Method-dependent number and topography of coronary narrowings

A comparative gross and light microscopic study of the coronary arterial bed carried out on 95 selected male subjects aged 51-55 years, revealed that the number and topography of narrowings (more than 50% luminal insufficiency) showed wide method-dependent variations. If only routine gross inspection of the major coronary arteries was performed (method 1) 52% of the subjects exhibited narrowings; if gross inspection was extended to the proximal segment of the first diagonal, first septal, left marginal, right marginal and posterior descending vessels, the proportion of subjects with coronary narrowings augmented to 61% (method 2); finally the use of the light microscopy to investigate vessels supplying the conduction system and terminal vessels (method 3) augmented this proportion to 73%. Conversely, we recorded the absence of narrowings encroaching more than 50% in 48% of the subjects with method 1, in 39% with method 2 and in only 27% with method 3. Using the second method we revealed in coronary branches 29 narrowings and with the third method 52 narrowings. From the 95 cases investigated 46 (48%) did not show narrowings in the major coronary arteries. Of these 46 cases, 17 (37%) exhibited narrowings in coronary branches. This would indicate that more than 1/3 of the subjects without greater than 50% narrowings in the major coronary arteries showed such lesions in the branches of these major coronary arteries. The results of this study demonstrated the necessity of gross and light microscopic examination of the whole coronary arterial bed in all attempts to offer a realistic anatomo-clinical correlation in ischemic heart disease: they also demonstrated that the atherosclerotic involvement of the coronary arterial bed is not limited to the segments grossly examined by each pathologist.