European Journal of Cardiovascular Medicine

Clopidogrel pretreatment significantly improves outcome in patients undergoing percutaneous coronary intervention (PCI), but it is not well established if the ad hoc loading of clopidogrel before the PCI and after coronary angiography is efficient and safe for the patient. According to the results of PRAGUE-8 and ARMYDA-5 PRELOAD trials, in-lab loading with 600mg clopidogrel might be safe and effective alternative to pre-treatment given several hours before diagnostic angiography or PCI. Still there is concern about adequate platelet inhibition, which can be overcome either with new loading scenarios or introducing more potent, more predictable, faster onset antiplatelet drugs, such as prasugrel and ticagrelor. Although increasing evidence suggests a link between residual platelet reactivity and adverse clinical outcomes, large scale clinical trials are still necessary to determine whether changes in therapy based on results of platelet function testing improve clinical outcomes, and thus will determine whether broader use of platelet function testing in clinical practice is warranted.

Objectives: The aim of current study is to evaluate relation between body mass index (BMI) and in-hospital outcome in patients undergoing percutaneous coronary intervention (PCI). Background: Relation between body mass indexes (BMI) with percutaneous coronary intervention (PCI) has shown in different studies. Recent studies suggested a paradox relation between different BMI values and outcome in certain patients. Methods: In this prospective study, 1134 patients (81.7% male, 18.3% female with mean age of58.18±11.16 years) whom undergone PCI between January 2011 and December 2011 were chosen and their BMI and disease outcome was studied. Classification of BMI was: healthy weight (18.5 to24.9 kg/m2), overweight (25 to 29.9 kg/m2), moderate obesity (30 to 34.9 kg/m2) and severe obesity (over 35 kg/m2). Baseline patient characteristics and in-hospital outcome were compared among BMI categories. Results: Major adverse cardiac events (MACE) were significantly higher in patients with overweight and moderate obesity than two other groups. There was no difference in mortality, reinfarction, revascularisation, stroke and bleeding events among the 4 groups. Being overweight is an independent factor associated to in-hospital MACE (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.17 to 0.73, p=0.01) and mortality rate (OR 0.20, 95%CI 0.04 to 0.85, p=0.03). Conclusion: BMI overall is not correlated to in-hospital MACE and mortality; however, overweight patients are at reduced risk for MACE and mortality.

Background: Over the past three decades, Transradial-Access (TRA) has revolutionized cardiac catheterization, demonstrating superior safety and outcomes compared to other access points. The European Society of Cardiology has now endorsed TRA as a viable alternative to traditional methods. Challenges during TRA can arise despite its success, making a comprehensive assessment of forearm artery anatomy essential. Forearm artery angiography (FA) has emerged as a valuable tool to improve procedural success and reduce complications. In this study, we retrospectively analyze the impact of FA on a diverse patient population, aiming to enhance TRA's effectiveness and safety in cardiac catheterization procedures in Bangladesh. Aim of the study: This study investigates the potential for enhanced success rates of Coronary Angiography and Percutaneous Coronary Intervention (PCI) by utilizing Standardized Forearm Angiography in a diverse patient population. Methods: This is a prospective comparative study, a total of 480 patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2022 to December 2022.  Result: In this prospective study, 480 patients were analyzed, and various characteristics of the study population were examined. The average age of patients was 71.4 years, 71% male and 29% female. The study focused on forearm artery access, with 54.17% having right forearm access and 45.83% left forearm access. The most common access type for left forearm artery access was the distal radial artery, while the proximal radial artery dominated right forearm access. Arterial hypertension was the most prevalent variable, followed by diabetes mellitus and active smoking. The most common clinical indication for medical procedures was "Suspected CAD or chronic coronary syndrome." Etiological factors leading to medical conditions were also analyzed, with "Failure to achieve arterial puncture or introduce arterial sheath" being the most common factor, followed by "Kinking" and "Atherosclerotic occlusion." Conclusion: The retrospective analysis showcased promising results, indicating that standardized forearm angiography may lead to enhanced success rates in coronary angiography and PCI among a diverse patient population. This non-invasive approach could offer improved diagnostic accuracy and procedural outcomes, warranting further investigation and consideration for broader clinical implementation.

Background: Transcatheter Aortic Valve Implantation (TAVI) in a nonagenarian is a challenge and is usually performed under Monitored Anesthesia Care (MAC). Combining TAVI and Percutaneous Coronary Intervention (PCI) is associated with an increased risk of mortality. In this case report, we explore the challenges and strategies involved in successfully performing concomitant TAVI and PCI in a nonagenarian patient with Acute Decompensated Heart Failure (ADHF) and concurrent delirium under General Anaesthesia (GA). Notably, there are no documented cases in the existing literature that mirror the intricacies of this case, making it the first reported instance under GA in India.

