Incidence of asymptomatic coronary thrombosis and plaque disruption: Comparison of non-cardiac and cardiac deaths among autopsy cases
Incidence of asymptomatic coronary thrombosis and plaque disruption: Comparison of non-cardiac and cardiac deaths among autopsy cases
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DOI：
10.1016/j.thromres.2008.08.026
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发表时间：
2009-05-01
影响因子：
7.5
通讯作者：
Asada, Yujiro
中科院分区：
文献类型：
--
作者：
Sato, Yuichiro;Hatakeyama, Kinta;Asada, Yujiro
背景资料：尸检研究表明，死于急性心肌梗死（AMI）或冠状动脉猝死的患者血栓形成的发生率很高。方法：对102例非心源性死亡（NCD）和19例急性心肌梗死（AMI）死亡患者的心脏进行检查，观察NCD患者血栓形成和斑块破裂的发生率和形态学特征。10例NCD和14例AMI患者中发现新鲜冠状动脉血栓（10%对75%，P < 0.001）。在NCD病例中，分别有7例和3例血栓与斑块侵蚀和破裂相关。AMI患者斑块破裂的发生率明显高于NCD患者（54% vs.3%，p < 0.001）。NCD患者冠状动脉血栓较小，管腔面积无明显变化。NCD血栓下斑块的脂质核心较小，纤维帽较AMI厚。在心血管事件的危险因素中，高血压和糖尿病与NCD患者血栓形成的发生率显著相关。结论：冠状动脉血栓形成是NCD患者的常见并发症。这些小血栓可能与临床事件的发生无关，但与动脉粥样硬化斑块的进展有关。(C)2008爱思唯尔有限公司保留所有权利。
Background: Autopsy studies have revealed a high incidence of thrombus formation in patients who died of acute myocardial infarction (AMI) or sudden coronary death. However, the incidence of thrombus formation and plaque disruption in patients with non-cardiac death (NCD) remains unclear.Methods: To evaluate the incidence and morphological characteristics of thrombi and plaque disruption in patients with NCD, we examined 102 hearts from NCD autopsy cases and 19 from those who had died of AMI.Results: We found fresh coronary thrombi in 10 cases with NCD and in 14 with AMI (10% vs. 75%, p < 0.001). Seven and three thrombi were associated with plaque erosion and rupture, respectively among the NCD cases. The incidence of plaque rupture was significantly higher in AMI than in NCD (54% vs. 3%, p < 0.001). The size of coronary thrombi in NCD cases was small and the luminal areas were not significantly affected. Plaques beneath thrombi in NCD had a smaller lipid core and a thicker fibrous cap than those in AMI. Among risk factors for cardiovascular events, hypertension and diabetes mellitus were significantly associated with the incidence of thrombosis in patients with NCD.Conclusion: Coronary thrombosis is a frequent complication in patients with NCD. These small thrombi might not be associated with the onset of clinical events, but with plaque progression in atherosclerosis. (C) 2008 Elsevier Ltd. All rights reserved.