Causes of death from myocardial infarction before and after thrombolysis era: a pathologic study

One hundred and sixty-eight out of 296 patients who died of acute myocardial infarction (AMI) in the Coronary Care Unit were studied to assess the cause of death. Twenty-two of them had received thrombolytic therapy. The mean age of these patients was 64.3 +/- 18.2 years. One hundred and eight subjects were male and 60 were female. One hundred and nine cases (64.8%) showed, at postmortem examination, histopathologic alterations due to acute myocardial infarction (AMI). Death was due to heart failure in 35.8%, cardiogenic shock in 20% and ventricular arrhythmia in 44%. The other 59 patients died from complications superimposed upon AMI: reinfarction (23.7%), heart rupture (40.7%), myocardial fibrosis and reinfarction (18.6%), and cerebral infarction (17%). Two of these patients also showed massive pneumonia. In those subjects who had received thrombolytic therapy, a broad spectrum of arrhythmic and haemorrhagic complications were seen (68%). Four causes of death were seen in the subjects studied: AMI, superimposed cardiac complications, side-effects of thrombolytic treatment, and non-cardiac causes. Patients who did not receive thrombolysis mechanical events eg heart failure, characterized their deaths. In subjects who had received thrombolytic therapy, arrhythmic and haemorrhagic were widely observed.