Severe calcified coronary stenosis presents a significant challenge for interventional cardiologists during percutaneous coronary intervention procedures as patients with this condition are at high risk of suboptimal results and poor clinical outcomes. The management of coronary artery disease (CAD) continually evolving with the advancements in therapeutics modalities. Intravascular lithotripsy (IVL) has emerged as a crucial tool in CAD management. This minimally invasive technique uses high frequency sound waves to modify calcified coronary plaques safely and effectively, facilitating optimal stent deployment and improving clinical outcomes. The efficacy of IVL is enhanced by C2+ technology as it ensures consistent plaque modification by delivering the appropriate energy. Managing 120 pulses during IVL procedure is vital for achieving optimal plaque modification. Additionally, integrating optical coherence tomography (OCT) or intravascular ultrasound (IVUS) imaging with IVL provides real time guidance and assessment of plaque modification and stent placement. OCT imaging enables clinicians to accurately assess the extent of plaque modification and evaluate results in real-time, leading to improved procedural outcomes .This combination of technologies ensures accurate and targeted treatment, resulting in higher procedural success rates and better clinical outcomes for patients with CAD. IVL has revolutionized the management of CAD, providing a safe and effective means of plaque modification. Utilizing IVL in CAD management has proven effective in safely modifying calcified plaques, facilitating optimal stent deployment and improving clinical outcomes. In conclusion, the use of IVL as a key therapeutic modality, coupled with C2+ technology along with the integration of OCT imaging for procedural guidance, is essential for enhancing the precision and safety of plaque modification and stent deployment. This approach results in improved clinical outcomes for patients with CAD. 

Information about the impact of gender on the prognosis of acute myocardial infarction-cardiogenic shock (AMI-CS) in young adults is scarce. Techniques: A cohort of AMI-CS admissions between the ages of 18 and 55 that occurred between 2018 and 2023 was identified retrospectively using the National Inpatient Sample. It was determined which procedures were used: non-cardiac interventions, mechanical circulatory support (MCS), percutaneous coronary intervention (PCI), and coronary angiography. The use of cardiovascular interventions, the duration of stay, hospitalization expenses, and in-hospital death were all relevant outcomes. Results: There were 90,648 AMI-CS admissions for patients under the age of 55 in total, with 26% being female. Men's prevalence of CS increased from 2.2% in 2000 to 4.8% in 2017, whereas women's rates decreased from 2.6% in 2000 to 4.0% in 2017 (p<0.001). Women, had poorer socioeconomic position than men (all p<0.001). Acute non-cardiac organ failure, cardiac arrest, elevated ST-segment appearance, and PCI rates were all lower in women (all p<0.001). They also received less frequent coronary angiography (78.3% vs. 81.4%), early coronary angiography (49.2% vs. 54.1%), PCI (59.2% vs. 64.0%), and MCS (50.3% vs. 59.2%). An independent predictor of in-hospital death was female sex mortality (23.0% vs. 21.7%; adjusted odds ratio 1.11 [95% confidence interval 1.07–1.16]; p<0.001). Women had lower hospitalization costs (156,372±198,452 vs. 167,669±208,577; p<0.001) but comparable lengths of stay compared to men. Conclusions: In young AMI-CS admissions, women are treated less aggressively and experience higher in-hospital mortality than men.

Background: Myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved. The loss of viable myocardium initiates a process of adverse left-ventricular remodeling leading to heart failure. Cardiac transfer of Bone marrow and human peripheral blood mononuclear cells (PBMNCs) -derived stem cells can have a favorable impact in patients with myocardial infarction. Objectives: To study transplantation of non-expanded peripheral blood mononuclear cells (PBMNCs) in patients with Myocardial infarction with its safety and feasibility. Methods: It is ist prospective pilot study from the region with six months of follow-up. 10 Patients of ST-elevation acute anterior wall Myocardial infarction with occlusion of left anterior descending were taken for Echocardiography (2 blind operators) before coronary intervention. Percutaneous coronary intervention of left anterior descending (LAD) by drug eluting stent followed by intracoronary infusion of PBMNCs was done. 10 patients of acute anterior wall myocardial infarction were taken as control in whom only LAD stenting was done. PBMNCs suspension was infused distally to the occluding balloon through the central port of the balloon catheter. This maneuver was repeated 4 times to accommodate infusion of the total 20-ml cell suspension, interrupted by 2-3 minutes of reflow by deflating the balloon to minimize extensive ischemia. Left ventricular functions were compared at base line and after six months of follow up by blinded operators. Results: Demographic variables, clinical variables and left ventricular systolic functions at base line were comparable. After Six months of follow up in both case and control group there was improvement in left ventricular functions. But there was more improvement in Left ventricular functions in cases where intracoronary stem cell therapy was given in addition to LAD stenting as compared to control group. Increase in Ejection fraction and wall motion score index was statistically significant (P-value <0.05) in stem cell therapy group. Conclusion: Intracoronary PBMNCs infusion is a less invasive, more feasible, safer and a novel therapy for acute myocardial infarction patients who have depressed cardiac function. It causes significant improvement in parameters of left ventricular functions especially Ejection fraction and wall motion score index which are most important prognostic factor in myocardial infarction patients.

