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While coronary artery bypass grafting (CABG) surgery is effective in reducing the risk of myocardial infarction and subsequent cardiac events by improving myocardial perfusion, the risk of sudden cardiac death (SCD) remains notable. This retrospective observational study evaluated the efficacy of dual antiplatelet therapy (DAPT) in preventing sudden cardiac death (SCD) among patients undergoing CABG surgery at a major U.S. cardiac center (2012-2015). Data was manually extracted from electronic medical records between 23/04/2017 to 30/03/ 2018 and verified for accuracy, with patients categorized into DAPT or aspirin monotherapy groups based on discharge prescriptions. Of 2,476 patients followed in this post-CABG study, the analysis included 1,005 patients who received aspirin monotherapy (AMT) and 1,458 patients who received dual antiplatelet therapy (DAPT). AMT group had a significantly higher incidence of SCD compared to those on DAPT (3.1% vs 0.8%; OR = 3.831, 95% CI: 1.961-7.519; p < 0.001). The binary regression model indicated that a higher BMI was associated with an increased risk of SCD (HR = 1.064, 95% CI: 1.012-1.118, p = 0.014). However, patients prescribed P2Y12 antagonists (HR = 0.285, 95% CI: 0.135-0.603, p < 0.001), those with a GFR >  60 ml/min (HR = 0.314, 95% CI: 0.158-0.624, p < 0.001), and those with a higher ejection fraction (HR = 0.962, 95% CI: 0.939-0.986, p = 0.002) were less likely to experience SCD following CABG. A 1 kg/m2 increase in BMI is associated with a 6.4% increase in the risk of SCD. Morbidly obese patients with BMI >  35 were more likely to have experienced SCD than those with BMI < 35 (HR = 2.400, 95% CI: 1.204-4,787; p =  0.013). Similarly, patients with EF > 40% had decreased incidence of SCD compared to those with EF < 40% (HR 0.347, 95% CI:0.158-0.763; p = 0.008). Patients on AMT had higher all-cause (OR = 2.136, 95% CI 1.502-3.038; p < 0.001) and CV mortality (OR = 3.731, 95% CI 2.233-6.235; p < 0.001) but had lower incidence of major bleeding (by drop in hemoglobin criteria) (OR = 0.704, 95% CI: 0.595-0.833; p < 0.001) compared to the DAPT group. DAPT prescription after CABG improves survival and lowers risk of sudden cardiac death.

Background/Objectives: Coronary artery disease (CAD) remains the leading cause of mortality worldwide, with South Asia bearing a disproportionately high and rising burden, particularly at younger ages. The present study aimed to investigate genetic variants associated with premature coronary artery disease (PCAD) using whole-genome sequencing (WGS). Methods: WGS was conducted on 12 people (five PCAD cases, seven matched controls) to assess feasibility and methodology for future large-scale research. High-quality genomic DNA was sequenced at a minimum read depth of 10× with a quality threshold of Q30. Variant calling with stringent quality control identified single-nucleotide polymorphisms (SNPs), followed by annotation against gnomAD for allele frequencies and ClinVar for pathogenicity. Protein-coding variants were filtered, and candidate genes were prioritized for comparative analysis between cases and controls. Results: An average of over 8.8 million SNPs per individual was identified, with comparable overall variant distributions between cases and controls. Initial analyses revealed 120 SNPs exclusively present in PCAD cases. All protein-coding variants were rare (allele frequency < 0.0001), and none were previously classified as pathogenic in ClinVar. After filtration, 87 candidate genes were prioritized. Enriched or unique variants in PCAD cases are mapped to genes involved in lipid metabolism, endothelial dysfunction, inflammatory signaling, immune regulation, thrombosis, vascular remodeling, and metabolic processes. Additional variants were identified in genes related to smooth muscle proliferation, oxidative stress, and other biological pathways. Conclusions: This WGS pilot study provides an initial overview of the genomic landscape of PCAD in a South Asian cohort, highlighting rare variants across multiple biological pathways implicated in atherosclerosis that need validation in a large-scale study.

