BACKGROUND: Atrial fibrillation (AF) is common among frail older adults and poses complex management challenges due to reduced physiological reserve and heightened vulnerability to adverse outcomes. AIMS: This systematic...BACKGROUND: Atrial fibrillation (AF) is common among frail older adults and poses complex management challenges due to reduced physiological reserve and heightened vulnerability to adverse outcomes. AIMS: This systematic review (2015-2025) examined influence of frailty and advanced age on AF management and outcomes, focusing on anticoagulation, interventional therapies and quality of life. METHODS: Eligible cohort studies, trials, meta-analyses assessed outcomes including mortality, stroke, major bleeding, functional decline, recurrence, healthcare costs and quality of life with frailty measured using validated tools like Clinical Frailty Scale. RESULTS: Frail patients had a two-to threefold higher mortality risk and 40-50% greater incidence of stroke and major bleeding than non-frail peers. Low-dose NOACs reduced stroke in frail octogenarians but bleeding risk persisted. Rate control therapy improved symptoms yet increased hypotension risk. Catheter ablation showed lower success and more complications. CONCLUSIONS: Severe frailty and age ≥85 were associated with poorer outcomes, higher resourcutilization and reduced quality of life.
OBJECTIVE: Several high-risk electrocardiographic (ECG) phenotypes in acute coronary syndrome (ACS)-Wellens, de Winter, and Aslanger-signal critical ischemia or occlusion despite absent diagnostic ST-segment elevation my...OBJECTIVE: Several high-risk electrocardiographic (ECG) phenotypes in acute coronary syndrome (ACS)-Wellens, de Winter, and Aslanger-signal critical ischemia or occlusion despite absent diagnostic ST-segment elevation myocardial infarction (STEMI) and would benefit from expedited reperfusion. Data on their joint estimates are scarce. The objectives were: (1) to quantify their prevalence; and (2) to compare their baseline characteristics and angiographic vessel-burden. METHODS: In this prospective single centre observational study, 1223 consecutive ACS patients undergoing invasive coronary angiography were included with their ECGs reviewed against prespecified criteria for Wellens (Types A/B), de Winter, and Aslanger pattern. Their prevalence, baseline and angiographic features were analysed. RESULTS: High-risk ECG phenotypes occurred in 71/1223 (5.8%): Wellens 48 (3.9%), Aslanger 15 (1.2%), and de Winter 8 (0.7%). Wellens presented as non-STEMI (NSTEMI) 36/48 (75%) or unstable angina (UA) 12/48 (25%), representing 10.4% (48/463) of combined NSTEMI plus UA presentations. de Winter constituted 2.3% of anterior STEMI (8/351). Aslanger accounted for 3.6% of NSTEMI (15/415). Compared to other ACS, Aslanger patients were older (69.3 ± 9.3 years) with marked metabolic clustering (diabetes 73.3%, dyslipidaemia 73.3%). Wellens (54.5 ± 11.4 years) and de Winter (54.2 ± 7.9 years) were younger and smoking-predominant (60.4% and 62.5%, respectively). Angiographically, Wellens was single-vessel disease (SVD) predominant (56.2%); de Winter localized to the left anterior descending artery (100%) and Aslanger exhibited a multivessel signature. CONCLUSIONS: About 1 in 17 (∼6%) ACS presentations exhibits a high-risk ECG phenotype not captured by STEMI criteria and each with a distinct clinico-angiographic profile. Recognizing these patterns supports an occlusion myocardial infarction (OMI) focused approach and expedited invasive management.