Background: Antithrombin III (AT III) has a prime role in heparin induced anticoagulation required during cardiovascular and percutaneous coronary interventions. This anticoagulation adequacy is monitored by regular activated clotting time (ACT) estimation. If there is deficiency of AT III due to any reason the desired anticoagulation i.e. target ACT is not achieved after administrating standard dose of injection heparin. Hence, extra dose of injection heparin, fresh frozen plasma (FFP) transfusion or AT III concentrate are to be given to achieve target ACT. Aim and Objectives: The aim of this study was to find incidence of AT III deficiency in patients undergoing cardiovascular surgery and percutaneous coronary interventions. To evaluate the effect of inherent AT III levels on the ACT values to heparin over the physiologic range of AT III levels and co-relation of other factors (Factor V, Fibrinogen C, Protein C and Protein S) with AT III and their implications on CPB. Material and Methods: This was single center observational prospective study. The patients included in this study had cardiovascular diseases planned for surgical or percutaneous coronary interventions. All the patients were tested preoperatively for AT III and other anticoagulation factor levels. In all the patients ACT was monitored at regular intervals to keep a check on anticoagulation during procedure.  Results: In this study 267 patients underwent preoperative evaluation of AT III and other anticoagulation factor levels and incidence of AT III deficiency i.e. <80% was found in 59 (22%) patients. In open heart surgeries, 22 patients were treated with extra dose of injection heparin in addition to standard dose in whom mean ACT was prolonged from 471 seconds to 485 seconds and in 16 patients additional FFP transfusion was given and mean ACT was prolonged from 471 seconds to 544 seconds. In vascular procedures, 4 patients who required extra dose of injection heparin mean ACT was prolonged from 258 seconds to 434 seconds and in 16 patients additional FFP transfusion was given and mean ACT was prolonged from 258 seconds to 537 seconds. In 14 patients undergoing percutaneous coronary interventions mean ACT was prolonged from 217 seconds to 446 seconds after extra dose of injection heparin.  Conclusion: It is important to routinely measure the AT III and other associated coagulation factors before the patient undergoes any cardiovascular intervention as its incidence is significant in patients having cardiovascular disease.

Introduction: Coronary artery disease (CAD) remains a major global health concern, with left main coronary artery (LMCA) disease posing high risks due to the large myocardial area it supplies. Despite coronary artery bypass grafting (CABG) being the preferred revascularization strategy for unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as a viable alternative. However, data on ULMCA PCI outcomes in the Indian subcontinent are scarce. Materials and Methods: This single-center, retrospective study evaluated 253 patients who underwent ULMCA PCI using DES between January 2018 and June 2023 in Central India. Clinical, angiographic, and procedural data were analyzed with a median follow-up of 753.5 days. Comparative analyses were conducted based on SYNTAX scores and imaging-guided versus non-imaging-guided interventions. Results: The cohort's mean age was 61.3 years, with a predominantly male population (77.5%). Imaging guidance was employed in 30.4% of cases. The composite outcome (cardiovascular death, myocardial infarction, stroke) occurred in 11.6% of patients. Higher age and hypertension were identified as significant predictors of adverse outcomes. Conclusion: In this study, PCI for unprotected left main coronary artery (ULMCA) disease using drug-eluting stents (DES) demonstrated favorable short- and mid-term outcomes in an Indian cohort, even in a resource-limited setting. While procedural success was high, factors such as SYNTAX score and patient comorbidities such as age >60 yrs, hypertension significantly influenced outcomes. Imaging- guided interventions, though not altering mortality rates, appeared to enhance procedural safety. These findings support the feasibility of PCI as an alternative to surgery in select high-risk patients, emphasizing the need for further research to refine risk stratification and optimize intervention strategies.

Background: Cardiovascular diseases (CVD) are one of the leading causes of mortality and morbidity worldwide. Among them the spectrum of ischemic heart disease which encompass stable ischemic heart disease, unstable angina, NSTEMI & STEMI is the commonest cause. Coronary no-reflow is a frequent phenomenon that develops in patients with ST-segment elevation myocardial infarction during reperfusion therapy. In this study, we focused on to assess the prevalence of coronary no reflow in STEMI patients undergoing primary PCI. Methodology: This study was conducted in patients in Cath lab, Coronary Care Unit and different wards of the department of Cardiology in Apollo Multispecialty Hospital Limited during the period of 18 months spanning from November 2021 to April 2023. Consecutive patients of STEMI who had undergone PPCI were enrolled in this study. The patients to be included are those with STEMI above age≥18 years. They were divided into no reflow and normal flow and their characteristics were studied. Results: The prevalence of no reflow was 9.93%. Majority of the patients had age more than 60 years (55%) whereas 45% of the patients were younger than 60 years with males (71%) and females (29%). Common associated condition with patients undergoing percutaneous coronary intervention in present study was hypertension (86%), dyslipidemia (80%) and diabetes mellitus (93%). TIMI thrombus scale and Myocardial blush grade (MBG) was significantly higher in patients with hypertension. There was a significant difference found in TIMI thrombus scale and MBG between diabetic and non-diabetic patients. There were significant differences found in mean LVEF in respect to myocardial blush grade (MBG). Conclusion: The TIMI thrombus scale and myocardial blush grade was found to be higher in patients with no reflow undergoing PCI. The prevalence of no reflow after primary PCI is 9.93%. The co morbidities like DM, hypertension and dyslipidemia were more common among these patients.