Premature coronary artery disease (PCAD) is a growing public health concern, especially in South Asia, where traditional risk factors fail to fully explain the increasing incidence of early-onset myocardial infarction. To explore its molecular underpinnings, we conducted a pilot study analyzing plasma proteins and lipids to identify potential biomarkers and dysregulated pathways associated with PCAD. Label-free quantitative proteomics revealed distinct molecular signatures separating PCAD patients from age- and sex-matched healthy controls. Key alterations included upregulation of GALE, immunoglobulin genes, and KIF20B, suggesting enhanced inflammatory responses and proliferative activity associated with post-myocardial infarction cellular repair. Similarly, down regulations of various proteins linked to multiple functions, such as myocardial infarction, hemoglobinopathy, complement and coagulation cascade, and fatty acid and lipoprotein transport in hepatocytes, were observed. Untargeted lipidomics further revealed significant elevations in several phosphatidylcholine species (PC 42:5, PC 40:3, and PC 42:7), highlighting disruption of highly unsaturated phospholipid metabolism. Overall, these findings indicate that PCAD is a multifactorial disorder involving metabolic, immune, and vascular dysfunction beyond conventional lipid abnormalities, underscoring the need for larger cohort studies to validate these biomarkers and uncover novel therapeutic targets.

Background Despite advancements in surgical techniques, interventional procedures, novel pharmacotherapies, and other contemporary treatments, patients after coronary artery bypass graft surgery (CABG) remain at risk for graft failure and progression of native vessel disease progression. Consequently, secondary revascularization is often required. Methods This is a retrospective observational study evaluating the incidence, trends, and predictors of revascularization after CABG surgery. Results Of 2,476 patients followed in this post-CABG study, 1458 patients received dual antiplatelet therapy (DAPT) compared to 1005 patients received aspirin monotherapy (AMT). The overall incidence of revascularization was significantly higher in the DAPT group (14.54%, 212 out of 1458) compared to the AMT group (7.07%, 71 out of 1005), with an odds ratio (OR) of 2.24 (95% CI: 1.69–2.97, p  < 0.001). 770 patients who received DAPT for six months or more after surgery were compared in sub-analysis and were noted to have significantly higher incidence of revascularization compared to AMT (22.08% vs. 6.96%; OR = 3.157, 95% CI: 2.734–4.940; p  < 0.001). The binary regression model revealed that younger patients ( hazard ratio (HR) = 0.964, 95% CI: 0.95–0.97; p  < 0.001), diabetics (HR = 1.50, 95% CI: 1.12-2.00, p  = 0.007), patients who had fewer internal mammary artery grafts (HR = 0.54, 95% CI: 0.36–0.81, p  = 0.003), and patients receiving DAPT of any duration after CABG (HR = 3.47, 95% CI: 2.55–4.72, p  < 0.001) were more likely to receive revascularization after CABG. The model, comprising these four predictors, was able to explain 12.8% of the variance in post-CABG revascularization (Nagelkerke R² = 0.128; p  < 0.001). The survival rates were 96.5% for the DAPT group and 92.0% for AMT (odds ratio (OR) = 0.421, 95% confidence interval (95% CI): 0.269–0.658; p  < 0.001). Conclusion Diabetes mellitus, younger age, fewer Internal mammary artery grafts, and the use of DAPT after CABG were strong predictors of the need for secondary revascularization.