BACKGROUND: The aim of this study was to compare and correlate the right ventricular volumes and ejection fraction by 3D echo and cardiac MRI in postoperative tetralogy of Fallot patients with free pulmonary valve regurg...BACKGROUND: The aim of this study was to compare and correlate the right ventricular volumes and ejection fraction by 3D echo and cardiac MRI in postoperative tetralogy of Fallot patients with free pulmonary valve regurgitation. METHODS: Twenty-six patients with severe PR secondary to either pulmonary valvotomy or tetralogy of Fallot repair were evaluated using 3D echo and MRI. RESULTS: The mean end-diastolic volumes (ml/m) were 161.61 ± 29.31 and 170.16 ± 30.79 (p = 0.03) and the mean end-systolic volumes(ml/m) 83.74 ± 24.16 and 94.18 ± 24.13 (p = 0.12) on 3D echo and MRI, respectively. The mean RV ejection fractions were 47.90 ± 7.81% on 3D echo and 44.83 ± 8.29% on MRI (r = 0.89, P < .001). Similarly, there were strong correlations of both end-diastolic volume and end-systolic volume on 3D echo and MRI (r = 0.94 and r = 0.74, respectively). CONCLUSIONS: Three-dimensional echo was comparable with MRI in determining RV volume and ejection fraction in post operative TOF patients with free pulmonary regurgitation. It will be important to study 3D echo in a larger population of patients with TOF, which will be possible only through multi-centre collaboration.
BACKGROUND: Digital health technologies are promising tools to improve cardiovascular risk factors. We evaluated the impact of a multicomponent digital health program-including a mobile app, home blood pressure (BP) moni...BACKGROUND: Digital health technologies are promising tools to improve cardiovascular risk factors. We evaluated the impact of a multicomponent digital health program-including a mobile app, home blood pressure (BP) monitor, wearable activity tracker, and telecoaching-on hypertension and diabetes control in cardiac outpatients. METHODS: In this pragmatic randomized controlled trial, 240 adults with cardiovascular disease and hypertension and/or type 2 diabetes were assigned to receive either the digital health program plus usual care or usual care alone for 6 months. Co-primary outcomes were change in systolic BP and hemoglobin A1c (HbA1c). Secondary outcomes included risk factor target achievement, medication adherence, and quality of life. RESULTS: A total of 228 patients (mean age 57 ± 12 years; 38% women) completed follow-up. At 6 months, the intervention group showed a greater reduction in systolic BP compared with controls (-11.2 ± 12.6 vs -5.1 ± 11.8 mmHg; adjusted mean difference -6.1 mmHg, 95% CI -9.3 to -2.9; p < 0.001). Among participants with diabetes (n = 142), HbA1c decreased by -0.7 ± 1.1% versus -0.3 ± 1.0% (adjusted mean difference -0.4%, 95% CI -0.7 to -0.1; p = 0.008). More intervention patients achieved BP < 130/80 mmHg (52% vs 34%, p = 0.01) and HbA1c <7% (48% vs 32%, p = 0.04). Physical activity improved significantly, with increased step counts. More benefit observed in patients with poorly controlled baseline risk factors. Medication adherence and quality-of-life scores improved significantly. CONCLUSIONS: A multicomponent digital health intervention significantly improved BP and glycemic control in cardiac outpatients, supporting integration of digital strategies into secondary cardiovascular prevention.
OBJECTIVE: Coronary artery bypass surgery (CABG) in the elderly is associated with increased mortality. Comorbidities are also more common in the elderly. The objective of this study was to ascertain the impact of comorb...OBJECTIVE: Coronary artery bypass surgery (CABG) in the elderly is associated with increased mortality. Comorbidities are also more common in the elderly. The objective of this study was to ascertain the impact of comorbidities on mortality in elderly patients undergoing CABG. METHODS: All patients undergoing isolated off-pump CABG at a single-center from October 2014 to December 2021 were included. Patients were divided into two groups - <75 years and ≥75 years. Cox-regression analysis was done to assess for factors associated with mortality. Kaplan-Meier survival curves were used to assess survival. Due to unequal distribution of comorbidities between the two groups, 1:1 propensity score matching was done to assess the impact of age on outcomes. RESULTS: A total of 2200 patients who underwent off-pump CABG were included of which 139 were ≥75 years. Both operative mortality and intermediate-term mortality (mean 4.7 years) was higher in patients ≥75 years (6.5% vs 1.5% and 20.1% vs 8.9% p value < 0.001). Multivariate Cox-regression analysis showed re-exploration, high EuroSCORE II and the presence of chronic obstructive pulmonary disease to be associated with intermediate-term mortality. Overall survival was worse for patients ≥75 years (6-year survival 68.9% vs 89.6% p value < 0.001). However, on propensity matching these differences between the two groups disappeared. CONCLUSION: Factors other than age also contribute to mortality in elderly patients who undergo CABG. Comorbidity assessment should be an important focus of attention when evaluating risks for surgery in elderly patients.