Background: CTO PCI can provide significant clinical benefits, yet there is limited information on its safety in unselected patient populations. Objective:The aim of this study is to describe short term outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in a tertiary care hospital in southern India. Methods: We analysed the frequency of short-term clinical outcomes of CTO PCI between Jan 1, 2023, and Dec 31, 2023. Results: During the study period, total of 212 patients (men 178(84%) were treated with PCI for CTO. Out of these, 159 patients (75%) had successful PCI and was unsuccessful in 53 patients (25%).In a total sample of 212 individuals, 26 (12.3%) experienced coronary dissection, while 13 (6.1%) had coronary perforation. Cardiac tamponade requiring urgent intervention occurred in 9 patients (4.2%), and 7 patients (3.3%) needed urgent revascularization. Additionally, 4 patients (1.9%) suffered a stroke after the procedure, and 2 patients (0.9%) died. Compared to successful procedures, unsuccessful ones showed significantly higher rates of coronary dissection (34% vs. 5%, p < 0.0001), perforation (17% vs. 2.5%, p < 0.0001), and tamponade (9.4% vs. 2.5%, p = 0.031). However, no significant differences between unsuccessful and successful PCI were observed in terms of death (0% vs. 1.3%, p = 0.412), peri-procedural MI (0% vs. 1.9%, p = 0.314), urgent revascularization (1.9% vs. 3.8%, p = 0.506), or stroke (3.8% vs. 1.8%, p = 0.244). Conclusion: In the present study, failed CTO interventions are associated with a higher incidence of complications such as coronary dissection, coronary perforation, and cardiac tamponade compared to successful CTO interventions. Although periprocedural MI, death, and urgent revascularization occurred more frequently in successful attempts, the differences are not statistically significant.

Background: Intra-vascular lithotripsy (IVL) has piezo-electric crystals embedded in them, which generates multiple ultrasonic shockwaves when attempting to pre-dilate a severely calcified coronary artery. The calcific coronaries have various patterns of calcium deposition including superficial calcium, deep calcium, and nodular calcium. The data about periprocedural complications and effectiveness of IVL in dealing with different types of calcific lesions are lacking. This study tries to answer these questions. Results: This retrospective study spanning for 24 months, included 52 patients who underwent IVL. 50 out of 52 patients had severe calcific CAD. The mean minimum lumen diameter (MLD) at stenotic lesion is 1.18 ± 0.67 mm and mean lesion length of 24.8 ± 8.5 mm. Successful plaque modification was achieved in 100% of the cases. The optimal stent expansion in superficial calcium is 87.5% and similarly in deep and nodular calcium it is 57.14% (p: 0.0016). 1 mortality was noted 48 hours post procedure, though unrelated to procedure. Other serious complications include atrial fibrillation, side branch MI, coronary edge dissection, and coronary perforation which contributed 7.8% (4 out of 51). Minor complications include edge dissection, IVL balloon burst, and transient bradycardia which contributes 9.8% (5 out of 51).  Conclusion: The superficial calcific lesions are more malleable than deep calcium and nodular calcium put together. IVL successfully modifies calcific plaques to achieve optimum stenting in overwhelming majority of the patients. The complications associated with IVL ballooning are manageable and pose minimal risk when compared to other modes of calcific plaque modification presently available.

Objective: This study is aimed to assess the coronary sinus blood flow by transthoracic echocardiography in acute MI patients undergoing coronary angiography and comparing the coronary sinus flow pre and post percutaneous coronary intervention. Methods: The present hospital based prospective cross sectional descriptive study was conducted at KAHER University Hospital, Belgaum from January 2023 to June 2024 among 150 adult patients with acute coronary syndrome. Details on demographics, patient characteristics, laboratory parameters were recorded. Echocardiography parameters taken on admission were compared with the parameters post thrombolysis and post revascularization and was correlated with the severity of CAD and the success of revascularization Result: most of the patients were males. The patient population has a mean age of 60 years with a standard deviation of 11.29 years. The average Body Mass Index (BMI) is 27.61, suggesting that the population is, on average, slightly overweight, with a standard deviation of 4.68. The average diameter of the coronary sinus (CS) is 0.85 cm, with a standard deviation of 0.2 cm. Coronary Sinus Blood Flow (CSBF) per beat has a mean of 3.03 mL, with a standard deviation of 1.52 ml. On admission, the mean CSBF per minute is 218.63 mL, with a standard deviation of 93.64 mL. After Percutaneous Coronary Intervention (PCI), the mean CSBF significantly increases to 372.05 mL per minute, with a standard deviation of 126.15 ml, reflecting the effectiveness of PCI in improving coronary blood flow in this patient group. Overall, these results demonstrate that PCI significantly improves coronary blood flow in patients across all these categories, with the most substantial increases observed in those with STEMI-AWMI in the current study. Conclusion: Non-invasive evaluation of CSBF using transthoracic echocardiography is technically feasible in all patients undergoing PCI.It is a potentially simple, repeatable, cost-effective, non-cumbersome imaging modality for the assessment of CSBF in patients with CAD, and especially for those with AWMI. It can also be used to assess the effectiveness of treatment in patients with CAD. Results reflect hemodynamically significant changes in total coronary blood flow.

