Circulation, Vol 90, 2315-2323, Copyright © 1994 by American Heart Association
D Corrado, C Basso, A Poletti, A Angelini, M Valente and G Thiene
BACKGROUND--Atherosclerotic coronary artery disease, complicated by acute
thrombosis, is the usual cause of sudden death in adults. This study
addresses the pathology of coronary arteries in sudden death in the young
(< or = 35 years old). METHODS AND RESULTS--Among 200 consecutive cases
of sudden death in youth in the Veneto region of Italy, 37 (33 men and 4
women, age 18 to 35 years; mean, 29.4 years) showed obstructive
atherosclerotic coronary artery disease in the absence of other cardiac
pathological conditions and causes of death. No patient had previous angina
pectoris or myocardial infarction. Cardiac arrest occurred at rest in 30
subjects and was related to effort in 7. A histological study was carried
out on the obstructive coronary plaques. Degree of lumen stenosis and
extension of lipid core and intimal fibrocellular hyperplasia facing the
lumen were calculated morphometrically. Immunohistochemistry and electron
microscopy were used to further characterize the plaque cell population.
Single-vessel disease was found in 33 patients and triple-vessel disease in
4, with an overall total of 45 obstructive plaques, 34 of which were
located in the proximal left anterior descending coronary artery. At
histological study, only 10 plaques from 10 patients showed acute
thrombosis (occlusive in 5 and subocclusive in 5); the remaining 35 were
uncomplicated. Thirty-one plaques were fibrous in nature, while the other
14 were atheromatous. Compared with the atheromatous lesions, the fibrous
plaques were rarely complicated by thrombosis (3% versus 64%; P < .001)
and distinctly exhibited a fairly well-preserved tunica media (81% versus
21%; P < .001) as well as a stratum of neointimal fibrocellular
hyperplasia (68% versus 7%; P < .001), which on immunohistochemistry and
electron microscopy appeared to be proliferating smooth muscle cells.
CONCLUSIONS--In our study population, sudden death was precipitated by
acute coronary thrombosis in only 27% of patients with obstructive coronary
atherosclerotic plaque. Most of the young victims of sudden death with
obstructive coronary atherosclerosis showed single-vessel disease that
affected the left anterior descending coronary artery and was due to
fibrous plaques with neointimal smooth muscle cell hyperplasia and a
preserved tunica media in the absence of acute thrombosis.
ARTICLES
Sudden death in the young. Is acute coronary thrombosis the major precipitating factor?
Department of Pathology, University of Padua Medical School, Italy.
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