OBJECTIVE: To assess the value of the admission electrocardiogram (ECG) in predicting multivessel coronary artery disease (MVD) in patients with ST-elevation myocardial infarction (STEMI) and to identify novel predictive...OBJECTIVE: To assess the value of the admission electrocardiogram (ECG) in predicting multivessel coronary artery disease (MVD) in patients with ST-elevation myocardial infarction (STEMI) and to identify novel predictive patterns. METHODS: This was a single-center, retrospective observational study of 169 STEMI patients who underwent coronary angiography. Two cardiologists, blinded to angiographic findings, reviewed admission ECGs to identify the culprit artery and predict MVD using pre-specified criteria. Diagnostic accuracy metrics were calculated, and associations between ECG findings and MVD were assessed. RESULTS: MVD was present in 81 (48%) patients. While the ECG identified the culprit artery with 97% accuracy, its sensitivity for predicting MVD using standard criteria was low (21.0%), though specificity was high (94.3%). However, in inferior STEMI, ST depression in aVR was significantly associated with MVD (p=0.010; OR 4.2). In anterior STEMI, the absence of limb lead changes was a highly specific predictor of MVD (p=0.009; OR 13.3; Spec 98.4%). CONCLUSIONS: While the admission ECG is highly accurate for culprit artery localization, its sensitivity for MVD is low. ST depression in aVR in inferior STEMI and the absence of limb lead changes in anterior STEMI are novel, highly specific predictors of MVD that can enhance early risk stratification.
BACKGROUND: Evidence comparing non-aspirin single antiplatelet therapy (SAPT) with aspirin-containing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is limited. We performed a systematic...BACKGROUND: Evidence comparing non-aspirin single antiplatelet therapy (SAPT) with aspirin-containing dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is limited. We performed a systematic review and meta-analysis to evaluate the safety and efficacy of non-aspirin SAPT with a P2Y12 inhibitor started at or within one week of PCI. METHODS: Electronic databases were searched for studies evaluating non-aspirin SAPT after PCI. Primary outcomes were bleeding defined by Bleeding Academic Research Consortium (BARC) criteria [BARC 1-5 (any bleeding) and BARC 3-5 (major bleeding)], all-cause mortality (ACM), and cardiovascular mortality. Secondary outcomes were stroke, myocardial infarction (MI), need for revascularization, and stent thrombosis (STS). RESULTS: Seven studies (2 randomized controlled trials and 5 observational studies) including 5468 patients on non-aspirin SAPT were analysed. In the single-arm meta-analysis of non-aspirin SAPT, pooled prevalence was 5% (95% CI 3-11;I=92%) for any BARC 1-5 bleeding, 3% (95% CI 1-7;I=92.5%) for major BARC 3-5 bleeding, 2% (95% CI 1-3;I=65.4%) for ACM, 2% (95% CI 2-3;I=31%) for cardiovascular mortality, 1% (95% CI 1-1;I=0%) for STS, 1% (95% CI 0-1;I=40.1%) for stroke, 2% (95% CI 1-3;I=66.6%) for MI, and 2% (95% CI 1-4;I=75.9%) for revascularization. In pairwise analyses of the two trials, non-aspirin SAPT versus aspirin-based DAPT showed similar risks of all-cause mortality, cardiovascular mortality, bleeding, and stroke but higher risks of MI (odds ratio [OR]1.41;95% CI 1.01-1.97; P=0.05; I=0%) and revascularization (OR1.73; 95% CI 1.18-2.52;P=0.005;I=0%). CONCLUSION: Upfront aspirin-free SAPT after PCI was associated with increased risks of MI and revascularization without a reduction in bleeding compared with aspirin-based DAPT.
