Copyright © 2002 by the European Society of Cardiology.
Sudden unexpected death in young adults. Discrepancies between initiation of acute plaque complications and the onset of acute coronary death
Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
revised December 31, 2001; accepted January 2, 2002
Abstract
Aims To study the time relationship between the onset of coronary thrombosis and sudden unexpected cardiac death in young adults.
Methods and Results Hearts of 11 young adults (
35 years), who had died within 1h after onset of symptoms and presented with a coronary thrombotic occlusion were studied retrospectively for the type of underlying plaque complication and the time of onset of thrombus formation. In all cases tissue blocks were taken from the occluded artery and sectioned for microscopic evaluation. Of 11 culprit lesions 10 were mainly fibrocellular; only one was lipid-rich. Inflammatory cells were found in all plaques, albeit in highly variable amounts. Plaque erosion had occurred in nine; deep ruptures in two. Analysis of the plaque-related occluding thrombus revealed fresh thrombosis in three (both ruptured plaques and one erosion); the other eight, however, showed occlusion with different histological stages of organization of thrombus.
Conclusions Despite strict inclusion criteria for sudden death in these young adults, the majority must have had plaque instability for some time, since thrombus formation had occurred at least days to weeks prior to the acute event. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Sudden death, atherosclerosis, acute coronary syndromes, thrombosis, macrophages
f1 Correspondence: Anton E. Becker, MD, PhD, Department of Cardiovascular Pathology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
References
- Zipes DP, Wellens HJJ. Sudden cardiac death. Circulation. 1998;98:2334–2351
[Free Full Text] - Berenson GS, Srinivasan RS, Bao W, Newman WP 3rd, Tracy RE, Wattigney WA. Association between cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338:1650–1656
[Abstract/Free Full Text] - Kannel WB, Thomas HE. Sudden coronary death. The Framingham study. Ann N Y Acad Sci. 1982;382:3–20[ISI][Medline]
- Corrado D, Basso C, Poletti A, Angelini A, Valente M, Thiene G. Sudden death in the young. Is acute coronary thrombosis the major precipitating factor? Circulation. 1994;90:2315–2323
[Abstract/Free Full Text] - Angelini A, Thiene G, Frescura C, Baroldi G. Coronary arterial wall and atherosclerosis in youth (1–20 years ): a histologic study in a northern Italian population. Int J Cardiol. 1990;28:361–370[CrossRef][ISI][Medline]
- Virmani R, Rabinowitz M, McAllister HA. Coronary artery disease in 48 autopsy patients 30 years old and younger. Arch Pathol Lab Med. 1983;107:535–540[ISI][Medline]
- Farb A, Burke AP, Tang AL. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354–1363
[Abstract/Free Full Text] - Priori SG, Aliot E, Blomstrom-Lundqvist C. Task force on sudden cardiac death of the European Society of Cardiology. Eur Heart J. 2001;22:1374–1450
[Free Full Text] - Davies MJ. The investigation of sudden death. Histopathol. 1999;34:94–96[CrossRef]
- Cattoretti G, Pileri S, Parravicini C. Antigen unmasking on formalin-fixed, paraffin-embedded tissue sections. J Pathol. 1993;171:83–98[CrossRef][ISI][Medline]
- Mitchell RN, Cotran RS. Hemodynamic disorders, thrombosis and shock. Cotran RS, Kumar K, Robbins SL, Collins T. Robbins Pathologic basis of disease. Philadelphia: W.B. Saunders; 1999. p. 126–127
- Davies MJ, Bland JM, Hangartner JR, Angelini A, Thomas AC. Factors influencing the presence or absence of acute coronary thombi in sudden ischaemic death. Eur Heart J. 1989;10:203–208
[Abstract/Free Full Text] - Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J. 1983;50:127–134
[Abstract/Free Full Text] - van der Wal AC, Becker AE, Koch KT. Clinically stable angina pectoris is not necessarily associated with histologically stable atherosclerotic plaques. Heart. 1996;76:312–316
[Abstract/Free Full Text] - Davies MJ. The composition of coronary artery plaques. N Engl J Med. 1997;336:1312–1314
[Free Full Text] - Arbustini E, Dal Bello B, Morbini P. Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction. Heart. 1999;82:269–272
[Abstract/Free Full Text] - Burke AP, Farb A, Malcom GT, Liang Y, Smialek J, Virmani R. Effect of risk factors on the mechanism of acute thrombosis and sudden coronary death in women. Circulation. 1998;97:2110–2116
[Abstract/Free Full Text] - Libby P. Molecular bases of acute coronary syndromes. Circulation. 1995;91:2844–2850
[Free Full Text] - Moreno PR, Bernardi CH, Lopez-Cuellar J. Macrophages, smooth muscle cells, and tissue factor in unstable angina. Implications for cell mediated thrombogenicity in acute coronary syndromes. Circulation. 1996;94:3090–3097
[Abstract/Free Full Text] - Colli S, Lalli M, Rise P. Increased thrombogenic potential of human monocyte-derived macrophages spontaneously transformed into foam cells. Thromb Hemost. 1999;81:576–581[ISI][Medline]
- Flugelman MY, Virmani R, Correa R. Smooth muscle cell abundance and fibroblast growth factors in coronary lesions of patients with nonfatal unstable angina. A clue to the mechanism of transformation from the stable to the unstable clinical state. Circulation. 1993;88:2493–2500
[Abstract/Free Full Text] - Mann JM, Kaski JC, Pereira WI, Arie S, Ramires JA, Pileggi F. Histological patterns of atherosclerotic plaques in unstable angina patients vary according to clinical presentation. Heart. 1998;80:19–22
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. C van der Wal Coronary artery pathology Heart, November 1, 2007; 93(11): 1484 - 1489. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Z.H. Rittersma, A. C. van der Wal, K. T. Koch, J. J. Piek, J. P.S. Henriques, K. J. Mulder, J. P.H.M. Ploegmakers, M. Meesterman, and R. J. de Winter Plaque Instability Frequently Occurs Days or Weeks Before Occlusive Coronary Thrombosis: A Pathological Thrombectomy Study in Primary Percutaneous Coronary Intervention Circulation, March 8, 2005; 111(9): 1160 - 1165. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A M A Shehab, R J MacFadyen, M McLaren, R Tavendale, J J F Belch, and A D Struthers Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomic dysfunction: a pilot study Heart, November 1, 2004; 90(11): 1263 - 1268. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Thygesen and B. F Uretsky Acute ischaemia as a trigger of sudden cardiac death Eur. Heart J. Suppl., August 1, 2004; 6(suppl_D): D88 - D90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Lafont Basic aspects of plaque vulnerability Heart, October 1, 2003; 89(10): 1262 - 1267. [Full Text] [PDF]
|
|
|
|
 |
|
 P.J. Gallagher More histological information in acute coronary death Eur. Heart J., September 2, 2002; 23(18): 1406 - 1408. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||