Background: Timely reperfusion is essential in STEMI patients, with the choice between primary percutaneous coronary intervention (pPCI) and fibrinolytic therapy depending on treatment availability, delivery time, and ischemic duration. The pharmacoinvasive strategy involves immediate fibrinolysis followed by coronary angiography within 3–24 hours. This study compares the efficacy and safety of the pharmacoinvasive strategy to pPCI in STEMI patients during hospitalization. Methods: This was a cross-sectional study conducted on 138 patients divided into two groups (group 1 - primary PCI) and group 2 (pharmacoinvasive therapy). The study was carried out Department of Cardiology, Tirunelveli Medical College Hospital, Tirunelveli over period of one year after obtaining ethical clearance. Results: The mean age in Group 1 (n=69) was 54.93 ± 10.247 years, while in Group 2 (n=69), it was 54.46 ± 9.393 years. In a comparison between Group 1 (primary PCI) and Group 2 (pharmacoinvasive PCI), significant differences were found in pre-PCI TIMI scores. Group 1 had 10.1% with a TIMI score of 0, compared to 2.9% in Group 2 (p = 0.039). Both groups had similar distributions for TIMI scores of 1 and 2. After PCI, Group 1 achieved 100% TIMI 3, while 97.1% of Group 2 patients reached TIMI 3, with 2.9% having TIMI 2 (p = 0.154). The results of our study indicated no statistically significant difference in mortality between primary PCI and pharmacoinvasive PCI (0% vs. 1.4%, p = 0.316). Conclusion: Pharmacoinvasive strategy is non inferior to primary PCI. The pharmacoinvasive strategy, when compared to primary PCI (PPCI), demonstrates similar rates for both primary and secondary endpoints. The pharmacoinvasive strategy leverages the availability of fibrinolysis alongside the effectiveness of PCI.

Introduction: Primary percutaneous intervention is the preferred treatment for ST-elevation myocardial infarction. Even after the restoration of epicardial flow graded as thrombolysis in myocardial infarction flow (TIMI) after percutaneous coronary intervention, microvascular obstruction can occur, which in turn leads to poor left ventricular function. The main cause of microvascular obstruction is atheromatous microparticle embolization within the culprit artery causing increased infarct size, mortality, and positive remodeling of the heart, which leads to overt heart failure and increased mortality. Objective: To determine the association between Myocardial Blush Grade (MBG) post-PCI and Left Ventricular Ejection Fraction in patients with ST-Elevation Myocardial Infarction. To investigate the relationship between Myocardial Blush Grade and adverse cardiovascular outcomes (e.g., heart failure, recurrent infarction, mortality) in STEMI patients.  To determine predictors of myocardial recovery: Identify factors associated with favourable myocardial recovery, including procedural characteristics, patient demographics, and comorbidities, to better understand the determinants of post-PCI left ventricular function. Methods: The data will be analysed using IBM SPSS software version 26.0. For analysis of groups in the study, MBG ≥2 was considered as ‘high’ grade whereas MBG <2 was considered as ‘low’ grade. Descriptive statistics will be used to describe variables such as gender.  Mean and standard deviation will be used for calculating variables such as age and ejection fraction. Chi-square test will be used to compare the clinical characteristics of the high and low MBG groups. Independent samples t-test will be used to determine if differences between TIMI score and MBG will be significant with respect to age.  Risk ratios will be calculated for adverse outcomes and improved LVEF with respect to MBG. Logistic regression analysis will be performed to determine the confounders of the study. Result: MBG may be considered as an additional angiographic parameter to define angiographic success and also better prognosticate patients and decide on management plans to improve long-term patient outcomes. The study findings may contribute to risk stratification models, helping clinicians tailor interventions and improve outcomes for STEMI patients. Conclusion: In the present study, we found a significant association between MBG and TIMI, suggesting that MBG can predict adverse events after thrombolysis/PTCA in those with ACS. However, we found no association between age, gender, co-morbidities or EF.

Introduction: Failed thrombolysis in acute ST elevation myocardial infarction (STEMI) patients is not so uncommon and carries grave prognosis, especially in non-PCI capable settings. Various factors can affect the probability of having a successful or failed thrombolysis after fibrinolytic therapy in acute STEMI patients. We aim to study the clinical and coronary angiographic profile of acute STEMI patients with failed thrombolysis and compare it with those having successful thrombolysis. Material & methods: This was a cross sectional, observational, single centre study including 100 acute STEMI patients who received thrombolytic therapy and underwent coronary angiography. Those having contraindication for thrombolysis or undergoing primary percutaneous coronary intervention were excluded. The results were analysed statistically. Results: The mean age of 100 subjects was 57.92 ± 12.36 years (range 28 – 81 years) with male-female ratio 4:1. The mean window period was 5.89 hrs. 54% had anterior wall myocardial infarction (AWMI). Tenecteplase, streptokinase, alteplase and reteplase were used as the thrombolytic agents in 35%, 31%, 19% and 15% cases respectively. 81% had successful thrombolysis and 19% had failed. 86.9% patients presenting within 9 hrs had successful thrombolysis, compared to only 50% presenting after 9hrs. (p=0.003) 27.8% patients of AWMI had failed thrombolysis whereas only 8.7% with inferior territory infarction had failed thrombolysis (p=0.015). Single-, double- and triple vessel disease was seen in 30%, 35% and 24% respectively with left main involvement in 9%. No association was seen with single or multivessel involvement, thrombolytic agent used, age, gender, religion or risk factors such as smoking, hypertension and diabetes. LCx and RCA had higher proportions of successful thrombolysis (94.1% and 89.6% respectively) compared to LAD (72.2%, p=0.049). 90.1% cases of successful thrombolysis had angiographically significant lesion requiring revascularization. Conclusion: Late presentation, anterior territory involvement and LAD occlusions have higher chances of failed thrombolysis in acute STEMI patients. Coronary angiography and revascularization should promptly be considered in the post-thrombolysis management of acute STEMI patients particularly in failed thrombolysis.