Post-myocardial infarction ventricular septal rupture is a rare but fatal mechanical complication, frequently complicated by cardiogenic shock. We conducted a single-centre retrospective cohort study of seventeen surgica...Post-myocardial infarction ventricular septal rupture is a rare but fatal mechanical complication, frequently complicated by cardiogenic shock. We conducted a single-centre retrospective cohort study of seventeen surgically declined patients who underwent transcatheter device closure between 2014 and 2025. Cardiogenic shock was present in 15 of 17 patients (88.2%). Device implantation achieved high technical success; however, early mortality remained substantial, with only six patients (35.3%) surviving beyond 30 days. Deaths were mainly due to refractory shock and multiorgan failure. Survival was associated with lower SCAI shock stage, preserved lactate clearance, and higher arterial pH, underscoring the importance of physiological status.
Meena DS, Kumar D, Kumar B
… +7 more, Bohra GK, Midha N, Choudhary R, Deora S, Tak V, Sharma AK, Devnani M
Indian Heart J
· 2026 Mar · PMID 41887283
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BACKGROUND: Non-HACEK gram-negative pathogens are an emerging cause of infective endocarditis (IE) with limited data from lower-middle-income countries. This study aimed to evaluate the clinical characteristics, treatmen...BACKGROUND: Non-HACEK gram-negative pathogens are an emerging cause of infective endocarditis (IE) with limited data from lower-middle-income countries. This study aimed to evaluate the clinical characteristics, treatment, and outcomes of non-HACEK gram-negative IE in an Indian cohort. METHODS: This prospective observational study was conducted in a tertiary care center in western India. Clinical presentation, microbiology, echocardiographic findings, and treatment outcomes of non-HACEK gram-negative IE were analyzed and compared with patients who had IE due to other etiology. RESULTS: Among 121 patients with IE, 30 cases (24.8%) were due to non-HACEK gram-negative pathogens (median age: 48 years; 73.3% male). In this group, predisposing cardiac conditions were present in 56%, including prosthetic valves/devices in 26.6%. Pseudomonas aeruginosa was the most common etiology (n = 14, 46.6%), followed by E. coli (n = 6, 20%). The median vegetation size was 12 mm. Common complications included heart failure (56.7%), peripheral septic emboli (40%), and stroke (33.3%). Surgical intervention was performed in 23.3% of cases. The 60-day and 1-year mortality rates were 36% and 43.3%, respectively; relapse occurred in 11.8% of 1-year survivors. Compared to other etiology (n = 91), non-HACEK gram-negative IE had a significantly higher Charlson Comorbidity Index (2 vs 1, p = 0.035), persistent bacteremia (30% vs 12%, p = 0.02), and 60-day mortality (36.6% vs 17.6%, p = 0.032). CONCLUSIONS: Non-HACEK gram-negative IE predominantly caused by Pseudomonas aeruginosa, is increasingly recognized. Compared to other etiology, Non-HACEK gram-negative IE was linked to higher comorbidity scores, frequent persistent bacteremia, and greater early mortality, highlighting its aggressive clinical course.
