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Radial access for cardiac catheterization and intervention in India has been growing steadily over the last decade with favorable clinical outcomes. However, its usage by interventional cardiologists varies greatly among Indian operators and hospitals due to large geographic disparities in health care delivery systems and practice patterns. It also remains unclear whether the advantages, as well as limitations of transradial (TR) intervention (as reported in the western literature), are applicable to developing countries like India or not. An evidence-based review involving various facets of radial procedure for cardiac catheterization, including practical, patient-related and technical issues was conducted by an expert committee that formed a part of Advancing Complex CoronariES Sciences through TransRADIAL intervention (ACCESS RADIAL™) Advisory Board. Emerging challenges in redefining TR management based on evidence supporting practices were discussed to formulate these final recommendations through consensus. Keywords: Challenges, Radial access, Transradial intervention, Transradial consensus

Background: The use of optical coherence tomography−angio co-registration (OCT-ACR) in routine clinical practice is evolving with limited reporting of clinical outcomes We conducted this study to evaluate the impact of OCT-ACR on clinician decision making during percutaneous coronary intervention (PCI) Methods: Patients with clinically significant stenosis of >70% in at least 1 coronary artery were enrolled in the study The pre- and post-PCI procedural strategies were prospectively assessed after angiography, OCT, and ACR with data analyzed by an independent core lab We enrolled 500 patients from 9 centers in south Asia Twenty-eight patients had inadequate imaging, whereas data from 75 patients are yet to be analyzed by core lab due to COVID-19 Results: The interim results included 397 patients with a mean age of 57 8 ± 10 8 years Pre-procedural OCT resulted in a change in PCI strategy in 76% of lesions including change in stent length (57%), diameter (34%), strategy (10%), and landing zone (57%) (Figure) The use of ACR additionally altered treatment strategy in 23% lesions Postprocedural OCT demonstrated edge dissections (3%), underexpansion (18%), malapposition (17%), tissue/thrombus prolapse (8%), and incomplete coverage (1%), thereby requiring additional interventions for optimization in 36% lesions No change in strategy was observed with post-procedural ACR [Formula presented] Conclusion: This is the first South Asian study reporting outcomes of OCT-ACR−guided PCI in patients with coronary artery disease The use of OCT resulted in overall pre-procedural change of PCI strategy in 76% lesions compared with angiography Real-time ACR had an additional significant impact with change in strategy in 23% of lesions Categories: IMAGING: Imaging: Intravascular

Coronary bifurcation intervention is common but complex. Progress in this field has been made in recent years with considerable contribution from the Asia Pacific (APAC) region. However, the standard of practice varies across the APAC region due to differences in culture, socioeconomic state and healthcare set-up. Practice may also differ from the rest of the world. Hence, a panel of experts was invited to discuss topics relevant to bifurcation intervention in order to make a concerted effort to achieve consensus that is applicable within the region and in line with available evidence.

Background & aims Although Absorb Bioresorbable Vascular Scaffolds (A-BVS) are routinely used in the Asia-Pacific, there is little information on patient selection or deployment technique here. This document investigates the experiences of leading interventional cardiologists from the Asia-Pacific region with a focus on patient characteristics, deployment techniques and management. Methods and results A detailed questionnaire was distributed to 28 highly-experienced interventional cardiologists (‘Authors') from 13 Asia-Pacific countries. The results were discussed at a meeting on patient selection, technical consideration, deployment practices and patient management. Potential patient benefits of Absorb compared to metallic DES, the learning curve for patient selection and preparation, device deployment, and subsequent patient management approaches are presented. Conclusions Current practices are derived from guidelines optimized for European patients. Differences in approach exist in the Asia-Pacific context, including limited access to imaging and frequency of occurrence of complex lesions. Nevertheless, the use of the Absorb BVS (‘Absorb') in certain Asia-Pacific countries has flourished and practices here are continuing to mature.

A 54-year-old male patient diabetic with history of coronary angioplasty 4 years back with a drug eluting stent presented with anterior wall ST segment Elevation Myocardial Infarction. He was taken up for primary angioplasty, diagnostic angiogram showed 100% thrombotic occlusion of proximal left anterior descending artery with an aneurysm. A stent boost was done which showed a fragmented left anterior descending artery stent with disarticulation of both fragments. Two drug eluting stents one in proximal left anterior descending artery bridging the broken fragments of the previous stent and other in a mid left anterior descending artery lesion of 90% were deployed with excellent angiographic outcome with TIMI III flow.

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Hypertension (HTN) being one of the important risk factors for cardiovascular disease (CVD) is a significant health concern, especially in India. With age, prevalence of HTN, especially systolic HTN increases. Special attention needs to be directed to HTN in young ages (20- 40 years) due to lower awareness, need for early treatment and better control of HTN. HTN in the age group of 20-40 years needs critical reappraisal. Given the high prevalence of HTN in the general population in India, in this review we attempt to provide current evidence and expert opinion on epidemiology, aetiopathogenesis and treatment of HTN in young (20-40 years) Indians.

