Aims To study the incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) at a high volume center in South-east Asia. Methods Data from patients who had CAP during PCI from January 2016 to December 2019 at our center were collected. Clinical features, angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively. Results A total of 40,696 patients underwent PCI during the study period and the incidence of CAP was 0.13% (n = 51). Mean age was 60.0 ± 10.8 years and 69% were males. CAP cases involved complex type B2/C lesions in 73%, calcified lesions in 58%, and chronic total occlusions in 25%. Majority of patients presented as acute coronary syndrome (65%) and STEMI was the most frequent indication for PCI (33%). Most of the CAPs were Ellis type II (33%) and III (55%). CAP most frequently occurred during post dilation (n = 20) and wire manipulation (n = 17). Majority were treated by prolonged balloon inflation (53%) and covered stents (33%). Pericardiocentesis was required in 19 patients to alleviate tamponade. In one patient coil embolisation was done and two patients required bail-out emergency cardiac surgery. Periprocedural myocardial infarction occurred in 6% and in-hospital mortality was 10%. All-cause mortality accrued to 14% at 30 days and 16% at 6 months. Conclusion Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.

INTRODUCTIONThe twentieth century saw an unparalleled increase in life expectancy and a major shift in the cause of illness and death throughout the world. During this transition, Cardiovascular Disease (CVD) became the most common cause of death worldwide. A century ago CVD accounted for less than 10% of all deaths. Today it accounts for approximately 30% of deaths worldwide including nearly 40% in high income countries and 28% in low and middle-income countries. 1Based on data from the Framingham Heart Study, the lifetime risk of developing symptomatic coronary artery disease (CAD) after the age of forty is 49% for men and 32% for women. The World Health Organization (WHO) has estimated that by 2020, the global number of deaths from CAD would have risen from 7.2 million in 2002 to 11.1 million.2 The evaluation of Ischemic Heart Disease (IHD) in women presents a unique and sometimes difficult challenge for clinicians, owing to the differences in symptoms, clinical features and mortality as compared to men. The diagnosis and treatment of CAD has been primarily based on research conducted in men, either excluding women entirely or including limited number of women. 3This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and ABSTRACT Background: The evaluation of coronary artery disease (CAD) in women presents a unique and difficult challenge for clinicians, owing to the differences in symptoms, clinical features and mortality as compared to men. This study is to analyze the risk factors, clinical presentation, complications and outcome in women who presented with myocardial infarction. Methods: The study was conducted among women admitted with acute myocardial infarction in coronary care unit of KIMS Hospital, Hubli from January 2013 to December 2013. After inclusion and exclusion criteria 100 women underwent detailed history, clinical examination and investigations. Results: The mean age of the study group was 57.98 years. 49% of patients presented with atypical symptoms with majority being postmenopausal (87%). HDL cholesterol was the commonest risk factor followed by HsCRP, increased waist circumference and diabetes mellitus, with the least common risk factor being elevated homocysteine. Pump failure was the commonest complication. Double vessel disease was more common in diabetic population whereas single disease was common in non-diabetic population. Conclusions: Women clinically present with atypical symptoms that resulted in significant delay to reach hospital. Novel risk factors like HsCRP and homocysteine may improve risk detection in women with CAD. Identifying and targetting lifestyle risk factors. Diabetes mellitus in particular is the key to reduction in CAD in women.

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Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.

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