Rao RS, Chandra K, Sharma GN
… +5 more, Varshney PS, Joshi P, Somendra S, Kumar S, Senguttuvan NB
Indian Heart J
· 2026 Mar · PMID 41871714
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BACKGROUND: Rotational atherectomy (RA) is advantageous in calcified coronary lesions to ablate calcified plaques and optimize stent expansion but associated with complications like coronary perforation, dissection, and...BACKGROUND: Rotational atherectomy (RA) is advantageous in calcified coronary lesions to ablate calcified plaques and optimize stent expansion but associated with complications like coronary perforation, dissection, and slow/no-reflow. AIM: To evaluate the safety and periprocedural outcomes of RA with a modified approach in a real-world Indian scenario. METHODS: This 6-year, retrospective, single-operator study at an Indian tertiary care institution included 320 patients, operated using a modified RA approach, which integrated slow burr speed (150,000-155,000 revolutions per minute), short runs and pretreatment adrenaline with aminophylline to avoid temporary pacemaker (TPM). Data on demographics, periprocedural characteristics, and complications were collected. The primary endpoint was angiographic and procedural success. RESULTS: The patient cohort comprised predominantly men (80.31%) with a mean age of 67.92 ± 9.16 years. Common comorbidities included acute coronary syndrome (67.81%), diabetes mellitus (50.93%), and hypertension (67.81%). A total of 322 RA procedures (414 lesions) were performed. Of these 414 lesions, 7% were chronic total occlusions while 8.9% were in the left main coronary artery. TPM insertion was done in one (0.31%) patient who already had complete heart block. Imaging was performed in 35% of the procedures. Procedural success was achieved in 96.90% of the cases. Complications included slow flow/no-reflow in 4 cases (1.24%), dissection in 4 cases (1.24%), and burr entrapment in 2 cases (0.62%). CONCLUSION: The use of TPM can be avoided during RA, and slow/no reflow incidence can be reduced with pretreatment aminophylline and adrenaline. Small burr sizes with a slow rotation speed and short runs are key for safe and effective calcium ablation with this debulking modality.
Sonawane A, Chandra P, Jose J
… +4 more, Bansal S, Gupta R, Sudhir K, Senguttuvan NB
Indian Heart J
· 2026 Mar · PMID 41819447
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AIM: The Hydra THV incorporates an active release mechanism designed to facilitate the deployment of the supra-annular valve. The aim of the GENESIS-II study was to assess the safety and performance of Hydra THV at 6 mon...AIM: The Hydra THV incorporates an active release mechanism designed to facilitate the deployment of the supra-annular valve. The aim of the GENESIS-II study was to assess the safety and performance of Hydra THV at 6 months follow-up after treating severe aortic stenosis in patients at high surgical risk. METHODS: This prospective, multicenter, non-randomized, investigational study was conducted between November 2021 and November 2023. The study enrolled 40 patients with high surgical risk and symptomatic severe aortic stenosis from 19 sites across India. The primary safety endpoint of the study was cardiovascular mortality at 30 days, while the primary performance endpoint was device success, as defined by VARC-2. RESULTS: Among the 40 patients, the mean age was 74.4 ± 6.7 years, 65% were male, and the mean Society of Thoracic Surgeons (STS) risk score was 3.5 ± 1.6%. The device had a success rate of 95%. At 6 months, there was one cardiovascular death (2.5 %). All-cause death was observed in 5% patients. The incidence of new permanent pacemaker implantation was 7.9%. There was a progressive enhancement in effective orifice area, from 0.6 ± 0.2 cm at baseline to 1.9 ± 0.4 cm at 6 months (p < 0.001). Similarly, the mean aortic valve gradient significantly improved from 53.1 ± 12.5 mm Hg at baseline to 8.7 ± 3.3 mmHg at 6 months (p < 0.001) post-intervention. CONCLUSION: The results of 6 months follow-up after implantation of the Hydra THV with an active release mechanism in the GENESIS-II study demonstrated a high device success rate with favorable safety and performance of the device.