Background: The choice of vascular access in PCI affects procedural success, complications, and outcomes. Radial access (RA) is preferred for reduced bleeding and faster recovery, while femoral access (FA) remains crucial for complex cases. This study compares the impact of RA versus FA on procedural and clinical outcomes. Methods: A prospective observational study was conducted at a tertiary care hospital, over one year of period, enrolling 228 patients undergoing PCI. Patients were categorized into RA-PCI (n = 115) and FA-PCI (n = 113) groups based on access strategy. Primary outcomes included 30-day major adverse cardiovascular and cerebrovascular events (MACCE). Secondary outcomes assessed procedural efficiency (fluoroscopy time, contrast volume), access-site complications (bleeding, hematoma), and recovery parameters (ambulation time, hospital stay) Results: RA-PCI had lower fluoroscopy time (11.4 ± 3.8 min vs. 14.7 ± 4.2 min, p < 0.001), contrast use (130.5 ± 18.3 mL vs. 148.7 ± 22.1 mL, p < 0.001), and procedure duration (37.2 ± 6.1 min vs. 42.8 ± 7.4 min, p = 0.002). RA-PCI also had fewer major bleeding events (2.6% vs. 8.0%, p = 0.03), lower hematoma rates (3.5% vs. 10.6%, p = 0.02), shorter ambulation time (3.1 ± 0.9 h vs. 8.4 ± 2.3 h, p < 0.001), and reduced hospital stay (1.7 ± 0.5 days vs. 2.6 ± 0.8 days, p < 0.001). MACCE at 30 days was lower in RA-PCI (6.1% vs. 11.5%) but not statistically significant (p = 0.08). Conclusion: RA-PCI offers better procedural efficiency, fewer bleeding complications, and faster recovery than FA-PCI. While MACCE rates were lower with RA, significance was not reached. These findings support a radial-first approach, with further studies needed for long-term validation.

Background: Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Objective: To assess the bleeding and cardiovascular outcomes associated with DAPT in patients with varying degrees of baseline thrombocytopenia undergoing PCI. Methods: A prospective cohort study was conducted at a tertiary care hospital, enrolling 368 patients with thrombocytopenia undergoing PCI. Patients were stratified into mild (100,000– 150,000/mm³), moderate (50,000–100,000/mm³), and severe (30,000–50,000/mm³) thrombocytopenia. Outcomes included bleeding complications (BARC criteria), major adverse cardiovascular events (MACE), in-hospital mortality, and post-PCI complications. Univariate and multivariate models were used for analysis. Results: Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion: Moderate and severe thrombocytopenia are independent predictors of bleeding and cardiovascular events in patients on DAPT post-PCI. These findings emphasize the need for stratified management in this high-risk group. 

Background: Chronic Total Occlusions (CTOs) represent a complete blockage of a coronary artery persisting for more than three months. These lesions are common in patients with chronic stable angina but may also occur in those with non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Historically considered complex with high procedural risks, CTO interventions have seen significant advancements in safety and success rates due to improvements in technology and operator expertise. Successful revascularization has been shown to improve myocardial perfusion, alleviate symptoms, and enhance overall cardiovascular outcomes.

Aims and Objectives:

1. To study the clinical and angiographic profile of patients undergoing CTO angioplasty at a tertiary care center.
2. To assess the immediate procedural outcomes and complication profile in this cohort.

