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Microemboli and microvascular obstruction in acute coronary thrombosis and sudden coronary death: relation to

Robert S Schwartz1, Allen Burke, Andrew Farb

  • 1Minneapolis Heart Institute and Foundation, 920 East 28th Street, Suite 620, Minneapolis, Minnesota 55407.

Journal of the American College of Cardiology
|November 28, 2009
PubMed

Insights

Myocardial microvascular emboli and obstruction are common in acute coronary thrombosis. Plaque erosion, particularly in smaller vessels, is a frequent cause, leading to myocyte necrosis.

Area of Science:

  • Cardiovascular Pathology
  • Thrombosis Research
  • Microvascular Disease

Background:

  • Acute coronary thrombosis frequently leads to microemboli and microvascular obstruction.
  • Consequences of microvascular obstruction include myocyte necrosis, yet plaque characteristics remain incompletely understood.
  • This study investigates myocardial microvascular emboli and their relationship to coronary artery plaque.

Purpose of the Study:

  • To examine myocardial microvascular emboli and obstruction.
  • To correlate these findings with the type of plaque in epicardial coronary arteries.
  • To understand the histopathology of coronary artery plaque in relation to microvascular events.

Main Methods:

  • Examination of hearts from sudden coronary death patients.
  • Analysis of coronary artery plaque types (rupture, erosion).
  • Quantification of cardiac microemboli and assessment of intramyocardial vessel occlusion.

Main Results:

  • Forty-four hearts were analyzed; mean age at death was 51 years.
  • 26 plaque ruptures and 21 erosions were identified, with an average of 4.5 microemboli per heart.
  • Microemboli and obstruction were more common with plaque erosion, especially in vessels <200 µm, and frequently involved the left anterior descending artery.

Conclusions:

  • Microemboli and microvascular obstruction are prevalent in acute coronary thrombosis.
  • Plaque erosion is a significant source of microemboli, particularly in smaller intramyocardial vessels.
  • These microvascular events play a critical role in myonecrosis and patient outcomes.
Abstract

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