Ghati N, Narang R, Pati HP
… +2 more, Mishra AK, Basha A
Indian Heart J
· 2026 Mar · PMID 41796958
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OBJECTIVE: The effect of aspirin and clopidogrel is not uniform in all patients due to drug resistance. The study was designed to evaluate the prevalence of aspirin and clopidogrel resistance and its association with var...OBJECTIVE: The effect of aspirin and clopidogrel is not uniform in all patients due to drug resistance. The study was designed to evaluate the prevalence of aspirin and clopidogrel resistance and its association with various risk factors in stable CAD patients. METHODS: Total 151 clinically stable CAD patients taking either aspirin and/or clopidogrel were recruited in this prospective cohort study. Platelet function testing was performed using light transmittance platelet aggregometry. All the patients were prospectively followed up to detect any MACE (death, non-fatal MI, stroke, revascularization), worsening angina and bleeding from any site. RESULTS: Total 11 (7.28%) patients showed complete resistance to aspirin, and an additional 35 (23.18%) patients showed semi-resistance. For clopidogrel, 44 (29.2%) and 11 (7.6%) patients had complete and semi-resistance, respectively. The prevalence of dual antiplatelet resistance was 7.6%. In univariate regression analysis, diabetes mellitus [OR 2.2 (95%CI 1.1-4.4); p=0.03] and clopidogrel resistance [OR 20.2 (8-50.7); p<0.01] showed significant association with aspirin resistance. The parameters significantly associated with clopidogrel resistance were - hemoglobin level [OR 0.8 (0.7-1); p=0.03], erythrocyte sedimentation rate [OR 1 (1-1.1); p=0.04], family history of CAD [OR 5.1 (1.5-17.1); p=0.01] and aspirin resistance [OR 20.2 (8.0-50.7); p<0.01]. In multivariable analysis, apart from the significant association between aspirin and clopidogrel resistance, family history of CAD was the only independent predictor of clopidogrel resistance. The study was underpowered to detect any meaningful effect on MACE due to low event rate. CONCLUSION: In our study high prevalence of aspirin and clopidogrel resistance was detected. Although aspirin and clopidogrel resistance showed significant association with clinical risk factors, their association with MACE was inconclusive.
Thakur M, Bhatt M, Goyal A
… +4 more, Singh S, Roy A, Alam S, Khadgawat R
Indian Heart J
· 2026 Mar · PMID 41796957
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BACKGROUND: Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension and is associated with adverse cardiovascular outcomes. While its prevalence is well established among patients with resistant...BACKGROUND: Primary aldosteronism (PA) is the most prevalent cause of secondary hypertension and is associated with adverse cardiovascular outcomes. While its prevalence is well established among patients with resistant hypertension and hypokalemia, evidence regarding its occurrence in premature coronary artery disease (CAD) remains limited, particularly in South Asian populations with a high burden of early cardiovascular disease. OBJECTIVE: To determine the prevalence of PA in patients with premature CAD (≤45 years) and to describe their clinical and biochemical characteristics. METHODS: In this prospective observational study, 64 patients with premature CAD and 60 age-matched controls with CAD onset after 45 years were evaluated. Patients with a positive screening result-defined as plasma direct renin concentration (DRC) < 12 μIU/mL together with plasma aldosterone concentration (PAC) > 10 ng/dL-underwent a recumbent saline infusion test (SIT). A post-infusion PAC >5 ng/dL was considered confirmatory for the diagnosis of primary aldosteronism. Clinical, biochemical and cardiovascular parameters were systematically assessed. RESULTS: Among 64 patients with premature CAD, 2 (3.1%) were diagnosed with PA, whereas no cases were identified in the control group. PA-positive patients exhibited significantly higher systolic (161 ± 15.6 mmHg) and diastolic (94.0 ± 5.7 mmHg) blood pressures, longer hypertension duration, and echocardiographic evidence of left ventricular hypertrophy compared with PA-negative patients. CONCLUSION: PA may represent an underrecognized contributor to premature CAD in young adults. Larger multicenter studies are needed to validate these observations. Routine PA screening in young CAD patients could enable earlier diagnosis and targeted management, potentially reducing long-term cardiovascular morbidity.
