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Conventional radial access has become the default access for coronary angiography. Sometime, it is difficult to take a conventional radial access, especially in patients having severe arthropathies leading to limited wrist joint mobility. In such scenarios, distal transradial access (dTRA) can be adopted. We describe a case of an elderly male patient having rheumatoid arthritis with arthropathies. He presented to us with unstable angina; coronary angiogram was advised for ischaemia assessment. Right dTRA was adopted due to severe joint deformity at wrist joint, limiting joint extension. A successful coronary angiogram was performed via the right dTRA without major discomfort and complications. Haemostasis was secured with TR band radial artery compression device. In this case report, we have evaluated the importance of practising dTRA in a patient with severe arthropathies. [ABSTRACT FROM AUTHOR]

Objectives: Intralesional coronary artery calcification (CAC) is an important prognostic marker in terms of target lesion failure, target vessel revascularization and clinical outcomes. Intravascular ultrasound (IVUS) plays a pivotal role in the optimal management of calcified coronary arteries. We aimed to determine the clinical outcomes of IVUS guided intervention of calcified coronary lesions in a South Asian country. Methodology: We retrospectively studied a total of 134 consecutive patients, who underwent IVUS guided assessment of coronary arteries from January 2013 to March 2020 at a single center. Patients were categorized into two groups: those with coronary artery calcification (CAC, n=77) and without coronary artery calcification (non-CAC, n=57). The mean duration of follow-up was 40.3 ± 30.1 months. The two groups were compared based on their clinical characteristics, management, in-hospital events, follow-up, and major adverse cardiac events (MACEs) that included cardiovascular death, non-fatal MI, lifethreatening arrhythmia, bleeding, heart failure, stroke, and target vessel revascularization. Results: A total of 134 patients were included who had undergone IVUS and were divided into two groups patients with CAC (n=77) and non-CAC (n=57). Majority of the patients were male (n=97 [72.3%]), the mean age at presentation was 63.1 ± 12.9 years. In CAC group the most common risk factor was Age of the patient then dyslipidemia (n=68[88%] followed by hypertension (n=64[83%]) and diabetes mellitus (n=44[57%]), CAC group patients were more commonly presented with acute coronary syndrome (n=59[76.6%]), had prior PCI (n=40[52%]), had more LM disease (n=34 [44%], p=value 0.005), significant number of prior stent-ISR (n=27[47%]) p=0.024. Having CAC is associated with higher MACE (17 out of 26 events). Conclusion: Patients with CAC have more comorbidities and more commonly present with acute coronary syndrome. MACEs were recorded higher in the CAC group although the results are not statistically significant. [ABSTRACT FROM AUTHOR]

Background: There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward., Objectives: To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan., Methods: This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July-December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or associated diagnosis were enrolled., Results: A total of 636 patients were enrolled. The mean age was 68.5 ± 12 years and 49.5% (315) were male. 90.6% of the patients were admitted via emergency room. Majority (59.9%) had previously known AF and 40% developed new-onset AF during the hospital stay. Hypertension was the most common co-morbid condition (85.4%) followed by Diabetes Mellitus (40.1%). At least 9% had rheumatic heart disease. The median CHA 2 DS 2 VASc and HASBLED scores were 4 and 2 respectively. More than one-third of patients had sepsis as a primary diagnosis (36.8%). The in-hospital mortality of patients with atrial fibrillation was 6.7%. Patients with new-onset AF had higher mortality. Sepsis and stroke were independently associated with a higher mortality. There was no significant difference in median CHA 2 DS 2 VASc and HASBLED scores for patients with new-onset and previously known AF. On discharge, 83% of the eligible patients received oral anticoagulation., Conclusion: There was higher prevalence of chronic co-morbid conditions in the studied population leading to a higher CHA 2 DS 2 VASC Score. Sepsis and stroke were independently associated with higher in-hospital mortality., Competing Interests: None of the authors has any conflict of interest to reveal., (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)