Patient: Female, 46-year-old Final Diagnosis: Coronary artery dissection and stent dislodgement Symptoms: Chest pain Medication: — Clinical Procedure: PCI Specialty: Cardiology Objective: Rare disease Background: Coronary stent dislodgement is rare but carries serious complications like thrombosis, myocardial infarction, disruption of the systemic circulation, and coronary dissection, which can lead to sudden death. Thus, rapid evaluation and intervention are needed to restore blood flow to vital organs. Case Report: A 46-year-old woman with no relevant past medical history except for smoking, presented to the Emergency Department (ED) with left-sided chest pain. The physical exam was unremarkable. EKG showed ST segment elevation, and troponin was 4.03. She underwent cardiac catheterization, which showed 100% occlusion of the left anterior descending coronary artery (LAD). A drug-eluting stent (DES) was placed. Later, she had chest pain similar to the initial episode. EKG showed 1-mm elevation at ST segment in leads V1 and V2 and T wave inversion in leads V2, V3, V4, and V5. She underwent a repeat heart catheterization, which revealed a dissection in the middle LAD distal to the initial stent placement. She was treated with another stent overlapping the proximal stent. While attempting to cross the proximal stent, the stent came off the balloon, slipped from the wire, and went down into the descending aorta. Conclusions: Coronary artery stent dislodgement is a rare event that can lead to significant complications during PCI. Patient restlessness and small-sized, severely angulated, and previously stented coronary arteries are associated risk factors. The main treatment option is stent retrieval, either surgically or using other available techniques. If retrieval of the stent is impossible, crushing it against the blood vessel wall could be considered.

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Background: Association between serum vitamin D levels and lipid levels has been focus of research in recent times. The relationship of 25(OH)D and Atherogenic Index of Plasma is not well established among Indian population. We investigated the prevalence of vitamin D deficiency, its relation with serum lipids and AIP among IT employees. Methods: A retrospective observational study was conducted among employees of multiple IT firms in Bangalore, India. Participants were selected by convenient sampling from annual comprehensive health screening at work place. Serum lipid levels were assessed auto-analyser (ADVIA1650; Siemens, NY, USA). Serum 25(OH)D was assessed by Chemiluminescent microparticle immunoassay. AIP was calculated as log [Triglycerides/HDL-Cholesterol]. Results: Among 533 subjects included final analysis, mean of age was 33.18+/16.6 with Male:female ratio of 1.8:1. Vitamin D deficiency and AIP > 0.15 was observed in 405 (75.98%) and 450 (84.43%) participants respectively. Median HDL-cholesterol was significantly lower (42 Vs 45.5, P value 0.004) and LDL cholesterol was significantly higher (90 Vs 52, P value <0.001) among people with vitamin-D deficiency. LDL (Spearman Rho=-0.18, P <0.001) had weak negative correlation, Total cholesterol (Spearman Rho=-0.1, P Value <0.01) and VLDL (Spearman Rho=-0.18, P Value <0.001) had weak positive correlation with 25(OH)D. No statistically significant association was observed between AIP and vitamin-D. Interpretation & conclusions: More than two thirds of IT employees were deficient in vitamin D. Vitamin D deficiency was associated with significantly higher LDL, lower HDL and VLDL levels. No statistically significant association was observed between vitamin D and AIP. Keywords: Serum 25(OH)D, Lipid profile, IT employees, Adult, Atherogenic Index of Plasma (AIP) Key Messages: The prevalence of vitamin D deficiency is very high among IT employees as more than two thirds had serum 25(OH)D levels <20ng/dl. Vitamin D deficiency was associated with significantly higher LDL, lower HDL and VLDL levels. No statistically significant association was observed between vitamin D and Atherogenic Plasma Index(AIP). Long term prospective studies are need of the hour to understand the long term impact of vitamin deficiency on cardiovascular morbidity.