(Circulation. 1995;92:1701-1709.)
© 1995 American Heart Association, Inc.
Articles |
Sudden Coronary Death
Frequency of Active Coronary Lesions, Inactive Coronary Lesions, and Myocardial Infarction
From the Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC.
Correspondence to Renu Virmani, MD, Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Background The reported frequency of active coronary lesions (plaque rupture and coronary thrombosis) in sudden death due to coronary artery atherosclerosis (sudden coronary death) has varied from <20% to >80% of cases in previous series. In hearts lacking an active coronary lesion, sudden death has usually been attributed to a healed myocardial infarction. The purpose of the present study was to determine the frequency of active and inactive coronary lesions and myocardial infarction in individuals with sudden coronary death.
Methods and Results The hearts of persons who died as a result of
sudden coronary death underwent perfusion-fixation and
postmortem angiography. An active coronary lesion was defined
as a disrupted plaque, luminal fibrin/platelet thrombus, or both.
We defined an inactive lesion as having a cross-sectional luminal
stenosis of 
75% with neither plaque disruption nor luminal
thrombus. Ninety hearts were examined (from 72 men and 18 women; mean
age at the time of death, 51±10 years). Acute myocardial infarction
was present in 19 (21% [acute myocardial infarction only in 9,
both acute and healed myocardial infarction in 10]), healed myocardial
infarction only in 37 (41%), and no myocardial infarction in 34
(38%). Active coronary lesions were identified in 51 (57%):
acute thrombi plus disrupted plaques in 27, acute thrombi only in 21,
and disrupted plaques only in 3. In hearts with acute myocardial
infarction, active coronary lesions were significantly more
prevalent than in hearts with only healed myocardial infarction or
hearts lacking an acute or a healed myocardial infarction (89%, 46%,
and 50%, respectively; P<.005). Hearts without acute or
healed myocardial infarction and without active lesions were similar to
hearts with active lesions with respect to heart weight and severity of
epicardial coronary disease.
Conclusions Acute changes in coronary plaque morphology (thrombus, plaque disruption, or both) were found in 57% of cases of sudden coronary death. In hearts with myocardial scars and no acute infarction, active coronary lesions were identified in 46% of cases. Neither myocardial infarction (acute or healed) nor an active coronary lesion was present in 19% of hearts.
Key Words: death • sudden • plaque • infarction
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