Cancer-related vulnerable lesions in patients with stable coronary artery disease.

BACKGROUND: Coronary artery disease (CAD) has become a major cause of morbidity and mortality in cancer survivors. It is still unclear whether cancer history influences lesion characteristics. The purpose of this study was to investigate cancer-related lesion morphology in patients with CAD. METHODS: This study enrolled 400 patients with stable CAD. The patients were classified into a cancer survivor group (n = 69) and a noncancer group (n = 331). We investigated coronary lesion morphology by optical coherence tomography, and we assessed the prognosis in terms of both all-cause mortality and major adverse cardiovascular events (MACE). RESULTS: Adenocarcinoma was the most common histopathological diagnosis. Serum C-reactive protein levels were significantly higher in the cancer survivor group than in the noncancer group (cancer survivors 0.12 [0.05-0.42] mg/dL vs. noncancer 0.08 [0.04-0.17] mg/dL, p = 0.019). The cancer survivor group was more likely than the noncancer group to have thrombi (cancer survivors 30.4% vs. noncancer 15.4%, p = 0.004), and layered fibrotic plaques (LFPs; cancer survivors 18.8% vs. noncancer 3.6%, p < 0.0001). Cancer survivors had poorer outcomes than noncancer controls in terms of both all-cause mortality (p = 0.020) and MACE (p = 0.036). CONCLUSIONS: Because of underlying inflammation, CAD patients with cancer had more high-risk lesions than those without cancer, which could result in poorer prognosis for the former. This result might inform the management of CAD in cancer patients in terms of secondary prevention.

Impact of left ventricular ejection fraction and preoperative hemoglobin level on perioperative adverse cardiovascular events in noncardiac surgery.

The prediction of a perioperative adverse cardiovascular event (PACE) is an important clinical issue in the medical management of patients undergoing noncardiac surgery. Although several predictors have been reported, simpler and more practical predictors of PACE have been needed. The aim of this study was to investigate the predictors of PACE in noncardiac surgery. We retrospectively analyzed 723 patients who were scheduled for elective noncardiac surgery and underwent preoperative examinations including 12-lead electrocardiography, transthoracic echocardiography, and blood test. PACE was defined as cardiac death, non-fatal myocardial infarction, unstable angina, congestive heart failure, arrhythmia attack that needs emergency treatment (rapid atrial fibrillation, ventricular tachycardia, and bradycardia), acute pulmonary embolism, asystole, pulseless electrical activity, or stroke during 30 days after surgery. PACE occurred in 54 (7.5%) of 723 patients. High-risk operation (11% vs. 3%, p = 0.003) was more often seen, left ventricular ejection fraction (LVEF) (55 ± 8% vs. 60 ± 7%, p = 0.001) and preoperative hemoglobin level (11.8 ± 2.2 g/dl vs. 12.7 ± 2.0 g/dl, p = 0.001) were lower in patients with PACE compared to those without PACE. By multivariate logistic regression analysis, high-risk operation (odds ratio (OR): 7.05, 95% confidence interval (CI) 2.16-23.00, p = 0.001), LVEF (OR 1.06, every 1% decrement, 95% CI 1.03-1.09, p = 0.001), and preoperative hemoglobin level (OR 1.22, every 1 g/dl decrement, 95% CI 1.07-1.39, p = 0.003) were identified as independent predictors of PACE. Receiver operating characteristic analysis demonstrated that LVEF of 58% (sensitivity = 80%, specificity = 61%, area under the curve (AUC) = 0.723) and preoperative hemoglobin level of 12.2 g/dl (sensitivity = 63%, specificity = 64%, AUC = 0.644) were optimal cut-off values for predicting PACE. High-risk operation, reduced LVEF, and reduced preoperative hemoglobin level were independently associated with PACE in patients undergoing noncardiac surgery.