Takada Aya, Saito Kazuyuki, Ro Ayako, Kobayashi Masahiko, Hamamatsu Akihiko, Murai Tatsuya, Kuroda Naohito
Department of Forensic Medicine, Saitama Medical School, 38 Moro-Hongo, Moroyama, Iruma-gun, Saitama 350-0495, Japan.
Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S292-4. doi: 10.1016/s1344-6223(02)00153-0.
Old myocardial infarction (OMI) is one of the most important pathological manifestations in sudden cardiac death. Fatal arrhythmia arising from a fibrotic scar has been determined as the cause of death in most cases with old myocardial infarction. However, the significance of acute plaque disruption/thrombosis of the coronary arteries in those patients has not been investigated. We examined a series of 33 hearts from individuals with OMI who died suddenly during the period from 1998 to 2001. Detailed coronary pathological findings on these hearts indicated fresh or recent rupture of the coronary plaque with thrombosis in 18 cases (55%). As a result of comprehensive analysis, the sudden deaths were explained by acute coronary syndrome in 18 cases (55%), fatal arrhythmia in eight (24%), cardiac pump failure in five (14%), and other causes in two (6%) cases. Our findings revealed that a new coronary plaque rupture independent of the old infarct was a major cause of sudden cardiac death with OMI.
陈旧性心肌梗死（OMI）是心源性猝死最重要的病理表现之一。在大多数陈旧性心肌梗死病例中，由纤维化瘢痕引发的致命性心律失常已被确定为死因。然而，这些患者冠状动脉急性斑块破裂/血栓形成的意义尚未得到研究。我们检查了1998年至2001年期间突然死亡的33例OMI患者的心脏。这些心脏详细的冠状动脉病理检查结果显示，18例（55%）存在伴有血栓形成的冠状动脉斑块新鲜或近期破裂。综合分析结果显示，18例（55%）猝死由急性冠状动脉综合征所致，8例（24%）由致命性心律失常所致，5例（14%）由心脏泵衰竭所致，2例（6%）由其他原因所致。我们的研究结果表明，独立于陈旧梗死灶的新发性冠状动脉斑块破裂是OMI心源性猝死的主要原因。