Objective: To analyze the mean difference in total body composition on Bioelectrical Impedance Analyzer (fat percentage, lean body mass, visceral fat area, and segmental fat/muscle distribution) between young adults with SIHD and ACS. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Aug to Nov 2025. Methodology: Two hundred patients (males aged 18–45 years and females aged 18–50 years) were enrolled using non-probability convenience sampling. Patients with acute illness, inflammatory conditions, or uncontrolled endocrine disorders affecting body composition were excluded. Participants were categorized into ACS-Group and SIHD-Group. Body composition was assessed using the InBody 270 analyzer in the upright position, with measurements performed in the morning after an overnight fast. Results: Among the 200 study participants, the ACS-Group (n=100) had a slightly higher median age [38.0 (32.0–44.0) years] than the SIHD-Group [34.0 (29.5–42.0) years, p-value =0.05]. However, ACS patients demonstrated a higher heart rate (92.08±14.61 vs. 78.96±12.46 bpm), greater skeletal muscle mass [38.08 (36.43–39.92) vs. 29.52 (28.04–31.12) kg], higher lean body mass [57.77 (56.21–59.66) vs. 49.29 (47.71–51.59) kg], and an elevated waist-to-hip ratio (0.93±0.09 vs. 0.902±0.09) compared with the SIHD-Group. Conclusion: Body composition parameters and lipid abnormalities contribute to early-onset coronary artery disease, with distinct patterns in ACS and SIHD. Incorporating body composition assessment into conventional risk evaluation may enhance risk stratification and support targeted prevention in high-risk young individuals.

Coronary artery perforation is an infrequent yet serious complication of Percutaneous Coronary Intervention (PCI). Management includes conservative methods like prolonged balloon tamponade, emergency pericardiocentesis, in addition to implantation of covered stents, coil embolization of small vessels, as well as, Coronary Artery Bypass Graft (CABG) Surgery. Here we describe a unique case of coronary perforation management by using a man-made covered stent and an un-inflated semi-compliant balloon over a standard Drug Eluting Stent (DES).

Objective: To study the correlation of Neutrophil to Lymphocyte Ratio (NLR) with in-hospital mortality in patients of Acute Coronary Syndrome (ACS). Study Design: Analytical Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan, from Jul-Dec 2022. Methodology: One hundred and sixty patients regardless of gender and presented with ACS were included in this study. Their venous blood samples were taken, at the time of admission and were analyzed by the CBC analyzer (Mandray BC 6200) at pathology laboratory and who were delineated into high NLR (>5.25) and low NLR (≤5.25) groups. Their in-hospital morbidity and mortality outcomes were noted. Chi-squared test was applied to compare qualitative variables. Independent samples t-test was applied to compare mean values. Receiver Operating Characteristic (ROC) curve of NLR for predicting in-hospital mortality was plotted, and p-value of <0.05 was considered as statistically significant. Results: Out of n=160 patients, 88(55.0%) were in low NLR group, while 72(45.0%) were in high NLR group. In-hospital mortality was statistically higher in the high NLR group 17(23.6%) vs low NLR group, 3(3.4%), p<0.001). The area under the ROC curve of NLR for predicting in-hospital mortality was 0.75(0.64-0.84). The best cut-off value of NLR to predict in-hospital mortality was 6.70(72.9% sensitivity, 70% specificity) Conclusion: Patients in high NLR group have statistically higher in-hospital mortality. NLR is a sensitive and specific predictor of in-hospital mortality. Patients in the high NLR group also had lower mean EF, and higher mean troponin levels.

Objective: To study the association of Red Cell Distribution Width (RDW) with thrombus burden in patients of ST Elevation Myocardial Infarction (STEMI) undergoing Primary Percutaneous Coronary Intervention (PPCI). Study Design: Analytical Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi, Pakistan, from Aug 2022 to Dec 2022. Methodology: Using non-probability consecutive sampling, three hundred and sixty-nine (n=369) patients were included in the study. RDW values were obtained from complete blood count sent at presentation in emergency department. Thrombolysis in Myocardial Infarction (TIMI) thrombus grading was used to determine the angiographic thrombus burden. For quantitative variables, means and standard deviations were calculated, while frequencies and percentages were calculated for qualitative variables. Receiver Operating Characteristic (ROC) curve for RDW values for predicting thrombus burden was plotted. Correlation between RDW with thrombus burden was established. Eta, Chi-square and independent samples t-test was used to determine p-value. Results: The study included 369 STEMI patients, out of which 287(77.8%) were males and 82(22.2%) were females. 203(55.0%)patients had high thrombus burden while 166(45.0%) patients had low thrombus burden. Patients in the high RDW groupmore frequently had ventricular arrhythmias, and heart blocks. Mean RDW was 13.57±0.71 in low thrombus burden groupwhile it was 14.67±1.21 in high thrombus burden group. Area under the curve derived from ROC curve for RDW forpredicting high thrombus burden was 0.79(CI=0.74-0.83, p<0.001) Conclusion: The study demonstrates that high RDW is a sensitive and specific predictor of high angiographic thrombus bur...