Methods: This was a record-based descriptive study conducted in the Department of Cardiology, Government Medical College, Alappuzha. Data were collected from the CTO registry for a 2-year period (November 2022 to November 2024). Patients aged ≥18 years with angiographically confirmed CTO (duration >3 months) who underwent percutaneous coronary intervention (PCI) were included. Those with severe comorbidities, uncontrolled systemic conditions, or inability to provide consent were excluded. Data were extracted on demographics, comorbidities, clinical symptoms, angiographic features, procedural success, and complications, and were entered into a master chart for descriptive statistical analysis. Results: A total of 220 patients underwent CTO angioplasty during the study period. Most patients were elderly, with 66.36% aged >60 years. Males constituted 84.09% of the cohort. Hypertension (76.36%), type 2 diabetes mellitus (86.36%), and smoking (67.27%) were the most common risk factors. Prior PCI was seen in 50.90% and previous CABG in 15.45%. The predominant presenting symptoms were dyspnea on exertion (83.18%), easy fatigability (79.09%), and effort angina (71.36%), with most in NYHA Class II. The most common clinical presentation was UA/NSTEMI (55.45%), followed by chronic stable angina (37.27%) and STEMI (7.27%). Angiographically, double vessel disease was most frequent (69.54%), and the LAD was the most commonly involved CTO vessel (52.72%), followed by LCX (39.54%) and RCA (38.18%). Procedural success was achieved in 82.72% of cases. The most frequent complication was coronary perforation (15.45%), followed by nonfatal myocardial infarctions (10.45%), arrhythmias (8.18%), and no-flow/slow-flow phenomena (8.18%). Stroke and acute kidney injury were rare (1.36% and 0.91%, respectively). All-cause and cardiac-specific mortality were low at 0.91%. No patients required emergency CABG. Conclusion: CTO angioplasty, once considered a high-risk and low-success intervention, is now feasible and effective with a high procedural success rate and low mortality. Despite the complexity of cases and comorbid burden, the outcomes reflect improved technical capabilities and procedural safety. Early recognition, appropriate case selection, and expertise are crucial for favorable outcomes.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with an increasing burden in Bangladesh. Identifying the prevalence, risk factors, and angiographic patterns of CAD is essential for effective prevention and management. This hospital-based study aimed to assess the demographic characteristics, risk factors, severity, and treatment approaches among Bangladeshi patients with CAD. Methods: This cross-sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, from November 2023 to December 2024. A total of 107 patients admitted with suspected CAD were included. Results: The study included 107 patients, with a male predominance (76.6%) and a mean age of 51.7 ± 11.3 years. Hypertension was the most prevalent risk factor (38.3%), followed by smoking (33.6%) and diabetes mellitus (22.4%). Obesity and a family history of CAD were present in 22.4% and 16.8% of cases, respectively. Among the study population, 72.0% had confirmed CAD. Single-vessel disease was the most common pattern (30.8%), followed by triple-vessel disease (22.4%) and double-vessel disease (18.7%). Percutaneous coronary intervention (PCI) was performed in 23.4% of patients, while 7.5% were recommended for coronary artery bypass grafting (CABG). Optimal medical therapy (OMT) was the primary management approach in 21.5% of cases. Conclusion: This study highlights a high burden of CAD in Bangladesh, with modifiable risk factors playing a crucial role. Early screening, lifestyle modifications, and optimal management strategies are essential to reduce the impact of CAD in this population.

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two primary revascularization strategies for multivessel coronary artery disease (MVD) and left main coronary artery disease (LMCAD). While PCI offers a minimally invasive alternative, concerns remain regarding its long-term efficacy compared to CABG. This study aims to compare the long-term outcomes of CABG and PCI in patients with MVD and LMCAD. Methods: A retrospective cohort study was conducted on patients undergoing revascularization for MVD and LMCAD. Clinical outcomes, including major adverse cardiac events (MACE), all-cause mortality, myocardial infarction, and repeat revascularization, were assessed over a long-term follow-up period. Kaplan-Meier survival curves were used to evaluate event-free survival rates. Statistical analysis was performed using a Cox proportional hazards model to adjust for confounding variables. Results: The results supported that although CABG was associated with reduced occurrence of major adverse cardiovascular events (MACE) and repeat revascularization rates compared to PCI, survival at the end-results was similar among the two. Event-free survival was superior within the CABG group at each follow-up duration, in harmony with prior meta-analyses. Nonetheless, PCI still held acceptable long-term results, particularly in selected subjects with less elaborate coronary anatomy, affirming the validity of alternative use of surgery for revascularization. Conclusion: CABG and PCI are both effective forms of revascularization in patients with multivessel coronary artery disease (MVD) and left main coronary artery disease (LMCAD). Although CABG might be superior in event prevention in the long term, PCI is not necessarily inferior in general and especially not in properly selected cases. Personalized treatment planning on the basis of patient risk profile and anatomical complexity is paramount. More research is needed to improve selection criteria and long-term cardiovascular results for both modalities.

Introduction: The study examines the impact of myocardial blush grade on survival after primary percutaneous coronary intervention (PCI) in a high-risk AMI cohort undergoing mechanical reperfusion therapy at a tertiary referral center. Despite restoration of TIMI-3 flow, myocardial recovery is often suboptimal, leading to considerable mortality in high-risk patients. Aims: We sought to evaluate and validate the ability of the angiographic myocardial blush grade to risk stratify patients after successful angioplasty in acute myocardial infarction (AMI). Materials and methods: This was a quantitative, cohort study (observational) conducted in the Department of Cardiology at Burdwan Medical College and Hospital, Bardhaman, West Bengal 713104. The study was carried out over a duration of one year and included a total sample size of 100 participants. Result: Stent implantation was more common in the Final Blush 3 group (70%) compared to the Final Blush 0 to 2 group (54%), with a statistically significant difference (p = 0.03). Balloon angioplasty only was more frequently performed in the Final Blush 0 to 2 group (48%) compared to the Final Blush 3 group (28%), with a significant difference (p = 0.02). Conclusion: The study found no significant differences in clinical features between two groups with different myocardial blush grades. However, significant differences were observed in infarct territory, with more involvement in the Final Blush 0 to 2 group and more involvement in the Final Blush 3 group. Age, gender, and angiographic measurements showed no significant difference between the groups.

