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Plaque Histology and Myocardial Disease in Sudden Coronary Death
Quick Takes
- Evidence of acute plaque changes was present only in 48% of victims of sudden coronary death and 97% of the cases were associated with cardiac hypertrophy and/or fibrosis.
- Myocardial disease was present at the same prevalence regardless of the culprit plaque histology.
- These data suggest that preventive measures of sudden coronary death in CAD should highlight the treatment of concomitant myocardial disease.
Study Questions:
What is the role of plaque histology and concomitant myocardial disease in sudden coronary death (SCD)?
Methods:
The investigators assessed a study population derived from the Fingesture study, which has collected data from 5,869 consecutive autopsy-verified SCD victims in Northern Finland (population ~600,000) between 1998–2017. In this substudy, histological examination of culprit lesions was performed in 600 SCD victims whose death was due to coronary artery diseases (CAD). Determination of the cause of death was based on the combination of medical records, police reports, and autopsy data. Plaque histology was classified as either: 1) plaque rupture or erosion, 2) intraplaque hemorrhage, or 3) stable plaque. The authors used analysis of variances (ANOVA) and χ2 test to estimate the statistical significance of continuous and categorical variable distributions between the study groups of interest, respectively. If there was a statistically significant difference between the three study groups, further post hoc analyses were performed with Bonferroni correction. All variables with p < 0.10 in χ2/ANOVA analyses were included in the multivariable logistic regression models to assess predictors of SCD.
Results:
The mean age of the study subjects was 64.9 ± 11.2 years, and 82% were male. Approximately 24% had plaque rupture or plaque erosion, 24% had an intraplaque hemorrhage, and 52% had a stable plaque. Myocardial hypertrophy was present in 78% and myocardial fibrosis in 93% of victims. The presence of myocardial hypertrophy or fibrosis was not associated with specific plaque histology.
Conclusions:
The authors concluded that less than half of sudden deaths due to CAD had evidence of acute plaque complication, an observation which is contrary to historical perceptions.
Perspective:
This autopsy-based study of 600 SCD victims, whose death was attributable to CAD, reports that evidence of acute plaque changes was present only in 48% of victims and 97% of the cases were associated with cardiac hypertrophy and/or fibrosis. Furthermore, myocardial disease was present at the same prevalence regardless of the culprit plaque histology. Of note, those whose death occurred after physical exercise more commonly had plaque rupture or erosion, and those with plaque rupture/erosion were somewhat younger on average and more often had signs of recent myocardial infarction at autopsy. These data suggest that preventive measures of SCD in CAD should highlight the treatment of concomitant myocardial disease.
Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Exercise
Keywords: Arrhythmias, Cardiac, Autopsy, Cardiomegaly, Cardiomyopathies, Coronary Artery Disease, Death, Sudden, Death, Sudden, Cardiac, Exercise, Fibrosis, Heart Failure, Hemorrhage, Medical Records, Myocardial Infarction, Myocardial Ischemia, Plaque, Atherosclerotic, Secondary Prevention
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