Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Acute ischaemic lesions in death due to ischaemic heart disease
An autopsy study of 333 cases of out-of-hospital death
*Department of Histopathology, University Hospital Nottingham
Department of Medicine, University Hospital Nottingham, U.K
revised 2 November 1994; accepted 30 November 1994.
Correspondence: Dr I. H. Leach, Dept. of Histopathology, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, U.K.
Abstract
The frequency of acute coronary artery thrombus and myocardial infarction in subjects dying suddenly or unexpectedly from ischaemic heart disease (IHD) is still unclear, with previous autopsy studies reporting an incidence between 4% and 100%. In this study of 333 randomly selected out-of-hospital deaths, detailed autopsy showed IHD as the sole cause of death in 206 (62%). One hundred and seventeen acute coronary thrombi were present in 96 cases whilst four had an established acute infarct without an identifiable coronary thrombus. Thus 100 (48.5%) IHD deaths had evidence of an acute ischaemic lesion.
Acute lesions were equally prevalent among males and females, but the incidence declined with increasing age and they were less frequent among those with a prior clinical history of heart disease. One hundred and forty-seven IHD deaths were witnessed. The proportion of cases with an acute ischaemic lesion increased with the duration of pre-morbid symptoms. Of those with an acute lesion, only 17% died without symptoms compared to 63% of those without an acute lesion. All cases with symptoms lasting more than 3.5 h had an acute lesion.
Overall, almost half out-of-hospital IHD deaths in this study were related to an acute ischaemic lesion. Differences in the detail of the pathological examination and examination of differing sub-groups of the out-of- hospital death population probably account for the differing results of previous studies.
Key Words: Coronary artery thrombosis • ischaemic heart disease • sudden death
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