The prevalence, angiographic profile and clinical features, management, and outcomes of coronary artery perforation secondary to percutaneous coronary interventions in Pakistan: a retrospective cohort study

Coronary artery perforation (CAP) is a rare entity that is often fatal. The mortality rates reported as high as up to 21% hence prompt diagnosis, intervention, and treatment are paramount to survival for such patients. Several factors may predispose a patient to coronary artery intervention including chronic total occlusion, severe calcification and tortuosity, aggressive use of oversized balloons and stents, and use of athero-ablative devices. Therefore, it is significant to have an insight related to it as despite being rare, it is one of the most feared complications of percutaneous coronary intervention (PCI).

Method

We conducted a retrospective study of the patients who have undergone PCI at our institution from January 2015 to December 2021. During this duration, all the patients who had developed CAP based on angiographic review during the PCI were selected. The demographic, clinical, angiographic, procedure-related features, management of the CAP, and in-hospital and follow-up outcomes were gathered.

Result

Thirty-five thousand fifty-nine patients underwent PCI among which, only 93 (0.26%) patients were complicated with (CAP. Fifty-eight (62.4%) patients were in the 50-70 years age range. The most common vessel involved was the left anterior descending (36.5%) followed by the right coronary artery (32.3%). The angiographic calcification was present in 51.6% of patients, significant tortuosity greater than 90° was seen in 48.4% of patients, chronic total occlusion was observed in 42% of patients and In-stent restenosis was found in 8.6% patients. The highest mortality of four patients was seen in the CAP involving the right coronary artery.

Conclusion

Mostly the CAP involves large vessel perforations however both, the distal and large vessel perforations are related to the increased incidence of adverse clinical results which indicates the significance of the prevention and early identification and treatment of the perforation.

Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review

OBJECTIVE

Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development.

METHODS

For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression.

RESULTS

In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF.

CONCLUSION

Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.