We report the case of a 70-year-old male smoker who presented with inferior ST-elevation myocardial infarction (STEMI). Coronary angiography revealed total occlusion of the proximal right coronary artery (RCA). Primary percutaneous coronary intervention (PCI) was performed, including thrombus aspiration and drug-eluting stent implantation, achieving TIMI III flow. However, post- deployment angiography revealed a distal stent fracture and the presence of an underlying myocardial bridge, previously obscured by vessel occlusion and tortuosity. A second drug-eluting stent was successfully deployed across the fractured segment, with good final angiographic outcomes. The patient's hospital course was uneventful, and he was discharged in stable condition. This case highlights the unique and challenging scenario of myocardial infarction complicated by myocardial bridging and subsequent stent fracture. It underscores the importance of recognizing anatomical variants like myocardial bridges that can predispose to mechanical stress and stent failure, even in primary PCI settings. Careful lesion assessment, stent optimization, and high clinical vigilance are critical in managing such complex interventions

Background: Ischemic heart disease is one of main causes of death in industrialized countries. PCI is efficient therapeutic approach. Objective: to evaluate whether remote ischemic post-conditioning could reduce enzymatic infarct size in patients with acute ST-segment elevation myocardial infarction undergoing PCI. Methods: Study will be conducted in 100 patients presenting with 6-12hrs of onset of chest pain and diagnosed to be having acute STEMI in SSIMS&RC, Davanagere. All patients are prepared with thigh-sized limb cuff before arterial puncture. In active treatment group, protocol will be started with thrombolysis/balloon inflation, whichever occurred first, lower limb will be exposed to 3 cycles of ischemia/reperfusion, each obtained by 5min cuff inflation at 200mmHg, followed by 5min complete deflation. End point of study will be enzymatic infarct size assessed by AUC of CK-MB release. Blood samples will be collected before PCI, every 6hrs during first 48h and at 72hrs. Result: Among cases 28 patients (56%) had blush grade 3, 15patients (30%) had blush grade 2 and 7patients (14%) had blush grade 1 respectively after PCI among control group 10patients (20%) had blush grade 3, 20 patients (40%) had blush grade 2 and 20patients (40%) had blush grade 1 respectively after PCI. There was significant statistical difference between two groups. The AUC of serum CK release during the first 72 hours of reperfusion was significantly reduced in postconditioned group compared with control group. Conclusion: Remote post conditioning of lower limb significantly improves blush grading and enzymatic infarct size reduction with a trend towards significant reduction of mean ST segment deviation. Hence RIPC reduces enzymatic infarct size obtaining beneficial effect.

Background: Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) via primary percutaneous coronary intervention (PCI) is critical to reduce mortality and morbidity. Door-to-balloon (D2B) time, a key quality metric, is recommended to be ≤90 minutes by the American College of Cardiology/American Heart Association (ACC/AHA). This study evaluates D2B times and associated factors in a tertiary emergency department (ED) in North Kerala, India. Methods: A prospective observational study was conducted from January 2024 to December 2024 at a 750-bed tertiary care hospital in North Kerala. We enrolled 300 consecutive STEMI patients undergoing primary PCI. Time segments (door-to-ECG, ED-to-coronary care unit [CCU], consent, and post-consent-to-balloon) were recorded. Spearman’s correlation and multivariable logistic regression identified factors influencing D2B delays. Results: The mean D2B time was 62 ± 14.5 minutes, with 92% of patients achieving D2B ≤90 minutes. Consent time (mean 25.4 ± 11.3 minutes) showed a strong correlation with D2B time (ρ = 0.89, p < 0.001). Nighttime presentation (00:01–08:00) and prolonged consent time were independent predictors of D2B >90 minutes (odds ratio [OR]: 2.95, 95% CI: 1.45–6.02; OR: 1.12 per minute, 95% CI: 1.07–1.18). In-hospital mortality was 3.7%, higher in patients with D2B >90 minutes (12.5% vs. 2.9%, p = 0.02). Conclusion: The tertiary ED achieved commendable D2B times, but consent delays and nighttime presentations remain challenges. Targeted interventions, including streamlined consent processes and enhanced nighttime staffing, could further optimize outcomes

Acute coronary syndrome (ACS) complicated by atrioventricular (AV) block is a challenging clinical condition, requiring timely assessment and directed intervention to ensure the best outcome for the patient. This study examines the influence of different revascularization techniques, such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), in patients with ACS and associated AV block. Clinical and functional results were compared with an emphasis on mortality, myocardial recovery, and restoration of the cardiac conduction system. The study population included patients with ACS-related AV block stratified according to the treatment modality. We compared the effectiveness of early vs. delayed revascularization, with a focus on its potential to enhance conduction recovery and survival. The findings suggest that prompt revascularization, specifically PCI or CABG, dramatically improves survival rates and allows for conduction system recovery. Yet, the selection of intervention is still very much based on individual patient factors, such as infarct site, hemodynamic stability, and severity of conduction abnormalities. In addition, we noted that patients who received PCI had a greater probability of recovery of conduction, especially in those with transient AV block, while CABG was favored in extensive coronary artery disease. These results highlight the value of a patient-specific, individualized approach to the management of ACS with AV block, affirming the pivotal role of early and proper revascularization in enhancing clinical outcomes