| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 5948088 | Atherosclerosis | 2012 | 5 Pages |
PurposeThe 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.MethodsClinical 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.ResultsWe 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 (PÂ <Â 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; PÂ <Â 0.001). Overall, the independent predictors of plaque rupture were being in the group PACS (PÂ <Â 0.001, OR 2.86; CI, 1.82-4.52 for complex lesions and PÂ <Â 0.001, OR 3.43; CI, 2.1-5.6 for Ambrose's type II lesions) or SACS (PÂ <Â 0.001, OR 8.71; CI, 5.15-14.73 for complex lesions and PÂ <Â 0.001, OR 5.99; CI, 3.66-9.81 for Ambrose's type II lesions).ConclusionsNearly 50% of patients with perioperative ACS have evidence of coronary plaque rupture, characterizing a type 1 myocardial infarction.
⺠Nearly 50% of patients with acute coronary syndromes (ACS) after noncardiac surgery have evidence of coronary plaque rupture. ⺠The only independent predictor of plaque rupture in coronary angiography was having the diagnosis of ACS. ⺠ACS after non-cardiac surgery and spontaneous ACS have similar pathophysiology.
