SUDDEN CORONARY DEATH - FREQUENCY OF ACTIVE CORONARY LESIONS, INACTIVE CORONARY LESIONS, AND MYOCARDIAL-INFARCTION

Background The reported frequency of active coronary lesions (plaque r upture and coronary thrombosis) in sudden death due to coronary artery atherosclerosis (sudden coronary death) has varied from <20% to >80% of cases in previous series. In hearts lacking an active coronary lesi on, sudden death has usually been attributed to a healed myocardial in farction. The purpose of the present study was to determine the freque ncy of active and inactive coronary lesions and myocardial infarction in individuals with sudden coronary death. Methods and Results The hea rts of persons who died as a result of sudden coronary death underwent perfusion-fixation and postmortem angiography. An active coronary les ion was defined as a disrupted plaque, luminal fibrin/platelet thrombu s, or both. We defined an inactive lesion as having a cross-sectional luminal stenosis of greater than or equal to 75% with neither plaque d isruption nor luminal thrombus. Ninety hearts were examined (from 72 m en and 18 women; mean age at the time of death, 51+/-10 years). Acute myocardial infarction was present in 19 (21% [acute myocardial infarct ion only in 9, both acute and healed myocardial infarction in 10]), he aled myocardial infarction only in 37 (41%), and no myocardial infarct ion in 34 (38%). Active coronary lesions were identified in 51 (57%): acute thrombi plus disrupted plaques in 27, acute thrombi only in 21, and disrupted plaques only in 3. In hearts with acute myocardial infar ction, active coronary lesions were significantly more prevalent than in hearts with only healed myocardial infarction or hearts lacking an acute or a healed myocardial infarction (89%, 46%, and 50%, respective ly; P<.005). Hearts without acute or healed myocardial infarction and without active lesions were similar to hearts with active lesions with respect to heart weight and severity of epicardial coronary disease. Conclusions Acute changes in coronary plaque morphology (thrombus, pra gue disruption, or both) were found in 57% of cases of sudden coronary death. In hearts with myocardial scars and no acute infarction, activ e coronary lesions were identified in 46% of cases. Neither myocardial infarction (acute or healed) nor an active coronary lesion was presen t in 19% of hearts.