ABSTRACT Background: Premature coronary artery disease (CAD), defined as onset at or before 45 years of age, has a disproportionately higher prevalence among South Asians compared to Western populations, with Indian individuals particularly affected. Traditional lipid metrics primarily quantify low-density lipoprotein cholesterol (LDL-C) but often fail to reflect qualitative changes, such as LDL oxidation, which may contribute to residual cardiovascular risk. Objective: This study aimed to assess the concordance among three LDL-C estimation methods (Friedewald, Martin–Hopkins, and NIH Equation-2) and their relationship with oxidized LDL (ox-LDL) levels in young Indian adults with premature CAD. Methods: This case–control study enrolled 150 participants, including 100 patients with CAD and 50 age-matched controls. Standard lipid parameters were measured, and LDL-C levels were calculated using Friedewald, Martin–Hopkins, and NIH Equation 2 methods while ox-LDL levels were quantified using sandwich enzyme-linked immunosorbent assay. Intergroup differences were evaluated using Mann–Whitney U-test. Associations among LDL-C estimates, conventional lipid fractions, and ox-LDL were examined using Spearman’s rho correlation analysis. Results: LDL-C estimation by all three methods demonstrated strong concordance. However, ox-LDL showed no significant correlation with any of the LDL-C estimation methods. This indicates that ox-LDL “quality” reflects a distinct atherogenic dimension independent of LDL-C “quantity.” Conclusions: Although LDL-C equations provide reliable estimates of LDL cholesterol levels, they do not capture oxidative modifications that contribute to residual cardiovascular risk. Integrating ox-LDL assessment into routine screening may strengthen early detection and enable targeted prevention, addressing the escalating public health burden of premature CAD among young Indians.

ABSTRACT Background: Breast arterial calcification (BAC) visible on routine screening mammography is emerging as a potential marker for cardiovascular disease (CVD) risk in women. This study pooled data from three institutional cohorts in India to evaluate the association between BAC, angiographically confirmed coronary artery disease (CAD), and survival outcomes. Materials and Methods: We retrospectively analyzed mammograms from three cohorts: a screening population (2020–2021, n = 335), a breast cancer cohort (2013–2017), and a mixed screening/diagnostic group (2019–2023). BAC was graded (0–3) as per the Canadian Society of Breast Imaging criteria. Primary endpoints included obstructive CAD (≥50% stenosis) and all-cause mortality. Multivariable logistic regression and Cox models were adjusted for traditional risk factors (age, diabetes, hypertension, and dyslipidemia). Results: BAC prevalence in the screening cohort was 11.3%. Obstructive CAD was significantly more frequent in BAC-positive women (83.9%) compared to BAC-negative (4.0%), with an adjusted odds ratio of 32.1 (95% confidence interval: 11.4–90.8; P < 0.001). In the breast cancer cohort, BAC-positive women had a significantly lower median survival (28.6 vs. 43.6 months; hazard ratio = 1.92, P = 0.02). These findings were consistent across all cohorts. Conclusions: BAC independently predicts obstructive CAD and poorer survival among Indian women, beyond traditional risk factors. Routine BAC reporting in mammography and integrated cardio-oncology referrals may enhance cost-effective CVD risk stratification in India.

ABSTRACT Major aortopulmonary collateral arteries (MAPCAs) are nonregressed embryological connections present in patients with cardiac anomaly with compromised antegrade pulmonary flow such as tetralogy of Fallot. Depending on their angioarchitecture, they may be essential or nonessential and can affect the outcome of definite surgical repair in these patients in terms ranging from intraoperative difficulties to postoperative heart failure. Endovascular embolization of nonessential MAPCAs is a good option to manage these postoperative complications or for ease of doing surgery in a preoperative setting. Here is a case demonstrating preoperative endovascular embolization of nonessential MAPCAs with good surgical outcome.

ABSTRACT Background: Antiplatelet therapy plays a key role in the post-percutaneous coronary intervention (PCI) period. Current recommendations suggest dual antiplatelet therapy (DAPT) for at least 12 months for patients with acute coronary syndrome (ACS) undergoing PCI. We evaluated the clinical outcomes of switching from prasugrel to the more economical clopidogrel after 3 months. Methods: This observational prospective study was conducted at a tertiary care hospital between February 2021 and January 2024. Patients with ACS aged >18 years who were receiving prasugrel as their second antiplatelet agent were included. Results: Overall, 842 patients were included. Most patients were male (73.43%) with a mean age of 56.64 years. Hypertension was observed in 46.79% of patients. Acute anterior wall myocardial infarction (25.29%) was the most common ACS presentation. After switching to clopidogrel, 0.83% of patients (n = 7) were lost to follow-up. Myocardial infarction occurred in 1.3% of patients (n = 11), while both stent thrombosis and target lesion failure were observed in 1.06% (n = 9 each), and nonfatal ischemic stroke in 0.35% (n = 3). Target vessel revascularization was required in 1.18% (n = 10). Three deaths were recorded, and two patients experienced major bleeding. Conclusion: In patients with ACS who underwent PCI, switching from prasugrel to clopidogrel after 3 months did not significantly affect clinical outcomes. This strategy offers an economical DAPT option for patients with lower socioeconomic backgrounds.

