Vineet Bhatia

Safety of Prasugrel in Indian patients – Multicentric registry of 1000 cases

BACKGROUND Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding. For this reason it has not gained widespread usage in ACS patients undergoing PCI. There are no systematic data on the use of Prasugrel in Indian population. METHOD This is a prospective, multicentric, hospital registry of 1000 patients with ACS undergoing PCI who were administered Prasugrel. The primary safety endpoint of this study was major and minor bleeding while the efficacy endpoint is the composite of CV death, nonfatal MI, nonfatal stroke up to 30 days after PCI. Patients with high bleeding risk were excluded. RESULTS Most patients (91%) received loading dose of Prasugrel along with the maintenance dose getting according to the defined protocol. Patients were followed up to 30 days post procedure. Primary efficacy end point was reached in 3 patients only with two of them dying due to possible stent thrombosis and the third requiring revascularization of the target vessel for stent thrombosis. One major and 19 minor bleeding complications were recorded, with access site bleeding in 0.7% & non-access site bleeding in 1.2% of the subjects. CONCLUSION Prasugrel was found to be effective & not associated with a high incidence of bleeding in the high risk ACS patients when those at a high bleeding risk were excluded.

Type IV dual left anterior descending coronary artery: A rare anomaly

Type IV dual left anterior descending (LAD) coronary artery is a rare anomaly and was detected incidentally during a routine coronary angiogram. The article discusses the types of dual LAD and their clinical implications.

Saroglitazar: A New Drug to Treat Diabetic Hypertriglyceridemia

Dyslipidemia alone has been considered as one of the major modifiable risk factor for cardiovascular diseases (CVD) accounting for 50% of the 1st myocardial infarction (MI) cases worldwide.1 A recent epidemiological survey on prevalence of lipid abnormalities of the Indian population by Indian Council of Medical Research-India Diabetes Study (ICMR-INDIAB), has shown that 79% of Indian subjects above 20 years of age have abnormalities in at least one of the lipid parameters.2 In this survey, the most commonly found lipid abnormality was low-high density lipoprotein cholesterol (low HDL-C) in 72% subjects followed by high triglycerides (TG) in 29.5% subjects and then high low-density lipoprotein cholesterol (LDL-C) in 11.8% subjects.3 Prevalence of dyslipidemia is high in India, which calls for urgent lifestyle and pharmacological intervention strategies to prevent and manage this important cardiovascular risk factor.

Primary Angioplasty Using a Renal Stent in a Severly Ectactic and Occluded Left Anterior Descending Coronary Artery

Revascularization of ectatic coronary arteries in the setting of acute myocardial infarction pos- es great challenges for the operator. We report a case, where a peripheral renal stent was used successfully to treat the clinical situation.

Carcinoid Heart Disease: Classical Echocardiographic Features

Carcinoid Heart Disease (CHD) is an important and rare cause of acquired valvular heart disease. Clinical examination supplemented with Echocardiographic evaluation may give the first clue towards an under lying carcinoid tumor. We report a case with classical Echocar - diographic features of carcinoid heart disease.

Saddle Thrombus seen on Transthoracic Echo: A Rare Feature in Pulmonary Embolism

Page 51 The Saddle thrombus is a rare condition characterized by presence of a large thrombus which straddles the main pulmonary arterial trunk and its bifurcation leading to acute massive Pulmonary Embolism (PE). Its incidence among patients diagnosed with PE is approximately 2.6%.1 Saddle PE frequently results in significant hemodynamic instability and signals the potential for imminent hemodynamic collapse. This is rarely seen on Trans-thoracic echocardiography (TTE). We recently came across a patient who presented with breathlessness following transatlantic air travel. His TTE (routine and 3D) revealed a saddle thrombus in the main pulmonary arterial trunk extending into its two main branches (Figures 1 and 2). A CT pulmonary angiogram confirmed the same (Figure 3). He was subsequently successfully thrombolyzed and made an uneventful recovery.

Adenosine induced coronary spasm – A rare presentation

Adenosine is commonly used as a pharmacological agent in myocardial perfusion imaging, as an antiarrhythmic agent, and in Cath Lab. during PCI for treating no reflow phenomenon. Coronary spasm has been reported following adenosine injection during stress imaging. We report a rare complication with ST segment elevation, following adenosine injection, given for treatment of supraventricular tachycardia.