European Journal of Cardiovascular Medicine

Coronary artery disease (CAD) is a leading cause of mortality worldwide, particularly affecting younger adults with symptomatic atherosclerosis. This case report details a 44-year-old male patient presenting with chest pain and dyspnea, leading to a diagnosis of triple vessel disease (TVD). His medical history included hypertension and tobacco use, with a coronary angiogram revealing 100% occlusion in the left anterior descending artery (LAD) and right coronary artery (RCA), along with significant stenosis in other major vessels. Surgical intervention through coronary artery bypass grafting (CABG) was deemed necessary to restore blood flow. The surgery was conducted under general anesthesia with cardiopulmonary bypass, successfully utilizing both saphenous vein and internal thoracic artery grafts. Post-operative recovery was uneventful, and the patient was extubated within four hours. This case underscores the complexity of CABG in patients with TVD, highlighting the importance of tailored surgical strategies and meticulous technique to optimize outcomes and improve quality of life. The successful revascularization illustrates the potential benefits of CABG in high-risk patients with significant coronary blockages.

Background and Objectives: Coronary artery disease (CAD) results from interaction of many risk factors, environmental influence and genetic predisposition. Endothelial and vascular smooth muscle dysfunctions are early abnormalities in atherosclerosis development in cardiometabolic disease. Diabetes is a significant risk factor for cardiovascular disease due to elevated oxidant levels contributing to vascular dysfunction and impaired vasodilatory effect mediated through release of nitric oxide (NO). Endothelial function assessed by brachial artery Flow mediated dilatation (FMD), a non-invasive test has been shown to be impaired in patients of CAD. As diabetes has been CAD risk equivalent, this study is being done to evaluate the mean FMD value in patients with and without diabetes mellitus and to correlate endothelial dysfunction in these patients through FMD. Methods: A cross-sectional study was done from January 2020 to June 2021, in which 84 patients of CAD were enrolled after informed consent. The patients were divided into 2 groups of diabetics and non-diabetics. Statistical analysis was done to compare mean FMD value between the 2 groups of diabetes and non-diabetes patients by using independent sample t test and correlation of endothelial dysfunction in diabetes through FMD was done by chi square analysis.  Results: The mean age of patient was 53.81±9.52 years, males were predominant than females in the study with sex ratio of 1:4. The mean duration of diabetes was 4.91 with SD 1.22 years. The mean FMD in SVD (Single vessel disease) was 9.43± 4.48%, in DVD (Double vessel disease) mean was 8.55±2.83% and in TVD (Triple vessel disease) was 5.707±1.93%. Among the various biochemical parameters, increased creatinine, FBS, PPBS and TG was found to be statistically significant with respect to diabetes (p<0.01). The mean FMD (%) was found to be lower with values of 5.87 ±2.03% ( p<0.001) in diabetic group than in non-diabetic group, whose mean FMD was 11.51±3.27%. Conclusion: The mean FMD was found to be lower in diabetic group than in non-diabetic group, suggesting increased endothelial dysfunction in diabetic patients compared to non-diabetics in   patients with known CAD. Also, FMD was found to be negative correlated with risk of cardiovascular disease in diabetic patients, where lower FMD was found to be associated with higher risk of endothelial dysfunction. Therefore, FMD is a non-invasive, simple, reliable technique which serves as an alternative to invasive procedures and can help to identify patients with endothelial dysfunction who are at a higher risk of CAD, and initiate early and appropriate management.

Background: With the rising burden of coronary artery disease (CAD) in India, percutaneous coronary intervention (PCI) using multiple stents has become increasingly common in complex cases. However, data on outcomes for patients receiving ≥3 stents remain limited. Objective: To evaluate the Clinico-demographic and angiographic profile and assess short-term procedural outcomes in patients undergoing PCI with three or more coronary stents. Methods: A mixed-design cohort study was conducted at a tertiary center including 134 patients undergoing PCI with ≥3 stents. Data on demographics, clinical presentation, lesion characteristics, and procedural outcomes were analyzed. Results: Of 134 patients, 74% were male. Most were between 41–70 years (77%). TVD (46%) was the most common angiographic pattern. Type B (43%) and Type A (37%) lesions predominated. In-hospital complications were negligible; at 3 months, mortality was 1.49%, and angina occurred in 8.96%. Conclusion: PCI with ≥3 stents is safe and effective with favourable short-term outcomes in complex CAD. Long-term follow-up is warranted for definitive conclusions.