Chaturvedi H, Gupta R, Sharma SK
… +6 more, Makkar JS, Sharma KK, Natani V, Khedar RS, Bana A, Sharma S
Indian Heart J
· 2026 Mar · PMID 41794132
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OBJECTIVE: To assess influence of echocardiographic left ventricular ejection fraction(LVEF) on outcomes following percutaneous coronary intervention(PCI) in ST-elevation myocardial infarction(STEMI) and other acute coro...OBJECTIVE: To assess influence of echocardiographic left ventricular ejection fraction(LVEF) on outcomes following percutaneous coronary intervention(PCI) in ST-elevation myocardial infarction(STEMI) and other acute coronary syndromes(oACS). METHODS: Successive patients with ACS who underwent PCI from April'2019 to March'2022 were enrolled, while those who did not undergo PCI were excluded. In all patients, LVEF was obtained at hospital admission and classified into <30.0%,30.0-39.9%,40.0-49.9% and ≥50.0%. Details of risk factors, coronary angiography, interventions, management, and in-hospital and 3-year outcomes were obtained. Multivariate Cox-proportionate hazard ratios(HR) and 95% confidence intervals(CI), adjusted for age, sex, risk factors, presentation, angiography, interventions, management, and hospitalisation, for major adverse cardiovascular events(MACE) and deaths were calculated. RESULTS: Data of 3789 patients (men 3011, women 778) with ACS (STEMI = 1601; oACS = 2188) were available at baseline and 3.0yr (IQR 2.1-4.0) median follow-up. STEMI patients were younger, with more men, smoking, hypercholesterolemia, impaired LVEF, vasopressor support, hospitalisation duration, and in-hospital deaths vs oACS (p < 0.01). Important determinants of reduced LVEF were smoking, 3-vessel, left-main or left anterior descending CAD (p < 0.01). In both groups, patients with lower LVEF(<30.0%,30.0-39.9%) had more in-hospital deaths (p < 0.05). At 3-year follow-up, compared to LVEF >50.0%, multivariate-adjusted HR(95%CI) in LVEF<30.0% for MACE [STEMI 8.55(3.04-24.03); oACS 2.71(1.39-5.29)] as well as CV deaths [STEMI 16.50(3.64-74.71); oACS 3.72(1.40-9.85)] were significant (p < 0.001). For LVEF 30.0-39.9% group, HRs were of borderline significance [STEMI 2.26(0.86-5.89);oACS 1.34(0.76-2.36)] and not significant for LVEF 40.0-49.9% group. Outcomes were not significantly different in men and women. CONCLUSIONS: STEMI and other ACS patients undergoing PCI with LVEF<30% have significantly higher in-hospital and 3-year major adverse cardiovascular events and deaths.
Ghosh Dastidar D, Sau S, Mukhopadhyay T
… +14 more, Chakraborty S, Ghosh Dastidar N, Mondal MM, Yadav U, Soni S, Maji M, Chakraborty H, Mondal K, Yadav Y, Mahato S, Ghosh M, Dutta S, Das S, Ghosh S
SARS-COV-2 virus affects the cardiovascular system by various pathophysiological mechanisms. The incidence of Acute coronary syndrome (ACS) seems to be on rise in the peri-covid era. The proinflammatory and prothrombotic...SARS-COV-2 virus affects the cardiovascular system by various pathophysiological mechanisms. The incidence of Acute coronary syndrome (ACS) seems to be on rise in the peri-covid era. The proinflammatory and prothrombotic milieu is primarily responsible. Traditional atherosclerotic risk factors do not seem to be responsible for this increased incidence of ACS. We chose to test this hypothesis on young Indian population lacking the traditional atherosclerotic risk factors. If established, Covid 19 infection will at least be considered a risk modifier in causing ACS in future. Subsequently, we went on to study the differences in presentation, diagnostic implications, revascularization and management strategies and finally outcomes in ACS patients in the Peri-covid compared to the pre-covid era. To the best of our knowledge, this seems to be the first of its kind study from eastern India.
