Portal de Periódicos da CAPES

Clinicopathologic correlates of acute ischemic heart disease syndromes

1981; Elsevier BV; Volume: 47; Issue: 2 Linguagem: Inglês

10.1016/0002-9149(81)90407-0

1879-1913

L. Maximilian Buja, James T. Willerson,

Coronary Interventions and Diagnostics

To better define the relations among acute and chronic coronary arterial lesions and different syndromes of acute ischemic heart disease, the clinicopathologic findings in 100 recent myocardial infarcts in 83 patients were reviewed and the results correlated with those of previous studies. Severe atherosclerosis (greater than 75 percent narrowing of luminal cross-sectional area) involved three or more major coronary arteries in 65 percent; two arteries in 16 percent, one artery in 15 percent, and no arteries in 4 percent of cases. The incidence rate of recent occlusive coronary arterial lesions was 61 percent, including 50 (90.2 percent) of 55 grossly apparent transmural infarcts, 9 (34.6 percent) of 26 grossly evident subendocardial infarcts and 2 (10.5 percent) of 19 multifocal microinfarcts associated with clinical episodes of acute coronary insufficiency (p <0.001). The 61 recent occlusive lesions consisted of two thromboemboli, two isolated plaque hemorrhages and 57 in situ thrombi that were associated with a high incidence rate of plaque erosion, rupture and hemorrhage. Clinical conditions predisposing to reduced coronary perfusion were identified before the onset of 26.2 percent of infarcts with recent occlusions and 61.5 percent of infarcts without recent occlusions (p <0.001). Clinical onset of infarction was followed by severe cardiac pump failure or congestive heart failure in 63.9 percent of infarcts with and 41.0 percent of infarcts without recent occlusions (p = 0.04). From this and previous studies, it is concluded that (1) acute ischemic heart disease does not have a constant relation with the severity of chronic atherosclerosis; (2) myocardial necrosis commonly occurs in the absence of acute permanent coronary occlusion, but in this setting is usually limited to subendocardial involvement of variable extent; (3) acute coronary thrombosis frequently acts as a major factor in determining the extent and distribution of an evolving infarct, as indicated by the large incidence of occlusive coronary thrombi with regional transmural infarcts; and (4) coronary thrombus formation is not dependent on a generalized impairment of coronary perfusion, either before or after the onset of infarction.