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A large, randomised control trial known as PLATO study proved a turning point in the assessment of superiority of ticagrelor over clopidogrel in post- MI cases. This breakthrough in assessing the quantum of efcacy of ticagrelor over clopidogrel in post-MI patients led to changes in international guidelines. However, based on the mortality index associated with these two drugs, the outcome is not encouraging, and both ticagrelor and clopidogrel are on par in terms of efcacy or safety. Recurrent episodes of bleeding were more common in patients who were prescribed ticagrelor than in patients who were given clopidogrel. However, future trials with longer follow-up time periods may be able to answer all the remaining questions

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock (AMI-CS) or heart failure is associated with an unacceptably high in-hospital mortality of 33%–55% and a lost chance to accept PCI (Percutaneous Coronary Intervention). Aim: The aim of the study was to find out whether percutaneous hemodynamic support device Impella 2.5 improves prognosis of high-risk PCI patients or not. Methods: This study was a case series involving six patients who underwent a Left Ventricular Assist Device (LVAD, Impella 2.5, Abiomed, Danvers, MA) implantation after suffering from AMI with a very low ejection fraction and acute heart failure. The clinical experience and outcomes of the patients are hereby discussed. Results: All PCI procedures were safely completed under LVAD support. The hemodynamic parameters of all patients improved clinically over the next 30 days and following 12 months after Impella insertion except in two patients, of which one patient (Case number 6) died 4 days post-Impella protected PCI procedure due to acute left ventricle heart failure with cardiogenic shock and pulmonary oedema; and another one died at 12 months after Impella protected PCI procedure (Case number 4) due to decompensated heart failure and infected pneumonia. Conclusion: Percutaneous hemodynamic support is favorable and feasible during high risk Percutaneous Coronary Intervention (PCI). A bigger study is needed to substantiate the claims of the current study.

Background: .In developing countries like India CAD is one of the major causes of death. The pattern of coronary artery dominance has a significant clinical role. Left dominance is said to be associated with increase in acute coronary syndrome. The aim of this study was to determine the pattern of coronary artery dominance in Kashmiri population. Materials and Methods : The study was carried on 150 patients above 18 years of age who after routine clinical evaluation were to undergo coronary angiography for various indications and their angiogram was labelled as normal by cardiologist. Results: A total of 150 patients were included in the study, among them 102 were male and 48 were female patients. The mean age for females was 56.4±10.22 years with range from 40-89 years. The mean age of males were 56.1±10.83 years with range from 30-89 years. Right coronary artery was dominant in 130 (86.67%) subjects, left coronary artery was dominant in 15 (10%) subjects and co-dominant circulation was found in 5(3.33%) subjects. Conclusion: The right coronary artery dominance is more prevalent in Kashmiri population. Knowledge about coronary artery dominance provides helpful information to anatomist and is essential for interventional cardiologist.

Background: Knowledge of the coronary sinus venous anatomy is an important factor because of its relevance in electrophysiological procedures such as chronic resynchronisation therapy, mapping and ablation of arrhythmias. The advent of advanced invasive and interventional cardiac treatment and management tools for common disorders like heart failure has made understanding of coronary sinus anatomy necessary. The aim was to study the angiographic anatomy of coronary sinus and its tributaries in adult Kashmiri population and provide anatomical basis for cannulation of coronary sinus and its tributaries.Methods: Authors analysed the levophase angiogram of 150 subjects undergoing routine coronary angiography in the right anterior oblique and left anterior oblique view with the necessary caudal or cranial angulations.Results: The coronary sinus was formed by the union of GCV+LMV in 93.3% of subjects and by the union of GCV+PLV in 6.7% of subjects. The GCV and the MCV were the most consistent tributaries present in all the subjects. The mean length of CS was 71.70±9.7 mm when it was formed by GCV+LMV and 70.18±14.98 mm in case of GCV+PLV. The diameter of the CS ostium was 8.48±1.21mm. The mean diameter of GCV was 2.90±1.24 mm, MCV was 2.76±1.08 mm, LMV was 2.23±0.51 mm and the PLV was 2.25±0.53 mm. The opening angle of GCV was obtuse in all the cases, MCV drained at an acute angle in 62% subjects and LMV draining angle was acute in 31.33% cases. The valve of the CS was present in 32.7% subjects and absent in 67.3% subjects. The tortuosity was absent in 75.3%. The distance between CS ostium and the ostium of the vein ideal for lead implantation was between 10-40 mm in 76% subjects.Conclusions: The basic knowledge of coronary sinus and its tributaries play a significant role during electrophysiological procedures. The data obtained from the study can be utilised by interventional cardiologist for cannulation of coronary sinus in Kashmiri population.

Allergic reactions to pacemaker components are rare but well known . We present a case who developed pain, erythema and serosangious discharge immediately after permanent pace maker (PPM) implantation. There was no evidence of infection from ancillary investigations and the whole pacemaker system was explanted. New system was implanted on the opposite side and the patient once again had erythema and swelling of the wound with scant discharge. Hemogram revealed Eosinophillia and also IgE levels were increased. Patient was started on steroids which resulted in prompt healing of wound., Kalp pili bileşenlerine karşı alerjik reaksiyon nadir fakat iyi bilinen bir durumdur. Bu makalede kardiyak kalıcı peacemaker implantasyonundan hemen sonra ortaya çıkan ağrı, kızarıklık ve seroanjiyöz akıntı gelişen bir olguyu sunduk. Hastanın tetkiklerinde enfeksiyon bulgusu yoktu ve tüm peacemaker sistemi çıkarıldı. Diğer göğüs tarafına yeni sistem takıldı ve hastada yine eritem ve hafif akıntı ile birlikte yara yerinde şişlik oldu. Hemogramda eozinofili mevcuttu ve aynı zamanda IgE düzeyi artmıştı. Hastaya yara yerinin hemen iyileşmesi ile sonuçlanan steroid tedavisi başlandı