Optimal DCA produced a low residual percent diameter stenosis and a lower restenosis rate than seen in previous trials without an increase in early or late major adverse events.

Background: Acute Coronary Syndrome (ACS) is one of the major causes of morbidity and mortality in developing countries, which illustrates the need for rational prescribing of drugs to the patients. Aim: The aim of the study is to analyse the prescription pattern and drug utilisation for the drugs prescribed to the patients with ACS by checking the compliance with the standard guidelines provided by the American College of Cardiology/American Heart Association (ACC/AHA). Materials and Methods: A prospective observational study for a period of 6 months was conducted in the cardiology and cardiothoracic departments of a tertiary care hospital. The sample size was determined by using Rao software and percentage of the data was calculated using Microsoft Excel 2007. Results: A total of 270 patients were enrolled in the study in which males (219) dominated females (51) and were found in the age group of 60-69 years (92). Diabetes (62.9%) followed by hypertension (54.8%) were found to be the dominant risk factors. The prescribing frequency of dual antiplatelet therapy, statins, beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and nitrates was 93.3%, 97.3%, 94.1%, 76.3% / 14.1% and 41.2%. The treatment given to the patients was not completely in compliance with the ACC/ AHA guidelines (18.14%). Conclusion: The study provides an overall insight of the pattern of drugs prescribed to the patients with ACS which reveals the necessity of improving the rational prescribing of drugs in accordance with the standard guidelines.

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Aim Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. Methods & Results In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = −0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. Conclusions The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

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Ticagrelor is a potent reversible P2Y12 inhibitor with proven superiority over clopidogrel. Ticagrelor increases the tissue concentration of adenosine, thereby leading to bradyarrhythmia. This complication is reported to occur very early after initiating the drug. A randomized controlled trial reported that ticagrelor-induced pauses have an early onset without much clinical impact. However, our patient developed ticagrelor-induced hemodynamically significant sinus arrest 10 months after coronary artery stenting, which improved after stopping the drug. Ticagrelor should be considered as one of the uncommon reasons for late-onset sinus pause or bradyarrhythmia.

Straight back syndrome is characterized by loss of the normal upper thoracic kyphosis, leading to a reduced anteroposterior diameter and squashing of the heart. Most patients are asymptomatic; if symptomatic, chest pain and palpitations are most common. On examination, the abnormal clinical findings simulate organic heart disease that needs to be ruled out by echocardiography and cardiac catheterization. A lateral chest radiograph is diagnostic. This condition is commonly associated with mitral valve prolapse and bicuspid aortic valve. We describe an interesting case of straight back syndrome with all the classic and rarely reported clinical findings.

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