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Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction
E Arbustini1, B Dal Bello, P Morbini
1Department of Pathology, IRCCS-Policlinico San Matteo, Via Forlanini 16, 27100 Pavia, Italy. e.arbustini@smatteo.pv.it
Insights
Plaque erosion is a significant cause of coronary thrombosis, particularly in women suffering acute myocardial infarction. This pathological finding highlights differences in cardiovascular disease presentation between sexes.
Area of Science:
- Cardiovascular Pathology
- Thrombosis Research
- Sex Differences in Disease
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Understanding the underlying pathological substrates of AMI, such as coronary thrombosis, is crucial for effective treatment and prevention.
- Coronary artery disease can manifest through different mechanisms, including plaque rupture and plaque erosion.
Purpose of the Study:
- To determine the prevalence of plaque erosion as a substrate for coronary thrombosis in patients with AMI.
- To investigate potential sex-based differences in the prevalence of plaque erosion in AMI.
Main Methods:
- A pathological study was conducted on 298 consecutive patients who died from AMI without receiving thrombolysis or interventional procedures.
- Histopathological analysis was performed to identify the substrate of coronary thrombosis, including plaque erosion versus plaque rupture.
- Data on acute and healed myocardial infarcts and ventricular rupture were also collected.
Main Results:
- Acute coronary thrombi were present in 98% of cases.
- Plaque erosion was identified as the substrate for thrombosis in 25% of cases, with a significantly higher prevalence in women (37.4%) compared to men (18.5%).
- Healed infarcts and heart rupture were more common in women than in men, though the distribution of infarcts and thrombus location did not differ significantly between plaque rupture and erosion.
Conclusions:
- Plaque erosion is a substantial contributor to coronary thrombosis in patients with AMI.
- The prevalence of plaque erosion as a substrate for coronary thrombosis is notably higher in women than in men.
- These findings underscore the importance of considering plaque erosion, especially in female patients presenting with AMI.
Objective:
To evaluate the prevalence of plaque erosion as a substrate for coronary thrombosis.
Design:
Pathological study in patients with acute myocardial infarction not treated with thrombolysis or coronary interventional procedures.
Patients:
298 consecutive patients (189 men, mean (SD) age 66 (11) years; 109 women, 74 (8) years) dying in hospital between 1984 and 1996 from acute myocardial infarction, diagnosed by ECG changes and rise in cardiac enzymes.
Main Outcome Measures:
Histopathological determination of plaque erosion as substrate for acute thrombosis; location and histological type of coronary thrombosis; acute and healed myocardial infarcts; ventricular rupture.
Results:
Acute coronary thrombi were found in 291 hearts (98%); in 74 cases (25%; 40/107 women (37.4%) and 34/184 men (18.5%); p = 0.0004), the plaque substrate for thrombosis was erosion. Healed infarcts were found in 37.5% of men v 22% of women (p = 0.01). Heart rupture was more common in women than in men (22% v 10.5%, p = 0.01). The distribution of infarcts, thrombus location, heart rupture, and healed infarcts was similar in cases of plaque rupture and plaque erosion.
Conclusions:
Plaque erosion is an important substrate for coronary thrombosis in patients dying of acute myocardial infarction. Its prevalence is significantly higher in women than in men.