ABSTRACT Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly affecting approximately 0.002% of the population. This case report describes an adult male presenting with exertional chest pain and dyspnea, ultimately diagnosed with ARCAPA. Unlike its left-sided counterpart (anomalous origin of the left coronary artery from the pulmonary artery), ARCAPA is typically not fatal in infancy or childhood but can lead to various clinical manifestations, including sudden cardiac death. A 30-year-old male patient presented with a 3 month history of exertional chest pain and dyspnea. Initial investigations, including electrocardiography, cardiac markers, and echocardiography, were normal. However, an exercise stress test was positive, with the patient experiencing symptoms during Stage 2 of the Bruce protocol. Coronary angiography revealed retrograde filling of the right coronary artery from the left coronary arteries, suggesting an anomalous origin from the pulmonary artery. Cardiac computed tomography confirmed the diagnosis of ARCAPA and also showing compression of the right coronary artery’s origin between the aorta and main pulmonary artery. This case highlights the importance of considering congenital anomalies in the differential diagnosis of angina, especially in younger patients. Despite often being asymptomatic, ARCAPA carries a risk of sudden cardiac death, emphasizing the need for thorough investigation and management. Current guidelines recommend surgical intervention for all individuals diagnosed with ARCAPA, regardless of symptom status. However, the patient in this case declined surgical correction and is being managed medically with close follow-up.

ABSTRACT Primary percutaneous coronary intervention (PCI) is the gold standard for treating acute myocardial infarction (AMI). Stent malapposition, a complication more common in AMI due to plaque disruption and thrombus burden, increases the risks of stent thrombosis and restenosis. Angiography often misses subtle malapposition due to its limitations. Optical coherence tomography (OCT), with high-resolution imaging, enhances detection and correction of stent malapposition. The case series presents four patients with proximal stent edge malapposition during primary PCI for AMI. Malapposition, undetected by angiography, was identified using OCT. Corrective measures, including postdilation with high-pressure balloons, were guided by OCT findings. OCT identified malapposition in all cases, leading to successful correction and optimal stent apposition. Follow-up showed no adverse events, confirming the role of OCT in improving outcomes by addressing angiography’s limitations. OCT is invaluable for detecting and correcting stent malapposition during PCI. Routine use of OCT, especially in complex cases, can optimize procedural outcomes and enhance patient safety.

Cardiovascular diseases continue to be the leading cause of mortality worldwide, traditionally attributed to well-established risk factors such as hypertension, diabetes, and smoking. However, emerging evidence now highlights air pollution as a significant, yet often overlooked, modifiable risk factor. Both acute and chronic exposure to ambient pollutants, especially fine particulate matter, nitrogen dioxide, and ozone, have been strongly associated with increased incidences of myocardial infarction, stroke, heart failure, and arrhythmias. These effects are mediated through multiple pathophysiological mechanisms, including systemic inflammation, oxidative stress, endothelial dysfunction, and autonomic dysregulation, all of which contribute to accelerated atherosclerosis and thrombosis. Epidemiological research and real-world evidence consistently demonstrate a dose-response relationship between pollutant exposure and cardiovascular morbidity and mortality. Notably, vulnerable populations such as the elderly, individuals with preexisting cardiometabolic disorders, and communities in low-resource settings experience a heightened risk. Despite mounting scientific consensus, clinical risk assessment and regulatory frameworks have yet to fully integrate air pollution as a routine determinant of cardiovascular risk. This review seeks to synthesize current evidence, highlight critical translational gaps, and advocate for urgent action at both clinical and policy levels.

ST elevation is most commonly associated with ST elevated myocardial infarction, but there are various other conditions which can cause ST elevation such as pericarditis, Takotsubo cardiomyopathy, J wave syndromes such as Brugada and early repolarization syndrome, left bundle branch blocks, left ventricular hypertrophy, electrolyte imbalance such as hyperkalemia, hypercalcemia, and other nonischemic causes. Hence, all ST elevation should not be treated aggressively instead a detail history and clinical examination should be carried out and other causes of ST elevation should be ruled out before treating it as acute coronary syndrome.