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Sudden coronary death: comparison of patients with to those without coronary thrombus at necropsy
Insights
Coronary thrombi are uncommon in sudden coronary death (SCD) victims. Even when present, their significance remains unclear, as SCD victims without thrombi show similar severe coronary narrowing.
Area of Science:
- Cardiovascular Pathology
- Forensic Pathology
Background:
- Sudden coronary death (SCD) is a significant cause of mortality.
- The role of coronary thrombus in SCD pathogenesis is not fully understood.
- Understanding the characteristics of SCD victims with and without coronary thrombi is crucial for elucidating SCD mechanisms.
Purpose of the Study:
- To compare clinical and morphological findings in SCD victims with and without coronary thrombi.
- To investigate the association between coronary thrombus presence and demographic, clinical, and pathological features in SCD.
Main Methods:
- Retrospective analysis of 70 sudden coronary death (SCD) victims.
- Comparison of 13 SCD victims with coronary thrombus versus 57 SCD victims without coronary thrombus.
- Assessment of coronary stenosis severity, plaque characteristics, and arterial segment narrowing using cross-sectional area (XSA).
Main Results:
- SCD victims with coronary thrombi were younger (mean age 43 vs. 51 years) and had less maximal coronary stenosis (89% vs. 95% XSA narrowing).
- A higher proportion of minimally narrowed arterial segments (0-25% XSA) was observed in victims with thrombi (27% vs. 19%).
- No significant differences were found in sex, history of angina or myocardial infarction, heart weight, or extent of severe coronary narrowing (76-100% XSA).
Conclusions:
- Coronary thrombi are infrequent findings in victims of sudden coronary death.
- The presence of coronary thrombi in SCD does not correlate with more extensive severe coronary artery narrowing.
- The pathological significance of coronary thrombi in SCD remains uncertain due to similar degrees of severe coronary stenosis in victims with and without thrombi.
Abstract:
Among 70 victims of sudden coronary death (SCD), certain clinical and morphologic findings in the 13 with a coronary thrombus are compared with the findings in 57 victims without a coronary thrombus. The 13 with a thrombus were younger than those without (mean age 43 vs 51 years, p less than 0.02); had a lower mean percent of cross-sectional area (XSA) narrowing by plaque at the site of maximal coronary stenosis (89% vs 95%, p less than 0.01); and had a higher mean percent of 5-mm segments of the 4 major epicardial coronary arteries minimally narrowed (0 to 25% in XSA) by plaque (27% vs 19%, p less than 0.001). No differences occurred in the 2 groups with regard to sex, previous angina pectoris or clinical acute myocardial infarction, healed myocardial infarction at necropsy, mean heart weight, number of major coronary arteries narrowed 76 to 100% in XSA by atherosclerotic plaque, or the mean percent of 5-mm segments of the 4 major epicardial coronary arteries narrowed 76 to 100% in XSA by atherosclerotic plaque. Thus, coronary thrombi are infrequent in victims of SCD, and when observed, their significance is uncertain because victims of SCD without coronary thrombi have similar amounts of severe coronary narrowing.