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[Myocardial infarct and sudden death with angiographically undamaged coronary arteries]
C Basso1, P Stritoni, R Ometto
1Cattedra di Cardiologia, Università degli Studi di Padova.
Insights
Coronary angiography may underestimate arterial stenosis in patients experiencing myocardial infarction or sudden death. Detailed pathology revealed eccentric plaques missed by angiography, suggesting a need for critical evaluation of "normal" coronary arteries.
Area of Science:
- Cardiovascular pathology
- Interventional cardiology
- Diagnostic imaging
Background:
- Myocardial infarction and sudden cardiac death in young adults can be linked to coronary artery disease.
- Coronary angiography is the standard for diagnosing coronary artery stenosis.
Observation:
- Two young adults presented with ischemic cardiac events (ventricular fibrillation, cardiogenic shock).
- Coronary angiography initially appeared normal in both cases.
- Post-mortem examination revealed focal eccentric atherosclerotic plaques in the proximal left anterior descending coronary artery.
Findings:
- Angiography failed to detect significant stenosis due to eccentric plaques.
- Eccentric plaques can lead to underestimation of arterial lumen stenosis.
- Compensatory ectasia of the plaque-free arterial segment may mask stenosis.
Implications:
- Clinicians should critically assess angiographically normal coronary arteries in patients with ischemic cardiac events.
- Eccentric plaque morphology requires careful pathological and potentially advanced imaging evaluation.
- Underestimation of stenosis can have critical implications for patient management and prognosis.
Abstract:
Clinicopathologic findings in two young adults, who complained of ischemic cardiac arrest by ventricular fibrillation and of myocardial infarction complicated by cardiogenic shock respectively, are described. At coronary angiography, coronary arteries appeared normal. In both cases, detailed pathologic examination of the coronary arteries disclosed a focal eccentric atherosclerotic plaque in the proximal descending coronary artery, where selective coronary angiography had failed to reveal filling defects. These observations suggest a more critical attitude in evaluating angiographically normal coronary arteries in patients with myocardial infarction or aborted sudden death, and underline the possibility of arterial lumen stenosis underestimation, especially in the presence of eccentric plaque, with likely compensatory ectasia of the plaque-free wall segment.