Document Detail


Relationship of thrombus healing to underlying plaque morphology in sudden coronary death.
MedLine Citation:
PMID:  19818571     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess differences in thrombus healing between ruptured and eroded plaques, given the natural difference in lesion substrate and that thrombi might exist days to weeks before the presentation of sudden coronary death. BACKGROUND: Although the ability to distinguish ruptures and erosions remains a major clinical challenge, in-hospital patients dying with acute myocardial infarction establish that erosions account for 25% of all deaths, where women experience a higher incidence compared with men. METHODS: Coronary lesions with thrombi (ruptures, n = 65; erosions, n = 50) received in consultation from the Medical Examiner's Office from 111 sudden death victims were studied. Thrombus healing was classified as early (<1 day) or late stage characterized in phases of lytic (1 to 3 days), infiltrating (4 to 7 days), or healing (>7 days). Morphometric analysis included vessel dimensions, necrotic core size, and macrophage density. RESULTS: Late-stage thrombi were identified in 79 of 115 (69%) culprit plaques. Women more frequently had erosion with a greater prevalence of late-stage thrombi (44 of 50, 88%) than ruptures (35 of 65, 54%, p < 0.0001). The internal elastic lamina area and percent stenosis were significantly smaller in erosions compared with ruptures (p < 0.0001 and p = 0.02), where plaque burden was greater (p = 0.008). Although macrophage infiltration in erosions was significantly less than ruptures (p = 0.03), there was no established relationship with thrombus organization. Other parameters of thrombus length and occlusive versus nonocclusive showed no association with healing. CONCLUSIONS: Approximately two-thirds of coronary thrombi in sudden coronary deaths are organizing, particularly in young individuals-especially women, who perhaps might require a different strategy of treatment.
Authors:
Miranda C A Kramer; Saskia Z H Rittersma; Robbert J de Winter; Elena R Ladich; David R Fowler; You-Hui Liang; Robert Kutys; Naima Carter-Monroe; Frank D Kolodgie; Allard C van der Wal; Renu Virmani
Publication Detail:
Type:  Journal Article     Date:  2009-10-08
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-03-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  122-32     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Cohort Studies
Coronary Stenosis / etiology,  mortality,  pathology*
Coronary Thrombosis / complications,  pathology*,  physiopathology
Death, Sudden, Cardiac / epidemiology,  pathology*
Female
Granulation Tissue / pathology
Humans
Male
Middle Aged
Myocardial Infarction / etiology,  mortality,  pathology*
Retrospective Studies
Sex Factors
Time Factors
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Jan 12;55(2):133-4   [PMID:  20117380 ]

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