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Long-segment coronary ulcerations in survivors of sudden cardiac death
1Division of Cardiology, Stanford University Medical Center, Calif.
Insights
Long-segment coronary artery irregularities (type IIB morphology) are more common in cardiac arrest survivors and suggest advanced atherosclerosis. This morphology may indicate a higher risk of sudden cardiac death due to thromboembolism.
Area of Science:
- Cardiology
- Pathology
Background:
- Irregular coronary stenoses often indicate plaque rupture and thrombus formation.
- Long-segment, diffuse irregularities (type IIB) are more prevalent than focal lesions (type IIA) in cardiac arrest survivors without acute myocardial infarction.
Purpose of the Study:
- To investigate the clinical and angiographic characteristics of type IIB coronary morphology.
- To understand the pathogenetic significance of type IIB morphology in cardiac arrest survivors.
Main Methods:
- Analysis of clinical and angiographic data from 59 patients with type II coronary lesions.
- Comparison of characteristics between type IIB and type IIA morphologies.
Main Results:
- Type IIB lesions constituted 63% of all type II lesions.
- Patients with type IIB morphology were older than those with type IIA (p<0.05).
- A trend suggested type IIB morphology is associated with more extensive coronary artery disease (p<0.10).
Conclusions:
- Type IIB coronary morphology likely reflects advanced atherosclerosis.
- Platelet microemboli may contribute to spasm and ventricular tachyarrhythmias.
- Long-segment coronary ulcerations may carry a higher risk of thromboembolism and sudden death compared to focal lesions.
Abstract:
Angiographically irregular coronary stenoses usually represent plaque rupture with or without superimposed thrombi. Long-segment coronary stenoses with diffuse irregularities (type IIB morphology) have been shown to be more prevalent than focal irregular lesions (type IIA morphology) in survivors of cardiac arrest without acute myocardial infarction. To further understand the pathogenetic importance of type IIB morphology, the clinical and angiographic characteristics in 59 such patients were analyzed. Type IIB lesions accounted for 63% of all type II lesions. Type IIB patients were older than type IIA patients (p less than 0.05). There was a tendency for type IIB morphology to be associated with more extensive disease than other types of lesion morphology (p less than 0.10). Type IIB morphology probably reflects more advanced atherosclerosis. Platelet microemboli may precipitate spasm and/or acute ischemic ventricular tachyarrhythmias. It is possible that long-segment coronary ulcerations are associated with a higher risk for local coronary thromboembolism, and hence with sudden death, than focal lesions.