Incidence, predictors, and long term clinical outcome of angiographic definite stent thrombosis in real world scenario - A prospective cohort study.

BACKGROUND: The occurrence of stent thrombosis (ST) in real world scenario is far different from that mentioned in the literature. Our study identifies the various parameters of ST. METHODS: This is a prospective observational-cohort study where-in consecutive patients who received successful percutaneous transluminal angioplasty (PTCA) over the study period of 1-year was included and were followed for 1-year from the primary procedure. RESULTS: The overall incidence of definite ST was 1.4% and 1.7% at 30 days and 1 year respectively. The most common mode of presentation of ST was ST-elevation myocardial infarction (82.6%). The history of prior PTCA, multi-vessel disease, emergent PTCA, acute coronary syndrome and type B2/C lesions were found to be the independent predictors for definite ST. The incidence of late ST was significantly higher with bare metal stent (BMS) than drug-eluting stent (DES) (OR-2.4, 95% CI:1.3-4.5). At mean follow-up of 13.9 months after ST, the overall mortality was 36.9%. The independent predictors of mortality after ST were post-PTCA thrombolysis in myocardial infarction (TIMI) flow grade < 3, and cardiogenic shock at the time of presentation. CONCLUSION: The overall incidence of definite ST is high in the real world scenario and the DES fared better than BMS. ST carries a bad prognosis especially so if the patients present in cardiogenic shock, or unable to achieve TIMI-3 flow after PTCA.

Gemella morbillorum endocarditis in hypertrophic cardiomyopathy: a rare organism causing a large vegetation and abscess in an uncommon setting.

Mitral valve endocarditis complicating hypertrophic cardiomyopathy is rare especially in the absence of significant mitral regurgitation. The occurrence of large vegetation and an abscess formation is even rarer. Endocarditis occurs predominantly on the left ventricular aspect of the anterior mitral leaflet. We report a case of a 34-year-old woman with asymptomatic obstructive hypertrophic cardiomyopathy who developed mitral valve endocarditis with large vegetation and subsequently an abscess caused by a rare organism Gemella morbillorum, following dental extraction. The patient underwent antibacterial therapy followed by successful mitral valve replacement for severe mitral regurgitation and her postoperative course has been asymptomatic so far. This case is unique in describing endocarditis by a rare organism as a cause of large vegetation and an abscess on an unusual site on the mitral valve leaflet without predisposition of haemodynamically significant mitral regurgitation and illustrates the potential lifesaving role of timely intervention.

Familial hypercholesterolaemia presenting with coronary artery disease in a young patient.

A man in his early 20s presented with an angina on exertion and postprandial angina. Upon examination, the patient had carotid artery bruit and multiple tendon xanthomas. His lipid profile showed a very high total and low-density lipoprotein cholesterol; treadmill test was strongly positive. Subsequent coronary angiogram revealed triple vessel disease. The patient underwent revascularisation and is on lipid lowering therapy.