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Published on: January 28, 2020
Plaque histological characteristics in individuals with sudden coronary death
Takao Konishi1, Renu Virmani1, Hiroyuki Jinnouchi1
1CVPath Institute Inc., Gaithersburg, MD, United States of America.
Insights
Coronary artery disease (CAD) is a major cause of sudden cardiac death (SCD). This study found that coronary calcification patterns differ between plaque rupture and erosion, offering insights into atherosclerosis susceptibility.
Area of Science:
- Cardiovascular Medicine
- Pathology
- Radiology
Background:
- Coronary artery disease (CAD) is the primary cause of sudden cardiac death (SCD) in Western populations, accounting for 50-75% of cases.
- Sudden cardiac death with coronary thrombosis is often linked to plaque rupture (65%), plaque erosion (30%), or calcified nodules (5%).
Purpose of the Study:
- To evaluate the extent of coronary calcification in hearts of individuals who died from SCD.
- To investigate the relationship between coronary calcification patterns and the mechanisms of plaque instability (rupture vs. erosion).
Main Methods:
- Radiographic analysis of heart specimens from patients who experienced sudden cardiac death.
- Assessment of coronary calcification extent in relation to identified plaque types (rupture, erosion, calcified nodule).
Main Results:
- Absence of calcification was observed in nearly 50% of plaque erosion cases, compared to only 10% of plaque rupture cases.
- Stable plaques with significant luminal narrowing (>75%) frequently exhibited moderate to severe calcification (nearly 50% of cases).
Conclusions:
- Coronary calcification patterns vary significantly between plaque rupture and erosion, suggesting different underlying pathobiological processes.
- Identifying individuals susceptible to atherosclerosis through calcification assessment may aid in reducing SCD incidence, though current noninvasive methods capture only a portion of complicating lesions.
Abstract:
Coronary artery disease (CAD) remains the leading cause of death in the Western world in individuals >20 years of age. CAD is the most common substrate underlying sudden cardiac death (SCD) in the Western world, being responsible for 50-75% of SCDs. In individuals dying suddenly with coronary thrombosis, plaque rupture occurs in 65%, plaque erosion in 30% and calcified nodule in 5%. We evaluated the extent of calcification in radiographs of hearts from patients dying of SCD and showed that calcification is absent in nearly 50% of erosion cases whereas only 10% of plaque rupture show no calcification. Conversely, stable plaques with >75% cross-sectional area luminal narrowing show the severest calcification (moderate to severe) in nearly 50% of cases. Identifying individuals who are susceptible to atherosclerosis may help reduce the incidence of SCD. The identification of coronary calcifications by noninvasive tools, however, only captures a fraction of complicating coronary lesions.
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