Document Detail

Fatality of myocardial infarction in relation to the coronary anatomy: role of culprit lesion location.
MedLine Citation:
PMID:  15513298     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We set out to study the effect of the location of the culprit coronary lesion on myocardial infarction (MI) fatality by combining data from MI survivors in the coronary care unit (CCU) and autopsied patients with pre-hospital fatal MI. DESIGN: We studied two simultaneous series of men under 70 years with fatal pre-hospital MI (n = 36) and men admitted for acute ST-elevation-MI (n = 92). The culprit lesion was identified by the presence of thrombus at autopsy and by coronary angiography in patients admitted to the CCU. RESULTS: The culprit lesion was located in the right coronary artery (RCA) in 22 (61%) of 36 men with fatal MI compared to 30 (33%) of 92 men with non-fatal MI (P = 0.01). Seventy-three percent of fatal RCA occlusions were proximal as opposed to only 30% of non-fatal RCA occlusions (P < 0.001). Forty-four percent of all fatal MI were due to proximal RCA occlusion as opposed to only 10% of non-fatal MI (P < 0.005). CONCLUSIONS: Proximal RCA occlusions were very often found among men with fatal pre-hospital MI, whereas left-sided coronary occlusions were significantly more frequent in hospital-admitted survivors of MI. Left-sided coronary occlusions may be associated with a more favourable pre-hospital phase of acute MI compared to proximal RCA occlusions.
Jussi Mikkelsson; Markku Eskola; Kjell Nikus; Kari Pietilä; Pekka J Karhunen; Kari Niemelä
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of medicine     Volume:  36     ISSN:  0785-3890     ISO Abbreviation:  Ann. Med.     Publication Date:  2004  
Date Detail:
Created Date:  2004-11-03     Completed Date:  2005-02-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8906388     Medline TA:  Ann Med     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  474-9     Citation Subset:  IM    
University of Tampere, Medical School, Dept of Forensic Medicine and Research Unit of the Centre of Clinical Chemistry of Tampere University Hospital, Finland.
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MeSH Terms
Coronary Angiography
Coronary Thrombosis / pathology*
Coronary Vessels / pathology*
Logistic Models
Middle Aged
Myocardial Infarction / mortality*,  pathology*

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