Adriana Pastana

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

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: Ambroses classification and complex morphology. The presence of Ambroses 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 Ambroses 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 Ambroses 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 Ambroses type II lesions). CONCLUSIONS Nearly 50% of patients with perioperative ACS have evidence of coronary plaque rupture, characterizing a type 1 myocardial infarction.

Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities--the case of Brazil.

Background Worldwide distribution of surgical interventions is unequal. Developed countries account for the majority of surgeries and information about non-cardiac operations in developing countries is scarce. The purpose of our study was to describe the epidemiological data of non-cardiac surgeries performed in Brazil in the last years. Methods and Findings This is a retrospective cohort study that investigated the time window from 1995 to 2007. We collected information from DATASUS, a national public health system database. The following variables were studied: number of surgeries, in-hospital expenses, blood transfusion related costs, length of stay and case fatality rates. The results were presented as sum, average and percentage. The trend analysis was performed by linear regression model. There were 32,659,513 non-cardiac surgeries performed in Brazil in thirteen years. An increment of 20.42% was observed in the number of surgeries in this period and nowadays nearly 3 million operations are performed annually. The cost of these procedures has increased tremendously in the last years. The increment of surgical cost was almost 200%. The total expenses related to surgical hospitalizations were more than

Children First Study: how an educational program in cardiovascular prevention at school can improve parents’ cardiovascular risk

10 billion in all these years. The yearly cost of surgical procedures to public health system was more than

The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery

1.27 billion for all surgical hospitalizations, and in average, U

Perioperative cardiovascular evaluation: heads or tails?

445.24 per surgical procedure. The total cost of blood transfusion was near

Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

98 million in all years and annually approximately

Aspirin responsiveness safely lowers perioperative cardiovascular risk.

10 million were spent in perioperative transfusion. The surgical mortality had an increment of 31.11% in the period. Actually, in 2007, the surgical mortality in Brazil was 1.77%. All the variables had a significant increment along the studied period: r square (r2) = 0.447 for the number of surgeries (P = 0.012), r2 = 0.439 for in-hospital expenses (P = 0.014) and r2 = 0.907 for surgical mortality (P = 0.0055). Conclusion The volume of surgical procedures has increased substantially in Brazil through the past years. The expenditure related to these procedures and its mortality has also increased as the number of operations. Better planning of public health resource and strategies of investment are needed to supply the crescent demand of surgery in Brazil.

Improving cardiovascular prevention through patient awareness

Aim: To evaluate whether a multidisciplinary educational program (EP) in cardiovascular prevention (CVP) for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year. Methods and results: This was a prospective community-based study in Brazil during 2010 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents, and children were exposed to a weekly EP in CVP with a multidisciplinary health team. At onset and end of the study, we collected data from parents and children (weight, height, arterial blood pressure, and laboratory tests). We studied 197 children and 323 parents. Analyzing the parents’ FCR we found that 9.3% of the control group and 6.8% of the intervention group had more than a 10% year risk of cardiovascular heart disease (CHD) over the next 10 years. After the children’s EP for the year, the intervention group had a reduction of 91% in the intermediate/high FCR group compared with a 13% reduction in the control group, p = 0.002). In the same way, analyzing the FCR of all parents, there was a reduction of the average risk in the intervention group (3.6% to 2.8% respectively, p < 0.001) compared with the control group (4.4% to 4.4%, p = 0.98). Conclusion: An educational program in cardiovascular prevention directed at school-age children can reduce the FCR risk of their parents, especially in the intermediate/high risk categories.

Acute anemia and cardiovascular events after vascular surgery

Carmo et al in their article ‘‘The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery?’’ investigated the association between the anklebrachial index (ABI) and cardiovascular (CV) complications after noncardiac surgery. Those with abnormal ABI had increased CV complications. Cardiovascular disease (CVD) is a common cause of hospitalization and mortality worldwide. Therefore, clinicians have searched for predictors of CVD. Arterial stiffness (AS) is a noninvasive method to assess subclinical atherosclerosis, and it is also associated with coronary artery disease, hypertension, diabetes mellitus, stroke, and peripheral arterial disease. Pulse wave analysis (PWA) includes pulse wave velocity (PWV), augmentation index, and central aortic pressure. Other studies have reported abnormal PWA in patients with CVD, renal failure, and chronic inflammatory disease. Measurement of PWA is considered relatively simple, reproducible, and cost effective for CV risk estimation. The European Network for Non-invasive Investigation of Large Artery consensus for the assessment of AS considered PWV as the gold standard for the measurement of AS. Carmo et al used the ABI for CV risk estimation. Increased PWV and a low ABI are accepted as a marker of CVD and increased total CV risk. In this context, it would have been useful if authors had also measured PWV to assess AS. The authors reported that isolated troponin elevation was observed in 24.2% of the patients, and CV complication event rate was 6.4%. They suggest that physicians should perform troponin analysis after surgery in all patients. However, we could not determine whether there was any significant difference for troponin analysis between the 2 groups studied. More information could provide clearer information regarding the role of troponin in relation to CV complications after noncardiac surgery.

Abstract 19569: High-sensitive Troponin T Cut-off Value for Myocardial Infarction After Vascular Surgery

When dealing with surgical patients, a perioperative evaluation is essential to anticipate complications and institute measures to reduce the risks. Several algorithms and exams have been used to identify postoperative cardiovascular events, which account for more than 50% of perioperative mortality. However, they are far from ideal. Some of these algorithms and exams were proposed before important advances in cardiology, at a time when pharmacological risk reduction strategies for surgical patients were not available. New biomarkers and exams, such as C-reactive protein, brain natriuretic peptide, and multislice computed tomography have been used in cardiology and have provided important prognostic information. The ankle-brachial index is another significant marker of atherosclerosis. However, specific information regarding the perioperative context of all these methods is still needed. The objective of this article is to evaluate cardiovascular risk prediction models after noncardiac surgery.