Coronary Artery Disease (CAD) occurs at a younger age in Indians with over 50% of Cardiovascular Disease (CVD) mortality occurring in individuals aged less than 50 years. Although several risk factors have been suggested; smoking, dyslipidemia and hypertension are major risk factors in the young. In this review, we have pooled the current evidence on Ischemic Heart Disease (IHD) in young (20-40 years) and provided an opinion for the effective management of IHD in young Indians.

Introduction: Sudden cardiac death (SCD) is the most lethal manifestation of heart disease. In an Indian study the SCDs contribute about 10% of the total mortality and SCD post ST elevation myocardial infarction (MI) constitutes for about half of total deaths. Objective: Given the limitations of existing therapy there is a need for an effective, easy to use, broadly applicable and affordable intervention to prevent SCD post MI. Leading cardiologists from all over India came together to discuss the potential role of n-3 acid ethyl esters (90%) of eicosapentaenoic acid (EPA) 460 mg & docosahexaenoic acid (DHA) 380 mg in the management of post MI patients and those with hypertriglyceridemia. Recommendations: Highly purified & concentrated omega-3 ethyl esters (90%) of EPA (460 mg) & DHA (380 mg) has clinically proven benefits in improving post MI outcomes (significant 15% risk reduction for all-cause mortality, 20% risk reduction for CVD and 45% risk reduction in SCD in GISSI-Prevenzione trial) and in reducing hypertriglyceridemia, and hence, represent an interesting option adding to the treatment armamentarium in the secondary prevention after MI based on its anti-arrhythmogenic effects and also in reducing hypertriglyceridemia.

Background Prasugrel, a novel thienopyridine antiplatelet drug significantly reduces rates of stent thrombosis compared to clopidogrel, the current standard therapy, clopidogrel. However, it has been associated with an increased risk of both minor as well as major bleeding, including fatal bleeding. Objective The objective of this study was to document the rate of adverse events of prasugrel in clinical practice in acute coronary syndrome (UA/NSTEMI & STEMI undergoing PCI). Methods This was a multicentre, open-labeled, prospective, naturalistic study. A total of 2592 patients of STEMI or NSTEMI for primary or delayed PCI on prasugrel 60 mg loading and 10 mg of maintenance dose were enrolled. Outcome measures were stent thrombosis, death and major/minor bleeding over a follow-up period of three months. Results Of the 2592 patients, 14 were terminated from therapy. Out of 2578 patients, 1099 (42.6%) were STEMI and 814 (31.6) UA/NSTEMI, 2022 (78.3%) were male and 560 (21.7%) female. 1180 (45.8%) were diabetics. The average age of patients was 55.65 years. At the end of three months there was no death in study population. 43 (1.6%) patients experienced adverse events. Bleeding and chest pain were the most common (n = 9, 0.3% each), followed by gastritis in 5 patients (0.2%), weakness in 4 (0.2%) and vomiting in 3 patients (0.1%). Conclusion Prasugrel was well-tolerated, with a good safety profile, and the most common side effects being bleeding and chest pain.

Background Optimal inhibition of platelet aggregation (IPA) may afford greater protection against ischemic events during percutaneous coronary intervention (PCI). The objective of this study was to test several antiplatelet regimens in elective high-risk PCI patients by comparing different combinations of glycoprotein IIb/IIIa inhibitors and clopidogrel. Methods The study was a randomized open-label study at 3 heart centers in India. One hundred twenty patients were enrolled between July 2006 and September 2006. Patients were randomized to 1 of the 4 groups: group A—tirofiban, group B—eptifibatide, group C—tirofiban + clopidogrel 600-mg loading dose, and group D—eptifibatide + clopidogrel 600-mg loading dose. All patients received a clopidogrel maintenance dose after PCI. The primary outcome measure was the IPA assessed at 10 minutes, at 6 to 8 hours, and at 24 hours. Results The IPA was higher with high-dose tirofiban compared with eptifibatide at 10 minutes (95.88 ± 5.85% vs 91.22 ± 7.52%, P = .003) and at 6 to 8 hours (93.11 ± 7.6% vs 85.45 ± 11.03, P 95% IPA with the high-dose tirofiban regimen. Conclusions This head-to-head study comparing high-dose tirofiban with double-bolus eptifibatide demonstrated higher degree of platelet inhibition with high-dose tirofiban at 10 minutes and at 6 to 8 hours in patients undergoing elective high-risk PCI. The addition of clopidogrel did not acutely extend the IPA from intravenous glycoprotein IIb/IIIa inhibitors, but did so at 24 hours.