Coronary plaque rupture in patients with myocardial infarction after noncardiac surgery: Frequent and dangerous

Autor(es)

Gualandro, Danielle Menosi ^[1] ; Campos, Carlos Augusto ^[2] ; Calderaro, Daniela ^[1] ; Yu, Pai Ching ^[1] ; Marques, Andre Coelho ^[1] ; Pastana, Adriana Feio ^[1] ; Lemos, Pedro Alves ^[2] ; Caramelli, Bruno ^[1]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Med, Interdisciplinary Med Cardiol Unit, Heart Inst InCor, BR-05508 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Intervent Cardiol Unit, Heart Inst InCor, BR-05508 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: ATHEROSCLEROSIS; v. 222, n. 1, p. 191-195, MAY 2012.
• Citações Web of Science: 66

Resumo

Purpose: The pathophysiology of acute coronary syndromes (ACS) after noncardiac surgery is not established yet. Thrombosis over a vulnerable plaque or decreased oxygen supply secondary to anemia or hypotension may be involved. The purpose of this study was to investigate the pathophysiology of ACS complicating noncardiac surgery. Methods: Clinical and angiographic data were prospectively recorded into a database for 120 consecutive patients that had an ACS after noncardiac surgery (PACS), for 120 patients with spontaneous ACS (SACS), and 240 patients with stable coronary artery disease (CAD). Coronary lesions with obstructions greater than 50% were classified based on two criteria: Ambrose's classification and complex morphology. The presence of Ambrose's type II or complex lesions were compared between the three groups. Results: We analyzed 1470 lesions in 480 patients. In PACS group, 45% of patients had Ambrose's type II lesions vs. 56.7% in SACS group and 16.4% in stable CAD group (P < 0.001). Both PACS and SACS patients had more complex lesions than patients in stable CAD group (56.7% vs. 79.2% vs. 31.8%, respectively; P < 0.001). Overall, the independent predictors of plaque rupture were being in the group PACS (P < 0.001, OR 2.86; CI, 1.82-4.52 for complex lesions and P < 0.001, OR 3.43; CI, 2.1-5.6 for Ambrose's type II lesions) or SACS (P < 0.001, OR 8.71; CI, 5.15-14.73 for complex lesions and P < 0.001, OR 5.99; CI, 3.66-9.81 for Ambrose's type II lesions). Conclusions: Nearly 50% of patients with perioperative ACS have evidence of coronary plaque rupture, characterizing a type 1 myocardial infarction. (C) 2012 Elsevier Ireland Ltd. All rights reserved. (AU)

• Processo FAPESP: 09/05859-4 - Achados angiográficos das síndromes coronarianas agudas no perioperatório de operações não cardíacas - mesma fisiopatologia ou mecanismo diferente?
• Beneficiário: Bruno Caramelli
• Modalidade de apoio: Auxílio à Pesquisa - Regular