introduction: ST-segment elevation myocardial infarction (STEMI) is an emergency presentation of an acutely occluded coronary artery. Following the announcement of the COVID-19 pandemic (March 11, 2020), a global decrease in STEMI incidence has been observed. Incidence, characteristics, and outcomes for STEMI activation patients were investigated in the 5 years prior (“reference period”) to and 1 year into the pandemic (“pandemic period”). We assessed the hypothesis that pandemic period STEMI activations will have more severe infarction (elevated troponin I), a higher percentage of true STEMI, and worse outcomes (higher case fatality rate). Methods: STEMI activation incidence was obtained from an institutional database (reference period n = 430; pandemic period n = 31). Patient characteristics and outcomes were obtained retrospectively from electronic health records (EHRs). True STEMI was adjudicated based on chest pain, EKG, troponins, and angiogram. Results: Monthly STEMI activations declined significantly in the first year of the pandemic (2.50 ± .68 vs. 7.17 ± .41, P = <.001). No significant difference in demographic characteristics (age, BMI, and male-to-female ratio) were observed. True STEMI percentage was higher during the pandemic (80.65% vs. 70.93%), but not statistically significant. Peak troponin levels for true STEMI were significantly higher during the pandemic (98.83 ± 25.82 vs. 51.44 ± 4.11, P = .003). There was no significant difference in 30-day and 90-day case fatality rates. Conclusions: STEMI activation incidence declined significantly during the pandemic; interestingly, the proportion of these which were true STEMIs remained consistent. True STEMIs during the pandemic had higher troponin levels suggesting larger infarct, but there was no significant difference in case fatality. In conclusion, fewer patients presented with STEMI while case fatality remained unchanged despite more severe infarct occurrence during the pandemic.

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