OBJECTIVES: During transradial percutaneous intervention (PCI), sharp edge of guide catheter tip may produce "razor blade effect" leading to radial vascular injury. Pigtail assisted tracking (PAT) technique has been desc...OBJECTIVES: During transradial percutaneous intervention (PCI), sharp edge of guide catheter tip may produce "razor blade effect" leading to radial vascular injury. Pigtail assisted tracking (PAT) technique has been described to overcome it, but has not been systematically evaluated. We prospectively evaluated the safety and efficacy of PAT technique in transradial PCI. METHODS: Consecutive patients undergoing transradial-PCI were randomized into two groups (Group 1: transradial navigation using PAT technique, Group 2: transradial navigation without PAT technique). Patients were observed for forearm complications and radial artery patency was determined by vascular Doppler at 48 h. Primary end point was the composite incidence of radial artery spasm, angiographic radial artery injury, forearm hematoma and radial artery occlusion (RAO). Secondary end points were incidence of each of these individual variables. Predictors of forearm complications were determined by multivariate analysis. RESULT: Total 260 patients were finally included (130 patients in each group). Baseline and procedural characteristics were comparable in both groups. Majority [158 (60.8%) patients] had acute coronary syndrome. Primary outcome was significantly reduced by the PAT technique [15 (11.5%) vs. 33 (25.4%) patients; p = 0.004]. Individual outcomes were also significantly less in Group 1 [radial artery spasm 12 (9.2%) vs. 28 (21.5%), p = 0.006; angiographic radial artery injury 4 (3.1%) vs. 12 (9.2%), p = 0.04; forearm hematoma 6 (4.6%) vs. 17 (13.1%), p = 0.01; RAO 4 (3.1%) vs. 13 (10.0%), p = 0.02]. PCI without PAT technique and low body weight emerged as independent predictor for forearm complications. CONCLUSION: PAT technique is safe and significantly reduces the forearm complications.
Arora S, Aggarwal P, Kumar A
… +4 more, Jamshed N, Mishra PR, Ekka M, Sahu AK
Indian Heart J
· 2026 Feb · PMID 41713644
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OBJECTIVE: Vagal manoeuvres, particularly the Valsalva manoeuvre (VM), are recommended as first-line therapy for paroxysmal supraventricular tachycardia (PSVT). We aimed to compare the efficacy and safety of a modified V...OBJECTIVE: Vagal manoeuvres, particularly the Valsalva manoeuvre (VM), are recommended as first-line therapy for paroxysmal supraventricular tachycardia (PSVT). We aimed to compare the efficacy and safety of a modified Valsalva manoeuvre with the standard technique in terminating PSVT in the emergency department. METHODS: This prospective, randomised, parallel-group trial was conducted in the emergency department of a tertiary care hospital. Adults with stable PSVT were randomised (1:1) to receive either a modified or standard Valsalva manoeuvre. The modified manoeuvre involved a 40-mmHg strain for 15 s in a semi-recumbent position followed by immediate supine repositioning with passive leg elevation, while the standard manoeuvre comprised a 40-mmHg strain for 15 s in the semi-recumbent position alone. The primary outcome was return to sinus rhythm at 1 min, confirmed by electrocardiography. RESULTS: A total of 75 participants were enrolled (37 in the standard group and 38 in the modified group) on an intention-to-treat basis. Sinus rhythm was restored in 10 of 38 patients (26.3%) in the modified Valsalva group compared with 6 of 37 patients (16.2%) in the standard group (odds ratio 0.54; 95% CI 0.17-1.68; p > 0.05). No serious adverse events were observed in either group. CONCLUSIONS: The modified Valsalva manoeuvre demonstrated a higher, though not statistically significant, cardioversion rate compared with the standard technique. Both manoeuvres were safe and well tolerated. Larger adequately powered studies are required to establish definitive efficacy.