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Acute coronary syndromes complicating noncardiac surgery: angiographic findings and comparison with spontaneous events


As the world population ages, the number of patients undergoing noncardiac surgery is growing fast and cardiac complications are a major cause of morbidity and mortality after these surgeries. The etiology and pathophysiology of myocardial ischemia and infarction in this setting is still subject of controverses and there are no randomized controlled trails addressing the management of PMI.The presence of coronary plaques with complex morphologic features is the angiographic hallmark of unstable coronary syndromes and correlates with pathologic plaque rupture and thrombus. Intravascular ultrasound plaque rupture strongly correlates with complex angiographic lesion morphology. To our knowledge, there are no studies comparing PMI with spontaneous MI. The purpose of this study is to compare the angiographic characteristics between acute coronary syndromes (ACS) in the perioperative setting, spontaneous ACS and chronic coronary artery disease.Angiographic and outcome data were prospectively recorded into a database for all patients that had an acute coronary syndrome related to noncardiac surgery at the Hospital das Clínicas of São Paulo Medical School for whom cardiologic evaluation was requested. We will collect clinical and outcome data and analyze angiograms of 120 consecutive patients with PACS, 120 patients with SACS and 240 consecutive patients with stable CAD at the Heart Institute (inCor) University of São Paulo Medical School. All angiographies will be analyzed by a single expert observer who will be unaware of the clinical diagnosis of the patients. The number and location of coronary lesions with obstructions greater than 50% will be recorded. Each lesion was classified as complex or not based on Ambrose's classification or the presence of at least one of the following: thrombus, dissection, ulceration, plaque irregularitiesand TIMI flow. The presence of complex lesions and of Ambrose types IIA and IIB lesions will be compared between the three groups using Fisher's exact test with a confidence interval of 95%. (AU)

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
GUALANDRO, DANIELLE MENOSI; CAMPOS, CARLOS AUGUSTO; CALDERARO, DANIELA; YU, PAI CHING; MARQUES, ANDRE COELHO; PASTANA, ADRIANA FEIO; LEMOS, PEDRO ALVES; CARAMELLI, BRUNO. Coronary plaque rupture in patients with myocardial infarction after noncardiac surgery: Frequent and dangerous. ATHEROSCLEROSIS, v. 222, n. 1, p. 191-195, MAY 2012. Web of Science Citations: 66.

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