Background The data on infective endocarditis after transcatheter aortic valve implantation (TAVI) is scarce and limited to case reports and case series in the literature. It is the need of the hour to analyze the available data on post-TAVI infective endocarditis from the available literature. The objectives of this systematic review were to evaluate the incidence of infective endocarditis after transcatheter aortic valve implantation, its microbiological profile and clinical outcomes. It will help us to improve the antibiotic prophylaxis strategies and treatment options for infective endocarditis in the context of TAVI. Methods EMBASE, Medline and the CENTRAL trials registry of the Cochrane Collaboration were searched for articles on infective endocarditis in post-TAVI patients till October 2018. Eleven articles were included in the systematic review. The outcomes assessed werethe incidence of infective endocarditis, its microbiological profile andclinical outcomes including major adverse cardiac event (MACE), net adverse clinical event (NACE), surgical intervention and valve-in-valve procedure. Results The incidence of infective endocarditis varied from 0%-14.3% in the included studies, the mean was3.25%. The average duration of follow-up was 474 days (1.3 years). Enterococci were the most common causative organism isolated from 25.9% of cases followed by Staphylococcus aureus (16.1%) and coagulase-negative Staphylococcus species (14.7%). The mean in-hospital mortality and mortality at follow-up was 29.5% and 29.9%, respectively. The cumulative incidence of heart failure, stroke and major bleeding were 37.1%, 5.3% and 11.3%,respectively. Only a single study by Martinez-Selles et al. reported arrhythmias in 20% cases. The septic shock occurred in 10% and 27.7% post-TAVI infective

Patient: Male, 62-year-old Final Diagnosis: Coronary artery disease • entrapped coronary guidewire • stent deformation Symptoms: Angina pectoris Medication: — Clinical Procedure: Angioplasty • coronary artery bypass grafting (CABG) Specialty: Cardiac Surgery • Cardiology Objective: Management of emergency care Background: Strangulation of the coronary guidewire is an infrequent complication of percutaneous coronary intervention (PCI), and it can lead to disastrous outcomes of stent thrombosis, vessel occlusion, and vessel damage. Case Report: Early-generation stents were made from stainless steel and had a bulky design as compared to cobalt-chromium or platinum chromium alloys, which have superior trackability at the cost of a thin core and low-strength struts, resulting in increased incidence of longitudinal stent deformation. We present a case of a 62-year-old active smoker with effort angina of Canadian Cardiovascular Society (CCS) class III. His coronary angiogram revealed a totally occluded right coronary artery (RCA). After placing 2 coronary guidewires (Run-through and Balanced middle-weight), Xience Xpedition (3.25×48 mm) and Promus Element (2.75×32 mm) were deployed through the whole length of the RCA. While placing the distal stent, the guidewire securing the posterior left ventricular (PLV) was trapped between 2 stents and all attempted maneuvers were unsuccessful in retrieving the wire. The stents sustained longitudinal deformation by the guide catheter, and subsequent arteriotomy for stent and wire retrieval and coronary artery bypass graft surgery were (CABG) performed. Conclusions: Despite the remarkable safety profiles of the percutaneous equipment, complications still occur even with experienced operators. Calcified and tortuous vessels are primarily at risk for wire strangulation between stents or side-branches, and better deliverability of newer drug-eluting stents (DES) comes at the cost of reduced longitudinal strength.

Long-Term Outcomes of Drug-Coated Balloon Angioplasty in The Treatment of Small Vessel Coronary Artery Disease Objectives: To determine the outcomes in patients with small-vessel disease (SVD) who underwent percutaneous coronary intervention (PCI) with a drug-coated balloon (DCB) and correlate these adverse outcomes with various risk factors. Methodology: The prospective cohort study was conducted at the Rawalpindi Institute of Cardiology (RIC) from January 2020 to December 2022. After being approved by the Hospital Ethics Committee, fifty-four patients who presented with SVD were enrolled using non-probability consecutive sampling. Written informed consent was obtained from the patients. They were treated with DCB and observed clinically on follow-ups at 15, 30, 60, and 90 days, & later after every 6 months for up to 2 years. Only those patients who presented with symptoms underwent repeat angiography. The outcomes assessed were cardiovascular mortality, myocardial infarction (MI), and target lesion revascularization (TLR). Results: Cardiovascular mortality occurred in 2(3.7%), MI in 3(5.6%) and TLR in 2(3.7%) patients. There was a significant association between cardiovascular mortality, MI, and TLR with diabetes mellitus and BMI. Age was only significantly related to cardiovascular mortality. Conclusion: A drug-coated balloon is an effective and feasible treatment modality for small vessel disease. The incidence of outcomes of cardiovascular mortality, MI, and TLR after DCB is low, making it a safe modality. Advanced age, obesity, and diabetes mellitus alone or with hypertension are the predicting factors of adverse outcomes after DCB in patients with SVD. Keywords: Drug-coated balloon, DCB, Small vessel coronary artery disease, SVD

Objective: To evaluate residual SYNTEX score as a predictor of 30-day mortality after primarypercutaneous coronary intervention (P-PCI) in ST-elevation myocardial infarction (STEMI) patients. Methodology: It was a quasi-experimental study conducted in the Emergency department of Rawalpindi Institute of Cardiology from September 2019 to September 2020. After the study approval from the ethics committee and informed consent, 200 patients presenting with acute STEMI were included by convenient sampling. Primary PCI was done in all patients by theconsultant cardiologists, and then the residual SYNTEX score (rSS) was calculated for each patient. Patients were allocated the case or control group based on rSS: patients with complete revascularization were included in controls and those with incomplete revascularization were labeled as cases. All patients were followed after primary PCI for 30-day mortality. The analysis of data was carried out by the Statistical Package for Social Sciences (SPSS) version 25. Results: The 30-day mortality occurred in 11(5.5%) patients. Mortality occurred in 9(4.5%) patients in the case group and 2(1%) patients in the control group with a significant p-value of 0.03There was a significant association between diabetes mellitus & 30-day mortality (0.032) and a family history of ischemic heart disease & 30-day mortality (0.026). This shows that rSS can be used as a reliable predictor of 30-day mortality after P-PCI in STEMI patients. The patients with high rSS score and risk factors of diabetes mellitus and history of ischemic heart disease are at higher risk of 30-day mortality. Conclusion: The residual Syntax score is a simple, reliable and significant marker of 30-day mortality after P-PCI in STEMI patients. It provides an accurate assessment of the extent of revascularization needed to prevent coronary artery disease and enhance the prognosis following P-PCI. It may also serve as a guide for additional PCI decisions. Keywords: Residual Syntax score; rSS; Primary percutaneous coronary intervention;Acute ST-elevation myocardial infarction; STEMI; P-PCI