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Major cardiac findings at necropsy in 366 American octogenarians
J Shirani1, J Yousefi, W C Roberts
1Pathology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
Insights
Atherosclerotic coronary artery disease is a leading cause of cardiac death in octogenarians, with significant narrowing found in 60% of major coronary arteries. Women with fatal myocardial infarction showed higher rates of ventricular rupture.
Area of Science:
- Cardiovascular pathology
- Geriatric medicine
- Pathology
Background:
- Octogenarians represent a growing demographic with unique cardiovascular disease patterns.
- Cardiac mortality is a significant concern in the elderly population.
- Understanding the specific causes of cardiac death in this age group is crucial for targeted interventions.
Purpose of the Study:
- To investigate the causes of death in octogenarians, with a focus on cardiac pathologies.
- To determine the prevalence and severity of atherosclerotic coronary artery disease in this population.
- To explore sex-based differences in fatal acute myocardial infarction.
Main Methods:
- Post-mortem examination of 366 octogenarian hearts.
- Classification of cause of death (cardiac, vascular, non-vascular).
- Detailed analysis of atherosclerotic coronary artery disease, including degree of stenosis and affected vessels.
Main Results:
- Cardiac disease accounted for 53% of deaths, with atherosclerotic coronary artery disease being the primary cause (65% of cardiac deaths).
- Significant coronary artery narrowing (>75%) was present in 60% of all subjects.
- Women with fatal myocardial infarction had a higher incidence of ventricular rupture (39% vs 9%) and fewer healed infarcts (20% vs 73%).
Conclusions:
- Atherosclerotic coronary artery disease is a major contributor to mortality in octogenarians.
- Significant coronary artery stenosis is highly prevalent in this age group.
- Distinct pathological patterns exist between sexes in fatal acute myocardial infarction.
Abstract:
We examined the hearts of 366 octogenarians (184 women [50%], 264 white [72%], mean age 84 +/- 4 years). The cause of death was cardiac in 195 (53%), noncardiac but vascular in 47 (13%), and noncardiac and nonvascular in 124 patients (34%). Of the 195 patients with fatal cardiac disease, atherosclerotic coronary artery disease was the cause of death in 127 (65%): acute myocardial infarction in 87 (69%), sudden cardiac arrest outside the hospital in 19 (15%), chronic congestive heart failure with healed myocardial infarction in 15 (12%), and complications of coronary bypass surgery in 6 (4%). At least 1 of the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries was narrowed > 75% in cross-sectional area by atherosclerotic plaque in 218 patients (60%). The mean number of significantly narrowed major epicardial coronary arteries was 1.7, 1.3, and 0.7 in those who died of cardiac, peripheral vascular, or noncardiovascular causes, respectively. Among the 87 patients (33 men and 54 women) with fatal acute myocardial infarction, the women more often had ruptured ventricles (21 of 54 [39%] vs 3 of 33 [9%]), and fewer women had healed myocardial infarcts (11 of 54 [20%] vs 24 of 33 [73%], p < 0.05). Calcific deposits were present in the epicardial coronary arteries in 285 patients (78%), in the mitral annulus in 140 (38%), and in aortic valve cusps in 153 (42%).(ABSTRACT TRUNCATED AT 250 WORDS)