BackgroundSeveral studies and meta-analyses have shown that direct stenting (DS) may improve clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI). But in most cases, the thrombolysis in myocardial infarction (TIMI) flow remains ≤ 1 after wire placement. We used deflated balloon to facilitate DS in patients with totally occluded culprit arteries. The aim of this study was to evaluate the feasibility, safety and outcomes of this novel technique in patients with STEMI in real-world clinical practice.MethodsThis was a prospective, observational, single-center pilot study. From September 2016 to June 2018, 454 patients were enrolled in the study. DS was performed when the culprit vessel was visualized with at least TIMI flow grade 1. Patients with complete occlusion of the vessel after wire placement were subjected to deflated balloon-facilitated DS technique (DBDS technique) and DS was done wherever possible.ResultsDS was done in 74% (n = 336) of the patients and 26% (n = 118) patients received stenting after pre-dilatation (PD). DBDS technique to facilitate DS was successful in 68% patients (211/309). Final TIMI 3 flow was achieved more frequently in the DS group as compared to PD group (96.7% versus 92.3%, P = 0.04). The procedural complications were also significantly lower in DS group (0.6% versus 7.6%, P < 0.001). DS group had significantly lower procedure time (33 ± 19 min versus 41 ± 17 min, P < 0.001), fluoroscopy time (6.2 ± 3.4 min versus 7.8 ± 32 min, P < 0.001), required lesser contrast volume (112 ± 16 mL versus 123 ± 18 mL, P < 0.001) and had lower procedural cost (310 ± 45$ versus 402 ± 56$, P < 0.001). ST-segment resolution > 50% after percutaneous coronary intervention (PCI) were significantly higher in the DS group (85.7% versus 71.1%, P < 0.001). At 30 days, the major adverse cardiac event (MACE) rate was significantly lower in the DS group (2.4% versus 9.3%, P = 0.02), mainly driven by lower rates of target lesion revascularization (TLR) (0.9% versus 4.2%, P = 0.01).ConclusionThis cost-effective technique appears to be simple, feasible and safe and is associated with superior clinical outcomes. It helps in maximizing DS and could offer an alternative to PD and aspiration thrombectomy in total occlusion. However, larger studies with longer follow up are required before a wider application of this technique.

Coronary interventions in patients with achondroplasia have been very rarely reported. The optimal approach to such patients in complex cases is not known. They pose special challenge to coronary revascularisation due to short stature, angle of their elbows, kyphoscoliosis, frequent obesity, and lack of specific equipments and experience. We present an interesting case of 67 years old man with achondroplasia who presented with significant angina symptoms and past history of IWMI. Transradial angiography showed chronic total occlusion (CTO) of right coronary artery. Coronary angioplasty was done via right radial approach using available hardware with good results. To our knowledge, this is the first case of radial angioplasty in an achondroplastic patient with CTO. The procedural difficulties and techniques have been discussed along with brief review of literature.

Background: Epicardial adipose tissue (EAT) has been related to increased cardiovascular risk in chronic kidney disease patients. However, prospective studies of EAT thickness in prediction of cardiovascular events in CKD patients are lacking. Moreover, there are inconsistencies in literature regarding cutoff of EAT thickness, standard technique and phase of measurement. Objectives: This study was undertaken to compare systolic and diastolic EAT thickness in prediction of CV events in non-dialysis dependent CKD patients. Methods: In this prospective, observational study, transthoracic echocardiography (TTE) was used to assess systolic and diastolic EAT thickness in 210 consecutive non-dialysis dependent CKD patients and followed up for at least one year for pre-defined end-points. Results: The mean systolic and diastolic EAT thickness in the CKD group (5.6±1.2mm and 4.2±1.1mm) was significantly higher than the non-CKD participants (4.3±1.0mm and 3.1±1.1mm), both P<0.001. Interclass correlation coefficient (ICC) agreement on measurements were 0.93 (95% CI: 0.79-0.98) for systolic EAT and 0.91 (95% CI: 0.74-0.97) for diastolic EAT. On multivariate linear regression analysis, only e-GFR remained as independent predictor of both systolic and diastolic EAT thickness. Receiver operating characteristics (ROC) analysis showed that diastolic EAT thickness of 5mm and systolic EAT thickness of 3.8mm had similar sensitivity (88% versus 87%, respectively) and specificity (72% versus 74%, respectively) to predict CV events in CKD patients. Conclusion: Both systolic and diastolic EAT thickness are significantly increased in CKD patients and can be used in CV risk stratification with similar sensitivity and specificity albeit with different cutoffs .

Harlequin ichthyosis is the most severe form of congenital ichthyosis and inherited in an autosomal recessive manner. The disease is marked by severe thickened and scaly skin on the entire body. It is a lethal disease, but patients can very rarely survive for several months or years. We present here cardiac abnormalities in a full term baby with Harlequin ichthyosis. To our knowledge, this is first case study to report associated cardiac abnormality in such patients. Further case studies are required to ascertain the findings and explore the cardiac involvement in this extremely rare disorder.

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