Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction
Histological analysis of coronary artery lesions in fatal postoperative myocardial infarction
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DOI：
10.1016/s1054-8807(98)00032-5
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发表时间：
1999-05-01
影响因子：
3.7
通讯作者：
Aretz, TH
中科院分区：
文献类型：
--
作者：
Cohen, MC;Aretz, TH
我们试图评价致命性术后心肌梗死（MI）的潜在冠状动脉病理学。据推测，非心脏手术后的大多数MI发生在需氧量增加超过冠状动脉血供的情况下。然而，大多数与手术无关的MI是由斑块破裂和冠状动脉内血栓形成引起的。在一项回顾性队列研究中，我们回顾了1841例连续尸检记录，从1981年至1995年在两个机构，并确定了26例术后心肌梗死与冠状动脉可用。12例患者出现斑块破裂（46%，95%置信区间[CI] 27%-67%）。在9例（35%）冠状动脉内血栓患者中，5例（56%;整个组的19%）完全闭塞。在总计33%（95% CI 16%-55%）的患者中，血栓发生在> 50%狭窄（横截面积）处。斑块破裂患者和非斑块破裂患者之间临床变量的唯一统计学显著差异是斑块破裂患者从手术到死亡的时间间隔较长（7.8 +/-4.4天vs 4.4 +/-4.8天; p = 0.047）。在这个尸检系列中，冠状动脉斑块破裂与几乎一半的致命性术后MI病例相关。旨在减少冠状动脉闭塞斑块破裂触发因素的策略可能会降低术后MI死亡率。Elsevier Science Inc.的《神经病理学》1999; 8：133 - 139（C）1999。
We sought to evaluate the underlying coronary pathology of fatal postoperative myocardial infarction (MI). It has been hypothesized that most MIs following noncardiac surgery occur in the setting of increased oxygen demand that exceeds coronary blood supply. However, most Mis not associated with surgery are caused by plaque rupture and intracoronary thrombosis. In a retrospective cohort study, we reviewed 1841 consecutive autopsy records from 1981 to 1995 at two institutions and identified 26 cases of postoperative MI with coronary arteries available. Plaque rupture was present in 12 cases (46%, 95% confidence interval [CI] 27%-67%). Of the 9 (35%) patients with intracoronary thrombus, 5 (56%; 19% of entire group) had total occlusion. Thrombus occurred on a >50% stenosis (by cross-sectional area) in a total of 33% (95% CI 16%-55%) of patients. The only statistically significant difference in clinical variables between patients with and without plaque rupture was longer interval from surgery to death in patients with plaque rupture (7.8 +/- 4.4 days versus 4.4 +/- 4.8 days; p = 0.047). In this autopsy series, coronary plaque rupture was associated with almost half of fatal postoperative MI cases. Strategies aimed at reducing triggers of plaque rupture with coronary occlusion might reduce postoperative MI fatality. Cardiovasc Pathol 1999;8:133-139 (C) 1999 by Elsevier Science Inc.