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Circulation, Vol 73, 418-427, Copyright © 1986 by American Heart Association
MJ Davies, AC Thomas, PA Knapman and JR Hangartner
A specific search for intramyocardial platelet aggregates was made in 90
patients who died suddenly of ischemic heart disease. Platelet aggregates
in small intramyocardial vessels were found in 27 (30%). There was a
significant difference (p less than .05) in the incidence of platelet
aggregates in patients with chest pain of recent onset (unstable angina)
before death (16/36, 44.4%) and that in those without it (11/54, 20.4%).
Multifocal microscopic necrosis with involvement of the full thickness of
the ventricular wall, including the subpericardial zone, was significantly
more common (p = less than .005) in the patients with platelet emboli
(55.6% vs 12.7%). With one exception, aggregates were confined to the
segment of myocardium immediately downstream of a major epicardial coronary
artery containing an atheromatous plaque that had undergone fissuring and
on which mural thrombus had developed. The results support the view that
platelet aggregates in the myocardium represent an embolic phenomenon and
are a potential cause of unstable angina. The association of myocardial
necrosis with such emboli could precipitate sudden death from ventricular
fibrillation.
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Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death
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