Objective: To determine the In-hospital outcome of early versus late coronary intervention in patients undergoing thrombolysis after acute myocardial infarction (STEMI). Study Design: Analytical Cross sectional study. Place and Duration of Study: Department of Cardiology, Punjab Institute of Cardiology, Lahore Pakistan from Jul 2021 to Dec2021. Methodology: Total of (n=100) patients regardless of gender between 30-80 years of age, presented with acute ST-elevated myocardial infarction (STEMI) at emergency room of PIC, Lahore and undergo thrombolysis with a thrombolytic agent after taking the informed consents were selected by a consecutive sampling technique. The demographic information which includes (name, age, gender, H/O diabetes, duration of STEMI) was noted. Then patients were randomly divided in two groups (Group A & B). In Group-A, patients were undergone PCI within 24 hours of thrombolysis. In Group-B, patients were undergone PCI after 24 hours of thrombolysis. Then all patients were followed-up in coronary care units for 07 days. If reinfarction occurs or patient was died during hospital stay, it was recorded. All the information was noted in a preformed structured proforma. Results: Out of 100 patients, 10 % (n=10) were in age group of 30-45 years and 90 % (n=90) were in age group of 46-80 years. The mean age was calculated as 60.16 ± 7.13 years. There were 90 (90 %) males whereas 10 (10 %) were females. The frequency of Re-Infarction in early Intervention group was 2(2%) and in late Intervention group it was 10%. (p<0.05).The frequency of mortality in early Intervention group was 2 (02%) and in late Intervention group it was 10%. (p< 0.05).Conclusion: Frequency of re-infarction as well as mortality was comparatively low in Intervention group. Therefore, the immediate restoring the patency of occluded coronary arteries can prevent or decrease myocardial damage due to acute myocardial infarction and henceforth, decrease morbidity and mortality..

Objective: To determine the frequency of cardiac arrhythmias in hypertensive patients. Study Design: Analytical Cross -sectional study. Place & Duration of Study: Tertiary Cardiac Center, Lahore Pakistan from Jan 2021 to Dec2021. Methodology: Two hundred patients (males and females), age between 20-80 years, suffering from hypertensive disease (Blood Pressure ≥ 140/90mmHg), one year before were assessed in the study. After that ECG was done according to International standards. Then patients undergone 24 hour Holter monitoring test. Presence of cardiac arrhythmia was confirmed by the interpretation of 12 lead ECG and 24 hour Holter report. All the data was noted. Patients with cardiac arrhythmias were treated in consultation from the Electrophysiology (EP) department of the hospital. By using the SPSS version 26, the statistical data was tabulated, analyzed and interpreted. Results: The mean age was calculated to be 58.64±7.74 years. In this study the males were 148(74%) while 52(26%) were females. The mean duration of hypertension was found to be 5.09±1.56 years. Cardiac arrhythmias were noted in 22(11%) cases. Out of 22 cases of cardiac arrhythmias, 02(1%) patients had premature atrial contractions, 02(1%) had atrial flutter, 04(2%) had premature ventricular contractions and 14(7%) had atrial fibrillation. Cardiac arrhythmias were significantly higher in patients above 40 years of age (p<0.05). There was no difference in both genders as well as duration of hypertension has unremarkable effect on cardiac arrhythmias (p>0.05). Conclusion: The research study concluded that in hypertensive patients, the cardiac arrhythmias frequency is low but its value is not unremarkable.