Out-of-hospital coronary heart disease death: acute pathological lesions
Elena Stalioraityte1, Juozas Bluzas, Zygmunt Mackiewicz
1Laboratory of Cardiac Pathology, Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
Insights
Sudden out-of-hospital coronary heart disease deaths are typically linked to acute myocardial infarction. Autopsies reveal early or definite infarction stages and new thrombotic events in coronary arteries as the primary cause.
Area of Science:
- Cardiovascular Pathology
- Forensic Medicine
- Clinical Cardiology
Background:
- Sudden cardiac deaths due to coronary heart disease (CHD) often occur unexpectedly outside hospitals within hours of symptom onset.
- Previous autopsy data on acute pathological findings in CHD deaths have been controversial.
- This study aimed to clarify the incidence and nature of acute pathological findings in CHD fatalities through detailed examination.
Purpose of the Study:
- To investigate the pathological basis of sudden out-of-hospital deaths attributed to coronary heart disease.
- To determine the incidence and characteristics of acute myocardial lesions and coronary artery pathology in these cases.
Main Methods:
- Autopsy, including detailed macroscopic and microscopic examination of coronary arteries and myocardium.
- Inclusion of 170 men from the Kaunas Acute Myocardial Infarct Register who died within 6 hours of symptom onset.
- Analysis of pathological findings related to acute ischemic myocardial lesions and coronary events.
Main Results:
- Out-of-hospital coronary deaths were linked to acute ischemic myocardial lesions in all cases (myocardial infarction in 92.9%, micronecrosis in 7.1%).
- Acute infarction stages identified included early (48.8%), definite (21.8%), and progressing (22.3%).
- New thrombotic coronary events were present in 88.8% of cases, including occlusive and non-occlusive thrombi.
Conclusions:
- Out-of-hospital coronary deaths are most frequently associated with early or definite stages of myocardial infarction.
- Detailed microscopic examination of the myocardium is crucial for accurately identifying these acute ischemic lesions.
- Acute coronary artery pathology often confirms these myocardial infarcts as the cause of sudden, out-of-hospital CHD deaths.
Background:
The majority of deaths due to acute coronary heart disease (CHD) occur outside hospital, unexpectedly, within the first few hours following the onset of the terminal event. Data on the incidence and nature of acute pathological findings in the affected hearts as seen in routine autopsies are somewhat controversial. Detailed pathological examination of coronary arteries and myocardium of such decedents was performed to clarify the situation.
Methods And Results:
Full autopsy and detailed macroscopic and microscopic examination of the coronary arteries and myocardium were performed in 170 men, all registered in the Kaunas Acute Myocardial Infarct Register, who died outside hospital of CHD within 6 hours from the onset of symptoms. Out-of-hospital coronary death was in all cases related to acute ischaemic myocardial lesions, either myocardial infarction (MI) in 92.9% of cases or patchy micronecrosis in 7.1%. In the former group, the following stages of acute infarction were found: early MI (hyperacute phase) in 48.8% of cases, definite MI (displaying grossly identifiable coagulative necrosis) in 21.8% and progressing MI (presence of signs of early MI adjacent to a healing infarction) in 22.3%. Signs of new thrombotic coronary events were found in relation to these acute ischaemic myocardial lesions in 88.8% of cases, as occlusive thrombus in 41.2%, non-occlusive, mural thrombus in 37.0% and microthrombi/microemboli in intramyocardial vessels in 10.6%.
Conclusions:
Out-of-hospital coronary death most commonly was related to the early or definite stages of myocardial infarction. Accurate identification of these acute ischaemic lesions was based on detailed microscopic examination of the entire ventricular myocardium, with consideration being paid to signs of cardiomyocyte involvement and early inflammatory reaction associated with it. Acute pathology of the affected coronary artery usually confirmed that these myocardial infarct lesions were the cause of the sudden out of-hospital CHD-related deaths.
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