Sudden cardiac death and acute pathology of coronary arteries

The pathology of sudden cardiac death still is a matter of controversy, particularly with respect to the state of the coronary arteries. A recent study has shown a high incidence of acute lesions and suggests a causal relationship. The present study has been designed to verify whether or not acute coronary arterial lesions occur frequently in patients with sudden cardiac death. Sixteen hearts were available. In each instance the patient had died within 6 hours from the onset of myocardial ischaemia. The coronary arterial system was extensively studied by post-mortem coronary angiography, decalcification, serial blocking and histological sectioning. Acute coronary arterial lesions, defined as plaque fissure, 'isolated' plaque haemorrhage and 'isolated thrombosis', were found in 14 of the 16 hearts (87.5%). The total number of acute lesions in the 14 hearts was 28. In 9 hearts plaque fissures were present, in 7 'isolated' plaque haemorrhages and in 5 an 'isolated thrombus'. Half of all acute lesions had occurred in an atherosclerotic plaque of pre-existing 50-75% luminal narrowing. The present study endorses the concept that acute coronary arterial lesions occur in a high proportion of patients with sudden cardiac death, plaque fissures with intramural haemorrhage and intraluminal thrombosis being the most common abnormality. It is tempting to attribute causal significance to such lesions in patients with sudden cardiac death. © 1986 The European Society of Cardiology.