HOW did GLP-1RAs bring about a paradigm shift in the guidelines of managing T2DM: A path to gluco-cardio Centricity

Diabetes is a common condition with a dismal prognosis. According to the International Diabetes Federation, 537 million people worldwide have diabetes. Cardiovascular disorders (CVD) are the major cause of death globally. Diabetes mellitus type 2 (T2DM) increases the risk of CVD. Since 2008, the FDA has required all new antihyperglycemic treatments to show no increased CV risk. Years of glucocentric diabetic therapy have left many patients on medicines with no known CV benefit. GLP-1 receptor agonists (GLP-1RAs) are excellent glucose-lowering medicines with little risk of hypoglycaemia, CVD and weight loss. GLP-1RAs may also delay renal disease development. As an adjunct to metformin or ongoing therapy, GLP1RAs or sodium-glucose cotransporter-2 inhibitors are recommended by the American Diabetes Association and the European Association for the Study of Diabetes (EASD). Thus, this review summarises GLP-1RA and their significance in the paradigm shift in diabetes care recommendations from glucocentric to gluco-cardiocentric

Intervenção coronária percutânea com técnica mini culotte estadiada para reestenose ostial de grande ramo lateral / Percutaneous coronary intervention with the staged mini culotte technique for ostial restenosis of the large side branch

O conhecimento da anatomia e da fisiologia de uma bifurcação é essencial na área intervencionista atual. A lesão de bifurcação é uma das alterações coronárias mais desafiadoras no tratamento percutâneo. Foram investigadas muitas estratégias intervencionistas devido ao alto nível de interesse nessas lesões, mas os resultados dos procedimentos e de longo prazo foram relativamente ruins. As melhorias em implante de stents e outros procedimentos intervencionistas reduziram a probabilidade de desfechos clínicos adversos, criando o ambiente mais favorável para os stents realizarem seu trabalho. O implante de stent provisional tem sido amplamente aceito como técnica intervencionista inicial nas lesões de bifurcação coronária pela comunidade médica há mais de 15 anos. A reestenose de um grande ramo é possível após angioplastia do vaso principal utilizando uma abordagem provisional de um único stent. Embora a reestenose do ramo lateral após angioplastia de bifurcação seja menos comum nos procedimentos modernos de bifurcação, ela ainda ocorre em 5% dos casos durante o acompanhamento angiográfico baseado em sintomas. Em nossa série de casos de cinco pacientes, a reestenose grave de ramo lateral apresentou sintomas de angina recorrente, que necessitou de revascularização do vaso-alvo. Ao aplicar os princípios de bifurcação, aprimoramos a etapa do mini culotte estadiado da técnica culotte de bifurcação, tornando-a mais fácil de usar e reduzindo a exposição à radiação e o tempo de operação.

Understanding the anatomy and physiology of a bifurcation is crucial in today's interventional field. The bifurcation lesion is one of the most challenging coronary conditions to treat percutaneously. Numerous interventional strategies have been investigated because of the high level of interest in these lesions, but the relatively poor procedural and long-term results. Improvements in stenting and other interventional procedures have reduced the likelihood of adverse clinical outcomes, by creating the most favorable environment for stents to do their work. Provisional stenting has been widely accepted as the initial interventional technique for coronary bifurcation lesions by the medical community for over 15 years. Restenosis of a major branch is possible after angioplasty of the main vessel using a provisional one-stent approach. Although side branch restenosis following bifurcation angioplasty is less common with modern bifurcation procedures, it still occurs in 5% of cases during angiographic follow-up for symptoms. In our case series of five patients, severe side-branch restenosis presented with recuring anginal symptoms, which required target vessel revascularization. By applying bifurcation principles, we improved the "staged mini culotte" part of the culotte bifurcation stent technique, making it more user-friendly, and reducing exposure to radiation and operating time.

The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A gender-based multi-center study

Objectives: In a retrospective study, we aimed to explore the prevalence of risk factors and trends of obstructive coronary artery disease (CAD) in Indian females <45 years of age compared to males of the same age group who underwent percutaneous coronary intervention (PCI). Materials and Methods: This was a retrospective, observational, multi-centre study of young Indian females and males (<45 years) who underwent PCI as per the guidelines at three high-volume centres in India. Results: In a group of 3656 patients under the age of 45 who had PCI, 3.1% of those with obstructive CAD were young women (n ¼ 113), while 6.9% were young men (n ¼ 254). Traditional risk factors such as hypertension (p ¼ 0.73), diabetes (p ¼ 0.61), and family history of premature CAD (p ¼ 0.63) were equally common in both genders, whereas dyslipidaemia (p < 0.001), overweight (p < 0.006), smoking (p ¼ 0.004) and, alcoholism (p < 0.001) were more common in young males. Acute coronary syndrome was the most common clinical presentation. Single-vessel disease was common, with the involvement of the left anterior descending artery as the most common angiographic feature. The prevalence of cardiogenic shock was 4.4% in females and 4.1% in males, while the in-hospital mortality rate was 1.77% in young females and 2% in young males. Conclusions: Obstructive CAD in young men and women accounted for 10% of all CAD cases requiring PCI. Although men account for the majority of patients, CAD in women under the age of 45 is not uncommon. Traditional risk factors are becoming more prevalent in younger women

Resolution of Primary Aortic Thrombosis after Dabigatran therapy—A New Hope for the Rare and Old Disease

The primary aortic thrombosis (PAT) is an uncommon noncardiac cause of distal peripheral embolization to lower extremities. Also, this condition develops in the absence of extensive atherosclerosis of aorta or abnormal dilatation like aneurysm of the aorta. In most of the cases, there was either no or minimal atherosclerosis of the aorta. The disease can involve any part of the aorta, but in most of the cases, the thoracic aorta below the origin of the left subclavian artery followed by the infrarenal portion of the abdominal aorta was the most common site of involvement. In our case, there was extensive thrombosis starting from the lower part of the thoracic aorta extending across both the renal arteries up to the aortic bifurcation without any underlying aortic pathology or hypercoagulable disease. There are no guidelines for the management of the PAT, but our experience is based on few case series, case reports, and meta-analysis where there are variable success rate using conservative medical management, endovascular procedure, or surgical thrombectomy. Vitamin K antagonist was the drug of choice in all the cases as a part of conservative medical management or used to prevent recurrence after the endovascular or surgical procedure. We present a case of PAT where the use of dabigatran leads to complete resolution and prevented the recurrence of the disease during two-year follow-up, which is the first and unique case report of the literature.