An Observational Study of Patients with Significant Coronary Artery Disease after Acute Coronary Syndrome on Medical Management

Introduction: Surgery is accepted as a traditional and standardtreatment of significant coronary artery stenosis with historyof an episode of acute coronary syndrome. This study involvesprognostically important descriptors to identify the factorsleading to functional improvement on medical managementin these patients who were at potential risk of majorcardiovascular and cerebrovascular events (MACCE). Thisongoing study attempted to find out whether the improvementof functional status are due to antianginal effect or more thanthat reversely remodelling coronary atherosclerosis.Material and methods: Between1st January 2016 and 31stJuly2017, the detailed investigations of 29 such patients wereobtained, who were on waiting list for CABG after beingreferred from cardiology department, many with history ofAMI. The improvement or deterioration of their functionalstatus while on treatment with guideline directed optimalmedical therapy (OMT) with atorvastatin (40 to 80 mg),aspirin(75mg) and clopidogrel (75mg), metoprolol succinate(12.5 to 50mg) with amlodipine (2.5 to 20mg), ramipril (1.25to 10mg) or telmesartan (20 to 80mg) for hypertension andheart failure prescribed at the discretion of the physicianalong with medications for diabetes and hypothyroidism, wereanalysed.Results: The first year follow-up was for the 29 patientsrecruited over 6 months. 17 patients with CCSA class III and1 with II had a baseline SYNTAX score of 29±6.2, while 11with class II had 20.3±3.2. The functional class improvedwith OMT medications was noted to be improving after 3 to 4weeks and by 12 months 62% were in class I. Duke ActivityStatus Index (DASI), improved from 19.3±3 to 23±2 at 6months and to 30.8±2 by 1 year in 18 patients. The associatedperipheral vascular disease symptoms also improved Mortalitywas 6.7%.Conclusion: In clinically stabilized patients with severe CAD,after ACS, with or without myocardial infarction, conservativemanagement with OMT, has been observed to improve cardiacfunction with reduced odds of mortality and improved qualityof life with lifestyle modification, some dietary and physicalrestriction.

Giant chondrosarcoma of chest wall.

Primary chest wall tumours are very rare. Chondrosarcoma is the most common tumour arising from the chest wall. We describe the occurrence of a slow-growing chondrosarcoma arising from the anterior chest wall in a 35-year-old male patient. The tumour was resected successfully and chest wall was reconstucted with prolene mesh and muscle flap. The patient was discharged uneventfully without any respiratory compromise. There was no recurrence after a three-year follow-up. Wide surgical resection with chest wall reconstruction appears to be the preferred treatment option for this rare tumour of the chest wall.