Background: Epicardial fat lies in close proximity to myocardium, and its metabolic activity correlates with the heart and coronary vessels. Epicardial fat thickness (EFT) reflects visceral adiposity rather than general obesity. It correlates with metabolic syndrome, insulin resistance, coronary artery disease (CAD), and subclinical atherosclerosis; therefore, it may serve as a simple tool for cardiometabolic risk prediction. Echocardiographic measurement of EFT is low-cost, rapid, and reproducible. Prior studies have shown conflicting results regarding correlation of EFT with severity of coronary stenosis. Hence, this study evaluated the hypothesis that echocardiographic EFT correlates with CAD severity. Objectives: To assess the association between epicardial fat thickness measured using transthoracic echocardiography and CAD severity by coronary angiography (modified Gensini score). Methods: A single-centre observational cross-sectional study conducted in the Department of Cardiology, Government Medical College, Kozhikode. Patients undergoing coronary angiography for suspected CAD (meeting inclusion criteria) were enrolled. All patients underwent clinical evaluation, ECG, 2D echocardiography with EFT measurement, and coronary angiography. Results: A total of 151 patients were included (mean age 53.4 years; 74.8% male). Of these, 53 (35.1%) had normal CAG and 97 (64.9%) had CAD. Normal CAG patients showed good LV function in 96.2% vs 36.7% in CAD patients; LV dysfunction was significantly more common in CAD (60.2%, p = 0.001). Among CAD patients, single-vessel disease (SVD) was found in 33.8%, double-vessel disease (DVD) in 18.5%, and triple-vessel disease (TVD) in 11.9%. Risk factors (DM, HTN, smoking, BMI) were not significantly different between groups. Mean Gensini score was 0 in normal vs 5.8 in CAD. Mean EFT was 3.2 mm in normal vs 7.1 mm in CAD patients (p < 0.001). EFT increased stepwise with CAD severity: SVD 6.56 mm, DVD 7.56 mm, TVD 7.82 mm vs 3.2 mm in normal (p < 0.001). Dyslipidemia patients had higher EFT (7.89 mm) than those with normal lipids (6.22 mm). Conclusion: Echocardiographic EFT was significantly higher in CAD patients than in those with normal coronaries and correlated with the severity of CAD (SVD/DVD/TVD). EFT is a simple, low-cost marker of coronary artery stenosis severity

Introduction: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide, with increasing prevalence in India. Risk stratification tools that are simple and inexpensive may help identify patients with higher disease burden. And also it is important To identify the most common presenting symptoms,To enumerate the angiographic profile of the participants & the vessels involved in ACS and To assess the risk factors associated with ACS. Materials and Methods: A prospective observational study was carried out,to study the clinical profile and to evaluate the angiographic severity of coronary artery disease in patients with acute coronary syndrome (ACS). The study included 122 consecutive patients aged above 18 years with an ECG/ECHO confirmed diagnosis of ACS after obtaining consent from participants. Patients with acute heart failure, prior history of stroke/TIA, PCI/CABG were excluded. Data related to demographic, clinical, and laboratory profiles were recorded. For each patient, the coronary angiography (CAG) findings were categorized as single-vessel disease (SVD), double-vessel disease (DVD), or triple-vessel disease (TVD). The relationship between the angiographic severity, and associated risk factors was assessed using appropriate statistical methods.and also clinical profile of the patients was studied. Results: Among study participants 71.7% were males, with mean age being 56.1 ± 10.5 years. Most common presentation was STEMI (65.0%), followed by unstable angina (21.7%) and NSTEMI (13.3%) respectively. Prevalence of SVD, DVD & TVD on CAG was 40.3%, 38.7% & 21% respectively. With CAG it was observed that, multivessel disease has significant association with higher levels of HbA1c (mean ± SD of  6.63± 1.4, p = 0.004), FBS (mean ± SD of 115.08 ± 51.3, p=0.039) & hypertension (p<0.001).  Conclusion: Among the patients presenting with ACS, majority were of STEMI. Prevalence of SVD among patients of ACS is more common in comparison with DVD & TVD. There is significant association between Multivessel disease and higher levels of HbA1c, FBS and hypertension.