European Heart Journal Advance Access published online on August 7, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp303
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Presence of vulnerable coronary plaques in middle-aged individuals who suffered a brain death
1 Department of Cardiovascular Medicine Fundacion Favaloro, and Consejo Nacional de Investigaciones Científicas y Técnicas, CONICET, Buenos Aires, Argentina
2 Cardiovascular Medicine, Hospital Universitario Fundacion Favaloro, Av. Belgrano 1746 (1093), Capital Federal, Argentina
3 Department of Pathology Fundacion Favaloro, Buenos Aires, Argentina
4 Department of Cardiovascular Medicine Fundacion Favaloro, Buenos Aires, Argentina
5 Comisión de Investigaciones Científicas, Provincia de Buenos Aires, Argentina
6 Tissue, and Homograft Bank Fundacion Favaloro, Buenos Aires, Argentina
Received 10 October 2008; revised 1 May 2009; accepted 3 June 2009 * Corresponding author. Tel: +54 11 4378 1200, Fax: +54 11 4378 1239, Email: epgurfinkel{at}ffavaloro.org
Aims: Vulnerable plaques in coronary arteries are frequently found in individuals who died suddenly or due to an acute coronary syndrome. The prevalence and characteristics of these plaques in the middle-aged apparently healthy population are unknown.
Methods and results: From a total of 652 hearts from transplant donors collected between 1996 and 2007, we selected those from apparently healthy individuals older than 40 years old who died of head trauma or stroke and had no evidence of prior vascular diseases. The coronary arteries were examined by serial sectioning at 3 mm intervals, and all areas of cross-sectional luminal narrowing were processed for histological, immunohistochemical, and morphometric studies. The atherosclerotic plaques were classified according to the American Heart Association Report. A total of 160 hearts were examined. Mean age was 50.3 ± 5.8 years. Sixty-eight hearts had no advanced coronary atherosclerotic lesions (Type I, II, and III of the American Heart classification). In the remaining 92 hearts, we found 179 plaques considered high-risk lesions (American Heart Association Type IV, V, and VI). These plaques were more frequently found in males (P < 0.001) and in those with a higher heart weight (P < 0.001). The median (25th and 75th percentiles) vascular narrowing value using a planimetric analysis was 32% (21–53). No significant association with the cause of death was found (P = 0.09).
Conclusion: High-risk coronary artery plaques not associated with significant vascular lumen reduction exist in 57% of patients who suffered a brain death with a mean of 1.11 lesions prone to rupture per individual.
Key Words: Atherosclerosis • Coronary disease • Stroke • Transplantation