Burke A P, Farb A, Malcom G T, Liang Y, Smialek J E, Virmani R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
JAMA. 1999 Mar 10;281(10):921-6. doi: 10.1001/jama.281.10.921.
Exertion has been reported to acutely increase the risk of sudden coronary death, but the underlying mechanisms are unclear.
To determine the frequency of plaque rupture in sudden deaths related to exertion compared with sudden deaths not related to exertion.
Autopsy survey. Coronary arteries were perfusion fixed and segments with more than 50% luminal narrowing were examined histologically. Ruptured plaques were defined as intraplaque hemorrhage with disruption of the fibrous cap and luminal thrombus. Exertion before death was determined by the investigator of the death.
Medical examiner's office.
A total of 141 men with severe coronary artery disease who died suddenly, including 116 whose deaths occurred at rest (mean [SD] age, 51 [11] years) and 25 who died during strenuous activity or emotional stress (age, 49 [9] years).
The frequency and morphology of plaque rupture was compared in men dying at rest vs those dying during exertion. Independent association of risk factors (total cholesterol, high-density lipoprotein cholesterol, glycosylated hemoglobin, cigarette smoking) in addition to acute exertion with plaque rupture were determined.
The mean (SD) number of vulnerable plaques in the coronary arteries of men in the exertional-death group was 1.6 (1.5) and in the at-rest group was 0.9 (1.2) (P=.03). The culprit plaque in men dying during exertion was plaque rupture in 17 (68%) of 25 vs 27 (23%) of 116 men dying at rest (P<.001). Hemorrhage into the plaque occurred in 18 (72%) of 25 men in the exertional-death group and 47 (41%) of 116 men in the rest group (P=.007). Histological evidence of acute myocardial infarction was present in 0 of 25 in the exertion group and in 15 (13%) of 116 in the rest group. Men dying during exertion had a significantly higher mean (SD) total cholesterol-high-density lipoprotein cholesterol ratio (8.2 [3.0]) than those dying at rest (6.2 [ 2.7]; P=.002), and the majority (21/25) were not conditioned. In multivariate analysis, both exertion (P=.002) and total cholesterol-high-density lipoprotein cholesterol ratio (P=.002) were associated with acute plaque rupture, independent of age and other cardiac risk factors.
In men with severe coronary artery disease, sudden death related to exertion was associated with acute plaque rupture.
据报道，运动可急性增加冠状动脉猝死风险，但其潜在机制尚不清楚。
确定与运动相关的猝死中斑块破裂的频率，并与非运动相关的猝死进行比较。
尸检调查。冠状动脉经灌注固定，对管腔狭窄超过50%的节段进行组织学检查。破裂斑块定义为伴有纤维帽破裂和管腔内血栓形成的斑块内出血。死亡前的运动情况由死亡调查员确定。
法医办公室。
总共141例严重冠状动脉疾病男性突然死亡，其中116例死于静息状态（平均[标准差]年龄，51[11]岁），25例死于剧烈活动或情绪应激期间（年龄，49[9]岁）。
比较静息状态下死亡男性与运动期间死亡男性斑块破裂的频率和形态。确定除急性运动外，危险因素（总胆固醇、高密度脂蛋白胆固醇、糖化血红蛋白、吸烟）与斑块破裂的独立关联。
运动死亡组男性冠状动脉中易损斑块的平均（标准差）数量为1.6（1.5），静息组为0.9（1.2）（P = 0.03）。运动期间死亡男性的罪犯斑块中，25例中有17例（68%）为斑块破裂，而静息状态下死亡的116例男性中有27例（23%）为斑块破裂（P<0.001）。运动死亡组25例男性中有18例（72%）斑块内出血，静息组116例男性中有47例（41%）斑块内出血（P = 0.007）。运动组25例中0例有急性心肌梗死的组织学证据，静息组116例中有15例（13%）有急性心肌梗死的组织学证据。运动期间死亡的男性平均（标准差）总胆固醇与高密度脂蛋白胆固醇比值（8.2[3.0]）显著高于静息状态下死亡的男性（6.2[2.7]；P = 0.002），且大多数（21/25）身体状况不佳。多变量分析显示，运动（P = 0.002）和总胆固醇与高密度脂蛋白胆固醇比值（P = 0.002）均与急性斑块破裂相关，独立于年龄和其他心脏危险因素。
在严重冠状动脉疾病男性中，与运动相关的猝死与急性斑块破裂有关。
