Rahul Gupta

Drug-coated balloons (DCBs) are rapidly gaining prominence, owing to the associated expanding clinical applications and therapeutic potential in interventional cardiology. Moreover, a growing body of evidence from randomized trials, observational studies, and meta-analyses supports the efficacy of DCBs across a broad spectrum of coronary lesions, positioning these devices as a viable, stent-free alternative to conventional strategies. DCBs aim to lower the risks inherent to stent implantation, such as stent thrombosis and in-stent restenosis (ISR), and to enable abbreviated dual antiplatelet therapy in high-bleeding-risk (HBR) patients. Although drug-eluting stents (DESs) remain the current standard in percutaneous coronary intervention, DCBs are emerging as a novel and promising option in diverse clinical settings beyond ISR, including de novo lesions in both small and large vessels, bifurcation disease, patients with a high risk of bleeding, and even acute coronary syndromes. This article aims to provide a comprehensive review of the evolving role, evidence base, and expanding indications of DCB-related therapy beyond ISR.

Background: SARS‐CoV2 has affected more than 73.8 million individuals. While SARS‐CoV2 is considered a predominantly respiratory virus, we report a trend of bradycardia among hospitalized patients, particularly in association with mortality.Methodology: The multi‐center retrospective analysis consisted of 1053 COVID‐19 positive patients from March to August 2020. A trend of bradycardia was noted in the study population. Absolute bradycardia and profound bradycardia was defined as a sustained heart rate < 60 BPM and < 50 BPM, respectively, on two separate occasions, a minimum of 4 h apart during hospitalization. Each bradycardic event was confirmed by two physicians and exclusion criteria included: less than 18 years old, end of life bradycardia, left AMA, or taking AV Nodal blockers. Data was fetched using a SQL program through the EMR and data was analyzed using SPSS 27.0. A logistic regression was done to study the effect of bradycardia, age, gender, and BMI on mortality in the study group.Results: 24.9% patients had absolute bradycardia while 13.0% had profound bradycardia. Patients with absolute bradycardia had an odds ratio of 6.59 (95% CI [2.83–15.36]) for mortality compared with individuals with a normal HR response. The logistic regression model explained 19.6% (Nagelkerke R²) of variance in the mortality, correctly classified 88.6% of cases, and was statistically significant X² (5)=47.10, p < .001. For each year of age > 18, the odds of dying increased 1.048 times (95% CI [1.25–5.27]).Conclusion: The incidence of absolute bradycardia was found in 24.9% of the study cohort and these individuals were found to have a significant increase in mortality.

Key Clinical Message: New onset low back pain which is recalcitrant to usual treatment should be evaluated aggressively even in the absence of fever or neurologic deficits. Corticosteroids given for back pain will accelerate occult spinal infection and may mask symptomatology leading to more severe disease.