Coronary heart disease in 48 autopsy patients 30 years old and younger

We studied 48 autopsy patients younger than 30 years who had severe coronary atherosclerosis. Twenty-one patients (44%) died suddenly, 26 (54%) had a history of chest pain, and one had chronic congestive heart failure. Twenty-one patients (44%) had single-vessel disease, 19 (40%) had two-vessel disease, and only nine (16%) had three or four major coronary arteries severely narrowed (greater than 75% cross-sectional area luminal narrowing) by atherosclerotic plaques. Thrombi in coronary arteries were noted in 27 patients (56%) and the left anterior descending coronary artery was the most frequently involved. The severity of coronary atherosclerosis was much less in patients younger than 30 years, and the atherosclerotic plaque consisted largely of foam cells, fibrous tissue, and pultaceous debris, with minimal calcific deposits. Thus, it is this population that is most likely to be susceptible to regression of the atherosclerotic plaque.